Results Of Physical Examination Research Articles

Focused assessment with sonography in trauma: experience of Al Jalla Hospital, Benghazi, Libya

Background: Focused assessment with sonography in trauma (FAST) is a commonly used tool in the diagnosis of trauma. The objective of this study is to compare the positive predictive value (PPV) and negative predictive value (NPV) of (FAST) and abdominal-pelvic computed tomography scans (CTAP) in cases of blunt abdominal injury, as well as to assess the need for abdominal surgery. The aims to investigate if any false negative ultrasound studies were associated with significant morbidity. The findings are also compared with previous studies. Methods: The data collected from the registry records of Al Jalla hospital over a two-year period from January 1, 2022, to December 31, 2023. Data on sonographic findings, computed tomography findings, and patient outcomes were collected. Diagnostic characteristics, including predictive values, were calculated. Results: A total of 220 patients were included.190 patients underwent FAST, with 25 (13%) showing positive results. Among 90 patients who underwent CTAP, 18 (20%) showed abnormalities, and 10 (5.3%) patients required surgery. When comparing FAST to CTAP in detecting abnormalities, the PPV and NPV were 0.625 and 0.857, respectively. When comparing FAST to the need for surgery, the PPV and NPV were 0.217 and 0.977, respectively. 4 patients (0.98%) had negative FAST results but still required surgery. No significant adverse outcomes or surgical interventions were observed in patients with normal vital signs, normal initial physical examination, and negative FAST findings who did not undergo CTAP. Conclusions: In patients with an initially normal physical examination and negative FAST results, emergent CTAP may be avoided.

Associations Between Tinnitus and Systemic Disease inAdolescents: Implications of Vitamin D Deficiency andAnaemia.

Tinnitus is one of the irritating symptoms that should be addressed in adolescents. Since tinnitus affects mental health, it is important to treat it. However, identifying the cause of tinnitus is very challenging and the treatment strategies of tinnitus are controversial. The objective of this study was to identify the prevalence of tinnitus in adolescents and systemic diseases as risk factors of adolescent tinnitus to find evidence for new treatment strategies. We extracted the subjects and data using the 5th Korea National Health and Nutrition Examination Survey from 2010 to 2012. One thousand five hundred ninety-three adolescents with bilateral normal tympanic membranes and availability of the results of physical, laboratory and audiological examinations, were selected. We evaluated their systemic diseases based on these results and assessed the association of tinnitus with demographic factors, systemic diseases and hearing levels. The prevalence of tinnitus in Korean adolescents was 21.7%. The hearing level was not associated with tinnitus. Tinnitus was significantly associated with age (p = 0.005), 25(OH)-D level (p = 0.007) and anaemia (p = 0.003). After controlling the other factors, age (p = 0.045), 25(OH)-D level (p = 0.041) and anaemia (p = 0.019) were independently related to tinnitus. Tinnitus in adolescents was significantly associated with age, vitamin D and anaemia. Physicians should consider the higher likelihood of these deficiencies or diseases in adolescent tinnitus patients. Additionally, recognizing these associations may be helpful in developing treatment strategies for adolescent tinnitus.

The influence of night shift work and associated factors on serum uric acid in aircraft maintenance workers

