Male Prevalence Research Articles

Prevalence and incidence of anal cancer in HIV-positive men: a systematic review protocol.

The objective of this review is to synthesize the best evidence available to determine the prevalence and incidence of anal cancer in HIV-positive men. Worldwide, an estimated 50,685 people were diagnosed with anal cancer in 2020 and an estimated 19,293 people died from the disease during the same year. From 2001 to 2015, the overall incidence of anal cancer increased by 2.7% per year, while mortality jumped by 3.1% each year. Evidence has shown that anal intraepithelial neoplasia can progress to cancer over time, particularly within the immunocompromised population. This review will consider studies conducted in any setting, in any geographical location that report on the prevalence and incidence of adult males aged 18 years or older from any racial or ethnic background who are HIV positive and diagnosed with any type of anal cancer. Participants will be included regardless of stage of anal cancer, type of cancer treatment used, or length of time diagnosed. CINAHL, MEDLINE, Embase, LBGTQ+ Source (EBSCO), Web of Science Core Collection, MedNar, WorldWideScience, and ProQuest Dissertations and Theses databases will be searched from 1990 till the present. Analytical and descriptive observational studies will be included and critically appraised by 2 independent reviewers. Data will be extracted using JBI standardized data extraction tools. If sufficient data are available, a meta-analysis will be conducted; otherwise, the findings will be presented in narrative format, including tables and figures to aid in data presentation. PROSPERO CRD42022327933.

Burden of chronic kidney disease in Nepal: An analysis of the burden of disease from 1990 to 2019.

Chronic kidney disease (CKD) has emerged as one of the major public health concerns. The increasing prevalence of its correlates such as obesity, diabetes, and hypertension has been, due in part responsible for the increased burden. However, very few studies have presented the comprehensive data on burden of disease particularly in developing countries like Nepal. In this study, we have performed an analysis on prevalence, mortality, years lived with disability (YLDs), years of life lost (YLLs) and disability-adjusted life years (DALYs) attributable to CKD in Nepal using Global Burden of Disease (GBD) Study 2019. The GBD 2019 study provides estimation of the prevalence, mortality rates, YLDs, YLLs and DALYs due to 369 different disease and 87 risk factors for 204 countries and territories across the world. In this study, we present Nepal specific data on prevalence, mortality, YLDs, YLLs and DALYs related to CKD. In 2019, there were 1,895,080 prevalent cases of CKD with 5,108 deaths, and a total of 168,900 DALYs were attributable to CKD. Age-standardized prevalence rate of CKD increased from 5,979.1 cases per 100,000 population (95% UI: 5539.7, 6400.4) in 1990 to 7,634.1 cases per 100,000 population (95% UI: 7138.8, 8119.4) in 2019 with higher prevalence in males. Similarly, the age-standardized mortality due to CKD increased for both sexes from 0.8 deaths per 100,000 population (95% UI: 0.6, 1.0) in 1990 to 2.6 deaths per 100,000 population (95% UI: 2.0, 3.3) in 2019. The burden of CKD as a percentage of total DALYs was 0.5% (95% UI: 0.4, 0.6) in 1990 and increased to 1.8% (95% UI: 1.4, 2.2%) in 2019. Kidney dysfunction, high systolic blood pressure, high fasting plasma glucose, high body mass index, low temperature, lead exposure, diet high in sodium, and high temperature were found to be the major risk factors for CKD. The study reveals that Nepal has a high and rising burden of CKD. Innovative strategies for prevention of CKD including health system preparedness for treatment services are required to respond to the rising burden of CKD.

Metabolic characterization of human sperm cells using the Seahorse metabolic flux analyzer.