Background and objectiveThe prevalence of 12-hour shift work is increasing in various occupations. Shift work has been linked to circadian rhythm disruption, which may lead to hormonal changes and metabolic disorders, including alterations in glucose, lipid, and purine metabolism. Despite this, there is limited research on the potential connection between work shifts and abnormal serum uric acid (SUA) levels. Furthermore, the factors that contribute to abnormal SUA levels in shift workers are not well-understood. Therefore, this study aimed to analyze the SUA levels of shift workers employed in an aircraft maintenance company, investigate the potential association between shift work and SUA levels, and explore the factors that may influence abnormal SUA levels in shift workers.MethodsA total of 2263 male workers from an aircraft maintenance company were included in this study using the cluster sampling method. The workers were divided into two groups based on their working shifts: night shift (N = 1047, 46.27%) and day working (N = 1216, 53.73%). A survey was conducted between April 1st and June 30th, 2022 to gather information on work, lifestyle, physical examination results, and other relevant factors. The survey included a self-designed demographic information questionnaire to collect data on workers’ characteristics, medical history, years of employment, smoking and drinking habits, and main lifestyle behaviors. The workers’ SUA levels were measured using uricase colorimetry. One-way ANOVA was used to compare the difference in the abnormal detection rate of SUA between the two groups, and multi-factor logistic regression analysis was used to identify the factors that influence abnormal SUA levels.ResultsThe study indicated that 48.9% of night shift workers and 43.8% in the regular day workers had abnormal SUA levels, with a significant difference between the two groups (χ2 = 6.125, P = 0.013). Factors such as circadian rhythm type, shift work, age, the taste of diet, type of diet, smoking, overweight or obesity based on body mass index (BMI), concentration of urine creatinine (CREA), total cholesterol, triglyceride, and low-density lipoprotein cholesterol were found to be correlated with SUA abnormalities (P < 0.05). The risk of developing SUA abnormalities was found to be higher in individuals with an intermittent (OR = 1.34, 95% CI: 0.83–2.12, P < 0.05) or evening circadian rhythm type (OR = 1.45, 95% CI: 0.86–2.43, P > 0.05) compared to those with a morning type. Additionally, factors such as night shift work, a high-sodium diet, smoking, a diet high in meat and low in vegetables, being overweight or obese, and higher levels of CREA were also found to increase the risk of developing SUA abnormalities. The study also revealed a significant dose-response relationship between BMI and abnormal uric acid levels. After controlling for other factors, the risk of developing SUA abnormalities was found to be 1.18 times higher in the night shift work group than in the day work group (OR = 1.18, 95% CI:1.02–1.34, P = 0.01).ConclusionShift work has been linked to a higher risk of developing SUA abnormalities, and there are several factors that may contribute to this risk. To prevent diseases, it is recommended that enterprises implement better health monitoring and management practices for shift workers.

Assessment of the Severity of COVID-19 on the Basis of Examination and Laboratory Diagnostics in Relation to Computed Tomography Imagery of Patients Hospitalised Due to COVID-19-Single-Centre Study.

From the moment the SARS-CoV-2 virus was identified in December 2019, the COVID-19 disease spread around the world, causing an increase in hospitalisations and deaths. From the beginning of the pandemic, scientists tried to determine the major cause that led to patient deaths. In this paper, the background to creating a research model was diagnostic problems related to early assessment of the degree of damage to the lungs in patients with COVID-19. The study group comprised patients hospitalised in one of the temporary COVID hospitals. Patients admitted to the hospital had confirmed infection with SARS-CoV-2. At the moment of admittance, arterial blood was taken and the relevant parameters noted. The results of physical examinations, the use of oxygen therapy and later test results were compared with the condition of the patients in later computed tomography images and descriptions. The point of reference for determining the severity of the patient's condition in the computer imagery was set for a mild condition as consisting of a percentage of total lung parenchyma surface area affected no greater than 30%, an average condition of between 30% and 70%, and a severe condition as greater than 70% of the lung parenchyma surface area affected. Patients in a mild clinical condition most frequently had mild lung damage on the CT image, similarly to patients in an average clinical condition. Patients in a serious clinical condition most often had average levels of damage on the CT image. On the basis of the collected data, it can be said that at the moment of admittance, BNP, PE and HCO3- levels, selected due to the form of lung damage, on computed tomography differed from one another in a statistically significant manner (p < 0.05). Patients can qualify for an appropriate group according to the severity of COVID-19 on the basis of a physical examination and applied oxygen therapy. Patients can qualify for an appropriate group according to the severity of COVID-19 on the basis of BNP, HCO3 and BE parameters obtained from arterial blood.

The Role of Tenascin-C in the Physiopathology of Familial Mediterranean Fever.