The concerning trend on male infertility global prevalence, together with the unexplainable causes in half of those cases, highlights that there are still aspects of this disease to be understood and solved. To address this issue, one should not only be aware of the limitations of the implemented diagnostic tools, but also understand the sperm cell in depth, structurally, biochemically, molecularly in order to develop reliable and ready-to-be new/improved diagnostic tools. In this sense, the sperm cells metabolism, highly related to its functionality, seems to be a promising aspect to explore. Though there is much information on the human sperm metabolism, there is still a lack of a quick integrated and comprehensive analysis that may be introduced with the potential to reveal innovative clinically relevant information. Find metabolic details on human sperm that can be accessed easily, in real time and using few cells, relying on the bivalent potential of the Seahorse flux analyzer (SFA). We have obtained standard records on human sperm cells' oxygen consumption rate (OCR) and extracellular acidification rate (ECAR), that together with the metabolic metrics provided information on sperm cells' oxidative and glycolytic metabolism. Furthermore, a metabolic interindividual variation was observed. Although the comparison with other species or cell types is not linear and warrant further studies, the metabolic profile of human sperm cells seems to be similar to that of other species. Altogether our results corroborate the value of SFA for metabolic human sperm cell analysis, warranting new studies, and anticipating several applications in the male infertility field.

Advanced Research in Electronics: The Perspective of Women

In the past, electronic engineering has been considered a purely male research field and, although this situation has changed slightly, the male prevalence in both academic and professional fields is still marked [...]

Oppositional defiant disorder.

Oppositional defiant disorder (ODD) is a disruptive behaviour disorder involving an ongoing pattern of angry/irritable mood, argumentative/defiant behaviour and vindictiveness. Onset is typically before 8 years of age, although ODD can be diagnosed in both children and adults. This disorder is associated with substantial social and economic burden, and childhood ODD is one of the most common precursors of other mental health problems that can arise across the lifespan. The population prevalence of ODD is ~3 to 5%. A higher prevalence in males than females has been reported, particularly before adolescence. No single risk factor accounts for ODD. The development of this disorder seems to arise from the interaction of genetic and environmental factors, and mechanisms embedded in social relationships are understood to contribute to its maintenance. The treatment of ODD is often successful, and relatively brief parenting interventions produce large sized treatment effects in early childhood. Accordingly, ODD represents an important focus for research, practice and policy concerning early intervention and prevention in mental health.

509-P: There Is No Blood for Improvement—Anemia Cuts Down Healing Chances in Diabetic Foot Patients

Aim: Anemia is considered a marker of severity of diabetes and diabetic foot syndrome (DFS) but is still controversial if it can be taken as a predictor of negative outcomes in these patients. Our study aimed to evaluate if anemia could be associated with a reduction of healing chances in patients admitted for DFS. Methods: We retrospectively analysed all patients admitted in our Department in 2021 for DFS, dividing them in two groups according to presence (Group A) or absence (Group B) of anemia, diagnosed on levels of total Hemoglobin (HB) and red blood cells (RBC) below normal values (HB 13 g/dl for men and 12 g/dl for women and RBC 4.5×106/mm3 for men and 4.2×106/mm3 for women). We compared the groups for clinical and demographic characteristics, blood chemistry, procedures and clinical outcomes: healing rate (HR) and recurrences rate (RR). Among anemic patients we compared clinical outcomes according to the reduction of HB or RBC alone or both. Results: We derived data from 196 patients: 114 patients in Group A [58.1%; age 70.9±10.6 yrs; male/female 75.4/24.6%; DM1/DM2 7.0/93.0%; Hba1c 57.5±18.6 mmol/mol; diabetes duration (DD) 20.1±11.9 yrs] and 82 in Group B (41.8%; age 68.4±10.9 yrs; male/female 61.0/39.0%; DM1/DM2 9.8/90.2%; Hba1c 60.6±16.2 mmol/mol; DD 16.8±11.9 yrs). Group A presented higher (p<0.05) male prevalence and shorter disease duration but no differences in comorbidities, and surgical or vascular procedures. Group A showed a lower HR (55.2% vs 76.8%, p=0.0028) and a higher RR (23.6% vs 17.1%, p<0.002). No difference in terms of HR, HT or R according to the different diagnostic criteria for anemia. In Cox’s logistic regression analysis only anemia negatively affected healing (HR 2.8, CI 95% 1.4-5.4, p=0.0037). Conclusions: Anemia is associated to a reduction in healing chances in DFS patients and represents an independent predictor of healing failure. Disclosure F.Giangreco: None. E.Iacopi: None. V.Malquori: None. L.Pieruzzi: None. C.Goretti: None. A.Piaggesi: None.