Familial Mediterranean fever (FMF) is an autoinflammatory disease common in the Mediterranean basin. It has been determined that tenascin-C level is increased in rheumatic inflammatory diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus, and systemic sclerosis. However, the role of tenascin-C has not been investigated in FMF. This study aimed to investigate serum tenascin-C levels in FMF patients and to investigate possible relationships between them. About 38 patients diagnosed with FMF and 40 healthy controls were included in the study. The patient's sex, age, clinical symptoms, physical examination, and laboratory results were recorded. Serum tenascin-C levels were determined by the enzyme-linked immunosorbent assay (ELISA) method. The serum tenascin-C levels were significantly lower in the FMF patients (10297 ± 8107 pg/ml) compared to the healthy control group (29461 ± 13252 pg/ml) (p < 0.001). In receiver operating characteristic(ROC) analysis, when the cut-off point was chosen as 11076 pg/ml, sensitivity was 77.1%and specificity was 91.9%. When the cut-off point was chosen as 19974 pg/ml, sensitivity was 91.4%and specificity was 75.7%. It was determined that the serum tenascin-C levels did not correlate with age, gender, and laboratory parameters in the healthy control group and FMF patients (p > 0.05). This is the first study investigating tenascin-C levels in FMF. Tenascin-C levels in FMF patients were lower than in healthy controls. Low tenascin-C levels in FMF, which are high in other chronic rheumatic diseases, may be a valuable indicator. Therefore, serum tenascin-C level seems to be a useful marker in distinguishing FMF patients from healthy individuals.

Peceleganan Spray for the Treatment of Skin Wound Infections

Peceleganan spray is a novel topical antimicrobial agent targeted for the treatment of skin wound infections. However, its efficacy and safety remain unclear. To assess the safety and efficacy of peceleganan spray for the treatment of wound infections. This multicenter, open-label, phase 3 randomized clinical trial recruited and followed up 570 adult patients diagnosed with secondary open wound infections from 37 hospitals in China from August 23, 2021, to July 16, 2022. Patients were randomized to 2 groups with a 2:1 allocation. One group received treatment with 2% peceleganan spray (n = 381) and the other with 1% silver sulfadiazine (SSD) cream (n = 189). The primary efficacy outcome was the clinical efficacy rate (the number of patients fulfilling the criteria for efficacy of the number of patients receiving the treatment) on the first day following the end of treatment (day 8). The secondary outcomes included the clinical efficacy rate on day 5 and the bacterial clearance rate (cases achieving negative bacteria cultures after treatment of all cases with positive bacteria cultures before treatment) on days 5 and 8. The safety outcomes included patients' vital signs, physical examination results, electrocardiographic findings, blood test results, and adverse reactions. Among the 570 patients randomized to 1 of the 2 groups, 375 (98.4%) in the 2% peceleganan treatment group and 183 (96.8%) in the 1% SSD control group completed the trial (n = 558). Of these, 361 (64.7%) were men, and the mean (SD) age was 48.6 (15.3) years. The demographic characteristics were similar between groups. On day 8, clinical efficacy was achieved by 339 patients (90.4%) in the treatment group and 144 (78.7%) in the control group (P < .001). On day 5, clinical efficacy was achieved by 222 patients (59.2%) in the treatment group and 90 (49.2%) in the control group (P = .03). On day 8, bacterial clearance was achieved by 80 of 334 patients (24.0%) in the treatment group and in 75 of 163 (46.0%) in the control group (P < .001). On day 5, bacterial clearance was achieved by 55 of 334 patients (16.5%) in the treatment group and 50 of 163 (30.7%) in the control group (P < .001). The adverse events related to the application of peceleganan spray and SSD cream were similar. This randomized clinical trial found that peceleganan spray is a safe topical antimicrobial agent with a satisfactory clinical efficacy rate for the treatment of skin wound infections, while the effectiveness of bacterial clearance remains uncertain. Chinese Clinical Trial Registry Identifier: ChiCTR2100047202.

Implementación del POCUS cardiaco en pacientes obstétricas durante el periodo preanestésico. Revisión narrativa

During the preanesthetic assessment of the obstetric patient, it is critical to assess the patient’s cardiovascular baseline condition, identify any potential risks, and facilitate behavioral modification to develop an individualized management strategy aimed at minimizing complications. Cardiac point-of-care ultrasound (POCUS) is a valuable instrument for assessing the morphology and function of the heart prior to surgery. Cardiac POCUS is not designed to replace comprehensive transthoracic echocardiography, which is the realm of cardiovascular anesthesiology and cardiology. However, when used in conjunction with anamnesis, physical examination, electrocardiogram, and previous laboratory results, cardiac POCUS is a valuable adjunct in the diagnostic toolbox of anesthesiologists. It allows for direct visualization of the heart and great vessels, with added benefits of speed, availability, and low risk for the patient. The purpose of this manuscript is to explore and describe the advantages of cardiac POCUS in the preanesthetic period of obstetric patients and its potential value for anesthesiologists through the identification of potentially hazardous conditions that may require individualized preoperative management.

The usefulness of universal ultrasound before hospital discharge for early diagnosing hip dysplasia in Korean neonates with breech presentation in a single center: A retrospective study.

Developmental dysplasia of the hip (DDH) is a broad-spectrum disorder. Early diagnosis and treatment are important for improved prognosis and a lower risk of long-term complications. Selecting high-risk infants is important for the early diagnosis of DDH using ultrasonography; however, there are no standard international guidelines. This study aimed to identify the usefulness of universal ultrasound before hospital discharge in breech-born neonates and proposes selective ultrasound for high-risk patients. A retrospective chart review was conducted to identify breech-born neonates who underwent hip ultrasonography before discharge for the detection of DDH between 2019 and 2023. Patients were categorized into DDH and non-DDH groups according to the ultrasound results. We compared sex, gestational age, birth weight, first-born status, twin pregnancy, associated anomalies, presence of symptoms, physical examination results, and timing of the first hip ultrasound. The medical records of the mothers were reviewed to identify the amount of amniotic fluid and duration of breech presentation. This study included 102 patients, of whom 62 and 40 were assigned to the non-DDH and DDH groups, respectively. Congenital anomalies, positive symptoms, and positive physical examination results were significant risk factors. However, female sex, first-born status, and oligohydramnios were not statistically significant. The duration of breech presentation during pregnancy was not significant. Additionally, the risk of Pavlik harnesses was higher in patients who underwent a positive physical examination. Universal ultrasonography before discharge is not recommended for the early diagnosis of DDH in all breech-born neonates because of the high rate of overdiagnosis. We recommend that ultrasonography be performed in patients with congenital anomalies, except for foot problems, or in those with a positive physical examination conducted by trained specialists.

Development, evaluation and validation of machine learning models to predict hospitalizations of patients with coronary artery disease within the next 12 months

BackgroundImproved survival of patients after acute coronary syndromes, population growth, and overall life expectancy rise have led to a significant increase in the proportion of patients with stable coronary artery disease (CAD), creating a significant load on the entire healthcare system. The disease often progresses with the development of many complications while significantly increasing the likelihood of hospitalization. Developing and applying a machine learning model for predicting hospitalizations of patients with CAD to an inpatient medical facility will allow for close monitoring of high-risk patients, early preventive interventions, and optimized medical care. AimsDevelopment and external validation of personalized models for predicting the preventable hospitalizations of patients with stable CAD and its complications using ML algorithms and data of real-world clinical practice. Methods135,873 depersonalized electronic health records of 49,103 patients with stable CAD were included in the study. Anthropometric measurements, physical examination results, laboratory, instrumental, anamnestic, and socio-demographic data, widely used in routine medical practice, were considered as potential predictors, a total of 73 features. Logistic regression, decision tree-based methods including gradient boosting (AdaBoost, LightGBM, XGBoost, CatBoost) and bagging (RandomForest and ExtraTrees), discriminant analysis (LinearDiscriminant, QuadraticDiscriminant), and naive Bayes classifier were compared. External validation was performed on the data of a separate region. ResultsThe best results and stability to external validation data were shown by the CatBoost model with an AUC of 0.875 (95% CI 0.865–0.885) for the internal testing and 0.872 (95% CI 0.856–0.886) for the external validation. The best model showed good performance evaluated through AUROC, Brier score and standardized net benefit (for the target NPV threshold) for the validation dataset that was only slightly similar to the train data. ConclusionThe metrics of the best model were superior to previously published studies. The results of external validation demonstrated the relative stability of the model to new data from another region that confirms the possibility of the model’s application in real clinical practice.