#6448 IMPACT OF PRE-DIALYSIS FOLLOW-UP ON OUTCOMES IN DIALYSIS PATIENTS

Abstract Background and Aims Pre-dialysis care aims to slow down the decline in kidney function and to prepare patients for their potential start of renal replacement therapy. Patients who received attention earlier showed reduced mortality and hospitalization, better uptake of peritoneal dialysis, and earlier placement of arteriovenous fistula for hemodialysis. The objective of this study is to analyze the impact of pre-dialysis care in dialysis patients from Fresenius Medical Care Latin America (FME LatAm). Method Patients incident to dialysis that started treatment at FME LatAm between January 2019 and December 2022 were included in this retrospective observational study. They were classified according to whether they received pre-dialysis care or not as CKD (more than 10 days of follow up;) or No CKD (less than 10 days). CKD group was subclassified regarding the length of stay in pre-dialysis care in 10 to 45 days (10-45), 45 to 90 days (45–90), and more than 90 days (>90). Demographic variables, vascular access, and lab variables were compared between CKD and No CKD, and within subgroups during the observation period. Values are expressed in mean ± SD. Values compared using Student t-test or ANOVA accordingly. Results CKD patients were older than No CKD (CKD: 61.5 ± 16.6 vs NoCKD: 60.6 ± 17.2; p = 0.02), with lower male prevalence (CKD: 57.5% vs NoCKD: 60.2%; p=0.001). No significative differences in prevalence of diabetes were found. Patients under pre-dialysis treatment showed a higher rate of PD referrals (CKD: 44.6% vs NoCKD: 7.3%; p <0.0001). Regarding vascular access, a higher percentage of CKD patients started dialysis with definitive access (AVF or AVG) (CKD: 47.9% vs NoCKD: 31.5%; p <0.0001). In the same way, prevalence of definitive accesses was higher in patients with longer CKD stay (10-45: 38.4%, 45-90: 57.3%, >90: 50.2%; p<0.0001). Within patients who started treatment with a catheter, a higher percentage of CKD patients already had a fistula or graft performed at treatment start (CKD: 7.3% vs NoCKD: 2.7%; p <0.0001). EPO prescription was higher as the time of follow-up was longer (10-45: 3.3%, 45-90: 7%, >90: 14.9%; p<0.0001). As expected for CKD patients haemoglobin was higher and ferritin was lower (Table 1). Though TSAT, Calcium, and Albumin were significative different between CKD and No CKD, the difference was not clinically relevant. Phosphorus and iPTH was higher in CKD patients and creatitine clearence calculated by MDRD was lower in those patients, opposite of expected (Table 1). Conclusion Older and male patients are more likely to have CKD follow-up. Pre-dialysis treatment has a deep impact on PD referral, EPO prescription, type of vascular access at admission, and ready-made vascular access at treatment start. Some laboratory results were not as expected, maybe due to non proper medication accessibility or inadequate financial support at predialysis stages. Even though, CKD follow-up is crucial to prepare patients for a better start of renal replacement therapy.