Health status and public health needs in a Togolese child health care centre modelled after the Dutch system

Background The charity foundation Association Soutien Enfants Togo started a child health care (CHC) centre in Togo that was modelled after the Dutch high-quality CHC system to improve child health. Aim To describe health care data of children who visited the centre. Subjects and methods Data were routinely collected between October 2010-July 2017. Outcomes were completed vaccinations, growth, development, lifestyle, physical examination, and laboratory testing results. Results In total, 8,809 children aged 0–24 years were available. Half (47.5%) of children aged 0–4 years did not receive all eligible free vaccinations from the government. The proportions of stunted children (all) or with a developmental delay (0–4 years) were 10.1% and 9.5%, respectively. In total, 40–50% of all children did not wash their hands with soap after toilet or before eating, or did not use clean drinking water. Furthermore, 5.1–6.6% had insufficient vision, high eye pressure or hearing loss. Sickle cell disease was detected in 5.3%. Conclusion A large group of children in need of prevention and early treatment were detected, informed and treated by the centre. Further research is needed to confirm if this strategy can improve children’s health in Sub-Saharan Africa. Our data are available for further research.

Association of Perinatal Depressive Symptoms with Breastfeeding.

Perinatal depression (PND) refers to depressive symptoms that occur in women during pregnancy and/or postpartum and is a common perinatal mental health problem. It is unclear whether early breastfeeding behavior is associated with PND symptoms in China. Therefore, this study aimed to investigate the association between PND symptoms and breastfeeding patterns for infants based on a large cohort. A prospective study was conducted in a community cohort from March 2021 to December 2022. In this study, maternal depressive symptoms were assessed using the Edinburgh postnatal depression scale (EPDS). The assessments were carried out 1 week before and 1 month after delivery. The socio-demographic information of the mothers, their intention to breastfeed, and their feeding status were investigated one-on-one by the hospital's trained medical staff through self-designed questionnaires. The maternity information and physical examination results were obtained through the healthcare records of the patients. A total of 442 pregnant women were included in the study, and the total detection rate of PND was 29.41%, among which the detection rate of mild PND was 24.66%, and the detection rate of severe depression was 4.75%. About 61.99% of the mothers had exclusive breastfeeding within 1 hour after delivery, and 83.71% had exclusive breastfeeding within 24 hours after delivery. The proportion of mothers with PND symptoms and those without PND symptoms who exclusively breastfed for the first time after delivery was 71.54% and 91.67%, respectively. The median duration of exclusive breastfeeding for mothers without depressive symptoms was 3(1,5) months, while the median duration of exclusive breastfeeding for mothers with depressive symptoms was 2(1,3) months, indicating that the duration of exclusive breastfeeding for mothers without depressive symptoms was longer (P < 0.05). There was an association between perinatal depressive symptoms and exclusive breastfeeding. Addressing perinatal depressive symptoms may extend the duration of exclusive breastfeeding.

How We Interpret Thrombosis with Thrombocytopenia Syndrome?

Platelets play an important role in hemostasis, and a low platelet count usually increases the risk of bleeding. Conditions in which thrombosis occurs despite low platelet counts are referred to as thrombosis with thrombocytopenia syndrome, including heparin-induced thrombocytopenia, vaccine-induced immune thrombotic thrombocytopenia, paroxysmal nocturnal hemoglobinuria, antiphospholipid syndrome, thrombotic microangiopathy (TMA), and disseminated intravascular coagulation. TMA includes thrombotic thrombocytopenic purpura, Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (HUS), and atypical HUS. Patients with these pathologies present with thrombosis and consumptive thrombocytopenia associated with the activation of platelets and the coagulation system. Treatment varies from disease to disease, and many diseases have direct impacts on mortality and organ prognosis if therapeutic interventions are not promptly implemented. Underlying diseases and the results of physical examinations and general laboratory tests as part of a thorough workup for patients should promptly lead to therapeutic intervention before definitive diagnosis. For some diseases, the diagnosis and initial treatment must proceed in parallel. Utilization of not only laboratory tests but also various scoring systems is important for validating therapeutic interventions based on clinical information.

An Image-Rich Educational Review of Breast Pain.

Breast pain is extremely common, occurring in 70% to 80% of women. Most cases of breast pain are from physiologic or benign causes, and patients should be reassured and offered treatment strategies to alleviate symptoms, often without diagnostic imaging. A complete clinical history and physical examination is key for distinguishing intrinsic breast pain from extramammary pain. Breast pain without other suspicious symptoms and with a negative history and physical examination result is rarely associated with malignancy, although it is a common reason for women to undergo diagnostic imaging. When breast imaging is indicated, guidelines according to the American College of Radiology Appropriateness Criteria should be followed as to whether mammography, US, or both are recommended. This review article summarizes the initial clinical evaluation of breast pain and evidence-based guidelines for imaging. Additionally, the article reviews cyclical and noncyclical breast pain and provides an image-rich discussion of the imaging presentation and management of benign and malignant breast pain etiologies.

Carbon monoxide poisoning manifesting with rhabdomyolysis, Takotsubo syndrome, and skin lesion: A case report

Carbon monoxide (CO) poisoning is characterized by non-specific and protean clinical manifestations, exhibiting a highly variable presentation. We present a case of an 83-year-old female Alzheimer&amp;rsquo;s patient, a non-smoker, who was found unconscious in her wheelchair by her caregiver at home. The heating in the apartment was powered by liquefied petroleum gas. On admission to the emergency department, her vital signs were normal, but she was unconscious and slightly dyspneic. The examination revealed red-colored skin lesions in the submammary area, where the wheelchair safety belt was firmly fastened. The rest of the physical examination results were unremarkable. The carboxyhemoglobin level was 23%, and there was an increase in creatine phosphokinase and troponin I levels. On the 2nd day of hospitalization in the emergency ward, the electrocardiogram revealed negative T waves in the V1&amp;ndash;V6 leads, while the bedside echocardiogram revealed apical ballooning of the left ventricle. The myocardial perfusion examination yielded a negative result for myocardial ischemia. In the management of patients with CO poisoning, it is important for emergency physicians to assess the presence of multiple organ and tissue disorders. Consequently, the patient was diagnosed with CO poisoning with skin, skeletal, and cardiac muscle involvement.

Feline tibial osteosynthesis

Diaphyseal fractures of the tibia occur as a result of trauma to the pelvic limb and are a rupture in the continuity of the diaphyseal corticosteroid bone. Animals with this type of fracture must be evaluated to determine whether it is the result of contusion or pathology, such as neoplasms. The study reports the case of a three-year-old mixed-breed feline, weighing three and a half kilos, with non-weight-bearing lameness on the right pelvic limb. The patient was attacked by a dog five days before the appointment. Upon physical examination, it was possible to observe loss of bone continuity in the right pelvic limb in the tibia region. There was an increase in volume, without apparent skin lesions. Radiographic, blood count and biochemical exams were performed. Based on clinical presentation, physical examination, imaging diagnosis and laboratory results, it was concluded that the animal had a fracture of the distal third diaphyseal tibia. Osteosynthesis of the tibia was indicated as treatment, in addition to prescription analgesics to alleviate the patient's pain.

Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation

With the significant increase in the use of extracorporeal membrane oxygenation in patients with severe respiratory failure, cardiogenic shock, and cardiopulmonary resuscitation, complications related to extracorporeal membrane oxygenation are increasingly being taken seriously. Cerebral injury is one of the most serious complications during extracorporeal membrane oxygenation treatment, and is an important factor affecting the hospital mortality rate and long-term quality of life. Due to the use of analgesics, sedatives, and muscle relaxants interfering with neurological physical examination results, cerebral injury that occurs during extracorporeal membrane oxygenation therapy is not easily detected in a timely manner. Therefore, bedside cerebral monitoring has important value in quickly detecting cerebral injury in patients with extracorporeal membrane oxygenation and providing early intervention guidance. Therefore, Extracorporeal Life Support Professional Committee of Chinese Medical Doctor Association organized relevant experts across the country to develop the"Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation", this expert consensus is based on the pathological and physiological mechanisms of cerebral injury in patients with extracorporeal membrane oxygenation. It is based on the current application status of cerebral monitoring technologies such as neurological physical examination, plasma brain injury biomarkers, brain imaging, intracranial pressure, cerebral blood flow, brain oxygen, electroencephalogram, and somatosensory evoked potential. Combining the special clinical application scenarios of extracorporeal membrane oxygenation and integrating the latest evidence-based medical evidence, we have formed 15 consensus recommendations which can be referenced by professionals in critical care medicine, neurology, cardiovascular disease, respiratory and critical care, emergency medicine, and other fields. Given the particularity, complexity, and individual differences of critically ill patients, the recommendations formed by this expert consensus need to implement personalized strategies.