A Population-Based Study of Eating Disorders in Young Persons in Malta: Prevalence in Males Nearly Equals that in Females

Objective: The objective of this study was to examine the prevalence of eating disorders and attitudes to food and eating for youths between 10 and 16 years of age, in order to aid in the diagnosis and treatment of eating disorders in young people through empirical research in a previously unexamined area. 
 Methods: The tool selected for this population-based study was the ChEAT, i.e. the Children’s Eating Attitudes Test. A representative cohort of 400, randomly sampled, young people aged 10-16, were asked all 26 questions of the ChEAT via telephone, while their parents/guardians were asked socio-demographic questions, 
 Results: 5.5% (2.25% M, 3.25% F) of the cohort scored at or above the cut-off of 20, indicating the presence of an eating disorder. No significant associations were found between disordered eating and socio-demographic data. 
 Conclusions: Findings indicate that males are catching up to females in eating disorder diagnoses. A male slightly higher mean ChEAT ≥20 could denote that disordered eating could be more acute for young men who are between 10 to 16 years old than it is for young women aged 10 to 16. The lack of significant association between the disordered eating and socio-demographic data could be a factor of the ages under examination in this study, and possibly these associations could arise at later ages.

Clinical value of perivascular fat attenuation index and computed tomography derived fractional flow reserve in identification of culprit lesion of subsequent acute coronary syndrome.

To explore the potential of perivascular fat attenuation index (FAI) and coronary computed tomography angiography (CCTA) derived fractional flow reserve (CT-FFR) in the identification of culprit lesion leading to subsequent acute coronary syndrome (ACS). Thirty patients with documented ACS event who underwent invasive coronary angiography (ICA) from February 2019 to February 2021 and had received CCTA in the previous 6 months were collected retrospectively. 40 patients with stable angina pectoris (SAP) were matched as control group according to sex, age and risk factors. The study population has a mean age of 59.3 ± 12.3 years, with a male prevalence of 81.4%. The plaque characteristics, perivascular fat attenuation index (FAI), and coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) of 32 culprit lesions and 30 non-culprit lesions in ACS patients and 40 highest-grade stenosis lesions in SAP patients were statistically analyzed. FAI around culprit lesions was increased significantly (-72.4 ± 3.2 HU vs. -79.0 ± 7.7 HU, vs. -80.4 ± 7.0HU, all p < 0.001) and CT-FFR was decreased for culprit lesions of ACS patients [0.7(0.1) vs. 0.8(0.1), vs.0.8(0.1), p < 0.001] compared to other lesions. According to multivariate analysis, diameter stenosis (DS), FAI, and CT-FFR were significant predictors for identification of the culprit lesion. The integration model of DS, FAI, and CT-FFR showed the significantly highest area under the curve (AUC) of 0.917, compared with other single predictors (all p < 0.05). This study proposes a novel integrated prediction model of DS, FAI, and CT-FFR that enhances the diagnostic accuracy of traditional CCTA for identifying culprit lesions that trigger ACS. Furthermore, this model also provides improved risk stratification for patients and offers valuable insights for predicting future cardiovascular events.

Primary biliary cholangitis: Epidemiology, prognosis, and treatment.

Primary biliary cholangitis (PBC) is a chronic cholestatic autoimmune liver disease characterized by a destructive, small duct, and lymphocytic cholangitis, and marked by the presence of antimitochondrial antibodies. The incidence and prevalence of PBC vary widely in different regions and time periods, and although disproportionally more common among White non-Hispanic females, contemporary data show a higher prevalence in males and racial minorities than previously described. Outcomes largely depend on early recognition of the disease and prompt institution of treatment, which, in turn, are directly influenced by provider bias and socioeconomic factors. Ursodeoxycholic acid remains the initial treatment of choice for PBC, with obeticholic acid and fibrates (off-label therapy) reserved as add-on therapy for the management of inadequate responders or those with ursodeoxycholic acid intolerance. Novel and repurposed drugs are currently at different stages of clinical development not only for the treatment of PBC but also for its symptomatic management. Here, we summarize the most up-to-date data regarding the epidemiology, prognosis, and treatment of PBC, providing clinically useful information for its holistic management.

Seroprevalence of SARS-CoV-2: Insights into the epidemiology of the pandemic

AimThis study aimed to assess the seroprevalence of SARS-CoV-2 and disease symptoms in Malakand, Pakistan. Materials & method623 samples with suspected SARS-CoV-2 were collected from different regions of Malakand and analyzed to detect SARS-CoV-2 IgG antibodies using ELISA. Results306 (49.1%) 0 f 623 patients were anti-SARS-CoV-2 IgG reactive, with a higher prevalence in males (75%) than females (25%). In this study, we enrolled two groups, subjects working in a non-medical setting and subjects working in a medical setting. Clinical symptoms were statistically linked with SARS-CoV-2. Four weeks of follow-up analysis of IgG titers in health care workers showed an increase in IgG antibodies titer. ConclusionThis study gives insights into the community-based spread of SARS-CoV-2 infection, associated immunity, and herd immunity in the studied population. This study can provide insights to the government about early vaccination of this population as most of the population is not yet vaccinated.

IMPACT OF DIFFERENT GUIDELINES ON THE PREVALENCE OF HYPERTENSION IN CHILDREN AND ADOLESCENTS

Objective: To assess the prevalence of hypertension (HTN) in youth according to the criteria of the European Society of Hypertension (ESH) (Lurbe, 2016), the American Academy of Pediatrics (AAP) (Flynn, 2017), and the Canadian Guidelines (Rabi 2020). Design and method: Four thousand nine hundred and forty evaluations in 2957 Caucasians of both sexes (1459 females), of European origin, from 5 to 18 years of age (mean age 11.0 ±3.2) were included and grouped in 5-12 yr, 13-15 yr and 16-18 yr. Blood pressure (BP) was measured in the non-dominant arm with cuff and bladder size adjusted to upper-arm girth. The three measurements of each office visit were averaged for analysis. Subjects were qualified as hypertensive (SBP and/or DBP) based on the thresholds defined by ESH, AAP and Canadian guidelines and differences among them were calculated. Results: According to the ESH, Canadian and AAP criteria, the percentage of hypertensives was 6.2%, 6% and 9.9%, respectively. The percentages in boys were 7.2%, 8.2% and 12.3%, while in girls were 5.1%, 3.6% and 7.4%. According to age, between 5-12 yr the prevalence of HTN was 6.2%, 5.2% and 10%. In those with 13-15 yr, HTN ranged at 7.3%, 6.8% and 8.6%, while in those with 16-18 yr, HTN was observed in 1.6%, 9.2% and 13.2%. The graphic expression of the different prevalence is shown in the Figures. Significant differences were observed for the total and male prevalence between ESH and Canada with AAP (p&lt;0.05). For girls, differences were observed among the 3 Guidelines. Conclusions: Overall, there are differences in the prevalence of HTN applying different Guidelines. Differences were largely dependent on age and sex.

EFFECTS OF LIFESTYLE ADVICE ASSOCIATED WITH BEETROOT-BASED NUTRACEUTICAL ON 24-HOUR BLOOD PRESSURE IN A POPULATION WITH HIGH-NORMAL BLOOD PRESSURE OR GRADE 1 HYPERTENSION