Risk factors of developmental dysplasia of the hip in infants: A meta-analysis based on cohort studies

IntroductionDevelopmental dysplasia of the hip (DDH) is a prevalent condition in children. Currently, the exact etiology of DDH remains uncertain. The objective of this study was to conduct a meta-analysis to investigate the risk factors associated with DDH in infants. The findings would provide a theoretical foundation for targeted early screening and diagnosis. HypothesisSeveral indicators, such as gender, intrauterine position, family history of DDH, gestational age, delivery mode, amniotic fluid levels, swaddling, parity, fetus number, combined musculoskeletal deformities, birth weight, and physical examination results, may serve as risk factors for DDH. Materials and methodsCohort studies investigating the risk factors of DDH in infants through logistic regression analysis were searched in the Wanfang, VIP citation, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc, Excerpta Medica Database (Embase), PubMed, and Cochrane Library databases up to May 2023. After extracting the data from eligible literature and assessing them using the Newcastle-Ottawa Scale (NOS), articles were selected based on pre-established inclusion and exclusion criteria. ResultsA total of eleven literature reports covering 979,757 infants were included in this meta-analysis. The publication bias did not significantly influence the results. The incidence rate of DDH was 47.99‰ among infants with risk factors compared to 3.21‰ in the general population. Risk factors for DDH included being female (OR=6.97, 95% CI: 5.18–9.39, p<0.001), breech delivery (OR=4.14, 95% CI: 3.09–5.54, p<0.001), positive family history (OR=4.07, 95% CI: 2.20–7.52, p<0.001), cesarean section (OR=1.11, 95% CI: 1.01–1.21, p=0.032), oligohydramnios (OR=3.93, 95% CI: 1.29–12.01, p=0.016), swaddling (OR=6.74, 95% CI: 1.25–36.31, p=0.026), firstborn status (OR=1.84, 95% CI: 1.49–2.53, p<0.001), combined musculoskeletal malformations (OR=2.27, 95% CI: 1.58–3.27, p<0.001), and physical signs of DDH (OR=8.71, 95% CI: 2.44–31.07, p=0.001). Premature delivery (OR=0.91, 95% CI: 0.88–0.95, p<0.001) was a protective factor for DDH. The relationship between multiple pregnancies (OR=0.58, 95% CI: 0.33–1.02, p=0.060) and low birth weight (OR=0.62, 95% CI: 0.14–2.76, p=0.529) in relation to DDH remained uncertain. DiscussionThis meta-analysis shows that female, breech delivery, positive family history, cesarean section, firstborn status, oligohydramnios, swaddling and combined musculoskeletal malformations are associated with DDH. Premature delivery appeared to be a protective factor against DDH. Nevertheless, the other factors need more research to reach more conclusive results. Level of evidenceIII; meta-analysis.

ANCYLOSTOMIASIS AND ISOSPORIASIS IN SIBERIAN HUSKY DOG

Ancylostomiosis is a parasitic disease caused by infection with Ancylostoma spp. These parasites infect the digestive tract organs in dogs. Severe infection will cause death in dogs. A ten-year-old male Siberian Husky dog had complaints of bloody diarrhea, lethargy, and decreased appetite. Physical examination results showed a limp dog, pale mucous membranes, capillary refill time (CRT) of more than 2 seconds. The results of microscopic examination of feces with the floating method showed the presence of Ancylostoma spp. and Isospora spp. Based on this examination, the case dog was diagnosed with ancylostomiosis and isosporiosis. The therapy given was antihelmintic with pyrantel 15 mg/kg BW per oral (PO) with repetition on the 3rd and 7th days after the first administration, metronidazole therapy 25 mg/kg BW/12 hours per oral for seven days, symptomatic therapy with kaolin pectin per oral 7 mL/12 hours for five days and supportive therapy with vitamins and iron. On the 6th day after treatment, the dog in this case showed good results. The dog became more active and there was no diarrhea. To prevent ancylostomiosis and isosporiosis infections, routine deworming and environmental hygiene are recommended.