Objective: 2018 ESH hypertension guideline supports life-style changes as initial approach to be taken in both subjects with high-normal blood pressure (BP) and patients with grade 1 hypertension and low cardiovascular (CV) risk. Among many nutraceuticals, most with unproven or unlikely benefits, bioactive substances enriched with nitrates, sources of nitric oxide (i.e. red beets) exert proven vasodilator effects and may decrease BP levels. Aim: to evaluate the effect of lifestyle advice and beetroot-based nutraceutical on 24-h BP in a population with high-normal BP or grade 1 hypertension and low CV risk. Design and method: Longitudinal study on 43 consecutive subjects referred to two hypertension centers. A 24-h ambulatory BP monitoring (ABPM) was performed at baseline and after 3 month the introduction of lifestyle advice and beetroot-based nutraceutical [Cosmony, Servier, a nutraceutical based on Beta vulgaris L. (500 mg of dry beetroot extract)]. Results: Mean age: 49.9±10.7 years. Male prevalence: 53.5%. Median follow-up: 98 (92-121) days. Overweight/obese prevalence: 58.1%. The 62.8% of subjects had a grade 1 hypertension. At baseline, 24-h BP, daytime BP and night-time BP were 127.2±6.8/79.6±5.6 mmHg, 131.3±7.5/83.4±5.5 mmHg and 117.8±7.7/70.2±5.0 mmHg, respectively. At follow-up, all BPs showed a statistically significant decrease (all p&lt;0.005), except for diastolic night-time BP (p = 0.074) (-3.4±5.9/-2.2±3.7 mmHg for 24h BP; -3.9±6.0/-3.0±4.0 for daytime BP and -3.3±7.4/-1.3±4.7 for night-time BP). The percentage of subject with daytime BP &lt;130/85 mmHg had increased from 25.6% at baseline to 48.8% at follow-up. The decrease in BP was independent of gender and overweight/obesity, whereas it was more evident in the group of grade 1 hypertensives compared with the group with high-normal BP. Conclusions: Lifestyle advice in association with a nutraceutical, source of nitric oxide, may be a valid initial non-pharmacological therapy in subjects with high-normal BP or grade 1 hypertension and low CV risk.

Sociodemographic distribution and correlates of nonfatal unintentional non-traffic-related injuries in Kenya: Results from the 2014 demographic and health survey.

Injuries are among the leading causes of mortality worldwide. There exists a paucity of nationally representative injury data from the sub-Saharan African region on the nature of injuries outside of road traffic contexts. The aim of this study was to estimate the prevalence of nonfatal unintentional injuries that occurred outside of the traffic environment among persons aged 15-54 years in Kenya. We used the 2014 Kenyan Demographic Health Survey data to estimate the prevalence of nonfatal unintentional injuries and their injury mechanisms. Binary logistic regression was used to estimate the odds of unintentional injuries and associated factors. Injury prevalence was three times higher among males (27.56%) compared to females (8.25%). The highest prevalence for females and males respectively was among those aged 15-19 years (9.80%) and (31.18%), rural residents (8.45%) and (30.05%) and those who consumed alcohol (18.13%), and (31.39%). For both females and males, the most frequent injuries were cuts (4.95%; 18.15%) and as result of falls (3.29%; 8.92%) respectively. Burns were more prevalent among females (1.65%) compared to males (0.76%). Among males, the demographic and contextual factors associated with nontraffic unintentional injuries were residing in a rural area (OR 1.33, 95% CI 1.14, 1.56), primary education (OR 2.02, 95% CI 1.48, 2.76), a higher wealth index (second quintile OR 1.41, 95% CI 1.19, 1.67) and consuming alcohol (OR 1.49, 95% CI 1.32, 1.69). Females who had completed primary, secondary (OR 2.43, 95% CI 1.92, 3.08) or higher education had higher odds of unintentional injuries. The findings mirror prior literature highlighting the clustering of demographic and behavioral factors which underlie predisposition to injuries outside of the traffic environment. Future nationally representative studies would benefit from deeper inquiry into and measurement of injury severity and health care utilization to inform strategic policy-relevant research.

A demographic study of acute megakaryoblastic leukemia using the national cancer database.

e19023 Background: Acute megakaryoblastic leukemia (AMKL) is a rare subtype of acute myeloid leukemia that, based on past studies, primarily affects children. Patients with Down syndrome (DS) have a higher risk of developing AMKL. While DS-associated AMKL has an overall survival rate of 80%, the prognosis of adult AMKL is much poorer (overall survival rate of &lt; 40%). The prognostic heterogeneity of AMKL warrants an investigation of its diagnostic trends in order to gain epidemiological insights. In this study, demographic data of AMKL patients was obtained from the National Cancer Database (NCDB) and analyzed to determine factors that affect the outcome of AMKL patients. Methods: In this retrospective cohort study, data from the 2004-2020 NCDB was analyzed to identify cases of AMKL with ICD-O-3 code 9910. Demographic data attached to the identified cases assessed included age, sex, race, Hispanic status, insurance status, facility type, surgery status, palliative care status, and Charlson-Deyo score. Descriptive statistics were obtained, and the incidence trends of AMKL were interpreted using regression analysis. Results: A total of 765 patients diagnosed with AMKL were identified in the database between 2004 – 2020 with a decreasing incidence of patients diagnosed per year (64 cases in 2004 and 11 cases in 2020; R^2 = 0.86). The average age of diagnosis was 40.3 years (SD = 32.4, range = 0 – 90 years, median = 51 years). AMKL exhibits slight male prevalence (55.2% vs 44.8% for females). The majority of the patients were Non-Hispanic White (77.6%). Most individuals had Charlson-Deyo comorbidity scores of 0 (79.1%). The incidence rates were similar across household income quartiles. 72.8% of AMKL cases were diagnosed in urban areas with a population of &gt; 250,000. Fewer cases were treated at community cancer programs as compared to either academic/research programs (45.1%) or integrated network cancer programs (20.6%). Private insurance (38.6%), Medicare (30.6%), and Medicaid (22.0%) were the most common insurance types. All patients received surgical intervention of the bone marrow and 3.2% of patients received palliative care. Conclusions: This NCDB-based demographic analysis on AMKL serves to improve the general understanding of AMKL. Surprisingly, the average and median ages of diagnosis are 40.3 and 51 years, respectively, which contradicts prior reports of AMKL being primarily a pediatric disease. Our analysis of the socioeconomic factors of AMKL patients showed that most AMKL patients were non-Hispanic Whites and diagnosed and treated in urban settings. In addition, the majority of AMKL patients had government insurance (54.6%; Medicare, Medicaid, and others). While this study provides initial insight into the role demographics play in the diagnosis and treatment of AMKL patients, further studies on how these factors contribute to their outcome would provide great value in understanding the social disparity in AMKL.

Georacial Epidemiological Estimates of Glucose-6-Phosphate Dehydrogenase Deficiency among Newborns in the United States.

Glucose-6-phosphate dehydrogenase deficiency (G6PDd) is the most common inherited enzyme deficiency disorder worldwide and a major risk factor for the development of severe hyperbilirubinemia. Racial diversity of phenotypes and genotypes in affected individuals is likely to exist in the United States because of changing population demographics. The aim of the present study was to predict an empirical estimate of annual prevalence of G6PDd in newborns adjusted for geography (state of birth), maternal racial identity, and sex of the infant. Birth statistics (2019) from National Center for Vital Statistics and CDC-WONDER data and race-specific prevalence of G6PDd in the United States were evaluated from published sources. We developed Simpson's diversity index (DI) for each State and correlated these to rates of G6PDd in neonates. Descriptive statistics including modeled prevalence and its association with DI were assessed using the Spearman's rho correlation test. We modeled state-specific prevalence for six states (California, Washington DC, Illinois, Massachusetts, New York, and Pennsylvania) using population-level allele frequencies and race, based on Hardy-Weinberg equilibrium. We estimated 78,010 (95% confidence interval: 76,768-79,252) newborns had G6PDd at birth in 2019 with cumulative median prevalence of 17.3 (interquartile range: 12.4-23.2) per 1,000 live births for United States. A strong association was noted for DI and prevalence of G6PDd (p < 0.0005). Five states (Washington DC, Mississippi, Louisiana, Georgia, and Maryland) have the highest projected G6PDd prevalence, with a range of 35 to 48 per 1,000 live births. The probability of G6PDd for female heterozygotes, based on male prevalence, ranged from 1.1 to 7.5% for each cohort in the select six states. States with diverse populations are likely to have higher rates of G6PDd. These prevalence estimates exceeded by several-fold when compared with disorders screened by existing state mandated newborn screening panels. These discrepancies are further confounded by known risk of severe neonatal hyperbilirubinemia that results with G6PDd and the life-long risk of hemolysis. Combined universal newborn predischarge screening for G6PDd and bilirubin could alert and guide a clinician's practices for parental education and closer medical surveillance during the vulnerable neonatal time period. · G6PDd is a common X-linked disorder that can present with varied phenotypes among newborns.. · Prevalence of G6PDd and genotype distribution varies with sex, race, and ethnicity.. · We present regional race- and sex-based estimates of G6PDd in the United States..