Association of sleep duration and physical exercise with dyslipidemia in older adults aged 80 years and over in China

Objective: To explore the impact of sleep duration, physical exercise, and their interactions on the risk of dyslipidemia in older adults aged ≥80 (the oldest old) in China. Methods: The study subjects were the oldest old from four rounds of Healthy Aging and Biomarkers Cohort Study (2008-2009, 2011-2012, 2014 and 2017-2018). The information about their demographic characteristics, lifestyles, physical examination results and others were collected, and fasting venous blood samples were collected from them for blood lipid testing. Competing risk model was used to analyze the causal associations of sleep duration and physical exercise with the risk for dyslipidemia. Restricted cubic spline (RCS) function was used to explore the dose-response relationship between sleep duration and the risk for dyslipidemia. Additive and multiplicative interaction model were used to explore the interaction of sleep duration and physical exercise on the risk for dyslipidemia. Results: The average age of 1 809 subjects was (93.1±7.7) years, 65.1% of them were women. The average sleep duration of the subjects was (8.0±2.5) hours/day, 28.1% of them had sleep duration for less than 7 hours/day, and 27.2% had sleep for duration more than 9 hours/day at baseline survey. During the 9-year cumulative follow-up of 6 150.6 person years (follow-up of average 3.4 years for one person), there were 304 new cases of dyslipidemia, with an incidence density of 4 942.6/100 000 person years. The results of competitive risk model analysis showed that compared with those who slept for 7-9 hours/day, the risk for dyslipidemia in oldest old with sleep duration >9 hours/day increased by 22% (HR=1.22, 95%CI: 1.07-1.39). Compared with the oldest old having no physical exercise, the risk for dyslipidemia in the oldest old having physical exercise decreased by 33% (HR=0.67, 95%CI: 0.57-0.78). The RCS function showed a linear positive dose-response relationship between sleep duration and the risk for hyperlipidemia. The interaction analysis showed that physical exercise and sleep duration had an antagonistic effect on the risk for hyperlipidemia. Conclusion: Physical exercise could reduce the adverse effects of prolonged sleep on blood lipids in the oldest old.

Machine learning-based prediction model for myocardial ischemia under high altitude exposure: a cohort study

High altitude exposure increases the risk of myocardial ischemia (MI) and subsequent cardiovascular death. Machine learning techniques have been used to develop cardiovascular disease prediction models, but no reports exist for high altitude induced myocardial ischemia. Our objective was to establish a machine learning-based MI prediction model and identify key risk factors. Using a prospective cohort study, a predictive model was developed and validated for high-altitude MI. We consolidated the health examination and self-reported electronic questionnaire data (collected between January and June 2022 in 920th Joint Logistic Support Force Hospital of china) of soldiers undergoing high-altitude training, along with the health examination and second self-reported electronic questionnaire data (collected between December 2022 and January 2023) subsequent to their completion on the plateau, into a unified dataset. Participants were subsequently allocated to either the training or test dataset in a 3:1 ratio using random assignment. A predictive model based on clinical features, physical examination, and laboratory results was designed using the training dataset, and the model's performance was evaluated using the area under the receiver operating characteristic curve score (AUC) in the test dataset. Using the training dataset (n = 2141), we developed a myocardial ischemia prediction model with high accuracy (AUC = 0.86) when validated on the test dataset (n = 714). The model was based on five laboratory results: Eosinophils percentage (Eos.Per), Globulin (G), Ca, Glucose (GLU), and Aspartate aminotransferase (AST). Our concise and accurate high-altitude myocardial ischemia incidence prediction model, based on five laboratory results, may be used to identify risks in advance and help individuals and groups prepare before entering high-altitude areas. Further external validation, including female and different age groups, is necessary.