Anatomic Location, Age, Gender and Staging of Osteosarcoma Patients Presenting to a Tertiary Care Centre

Osteosarcoma is a high grade primary skeletal malignancy characterised by spindle cells of mesenchymal origin depositing immature osteoid matrix. With an annual incidence rate of 3.1 cases per million in the US, Osteosarcoma accounts for less than 1% of all newly diagnosed cancer in adults and 3-5% of those in children, but it is the most common malignancy in adolescents outside of leukemia and lymphoma. In India, the incidence varies from 4.7% to 11.6%, where this malignancy is associated with significant morbidity and mortality. Our study shows that Age distribution histogram shows a bimodal distribution. We observed that the most common site of osteosarcoma is around the knee joint in proximal tibia and distal femur. In our study we found that the tumour has higher prevalence in males than females. Most of the patients presented to us at Enneking stage 2b and AJCC stage 2a and 2b. Keywords: AJCC-American Joint Commission on Cancer

Personalized rate control treatment for atrial fibrillation: a prospective case-control study on the use of diltiazem

Abstract Funding Acknowledgements Type of funding sources: None. Background Recent ESC Atrial Fibrillation guidelines introduced some changes in the options for rate control, such as the possibility to combine beta-blockers (BB) and non-dihydropyridine calcium channel blockers (NDCC), to address the need of personalized pharmacologic rate control strategy for AF. However, there are limited data on this topic. Purpose The aim of our study was to explore the prognostic impact of a personalized therapy (PT) for rate control, including the use of NDDC in patients with heart failure (HF) or in combination with BB, compared to standard rate control therapy (ST) as defined by previous ESC guidelines. Methods This is a single centre prospective observational registry on patients referred to our University Hospital for the management of AF between October 2013 and February 2019. Results We enrolled 1112 patients on exclusive rate control treatment, 125 (11.2%) were identified as patients with PT and 987 (88.8%) were on ST. In the PT group, 93/125 (74.4%) patients were prescribed BB + NDCC (±digoxin), while 85/125 (68.0%) were HF patients prescribed with NDCC, diltiazem in all cases. The mean age of patients was 73.5±12.0 years and 72.5±12.7 years in ST and PT groups, respectively. The two cohorts were homogeneous in terms of male prevalence, left ventricular ejection fraction and CHA2DS2-VASc score; while, HF was more frequent in PT group both in terms of patients with NYHA class ≥2 (41.3% in ST vs. 64.8% in PT, p&amp;lt;0.001) and prescription of diuretics (72.2% in ST vs. 88.0% in PT, p&amp;lt;0.001). Patients treated with PT had no difference in one-year overall survival compared to those with a ST (Figure 1 A). Notably, patients with HF in ST had a worse prognosis (p&amp;lt;0.001). (Figure 1 B) Conclusions Our results suggest a potential outcome benefit of NDCC for rate-control in AF patients, either alone or in combination with BB, also in selected patients with HF. Future controlled studies are needed to confirm our findings, and to identify subjects with higher benefit from such personalized rate-control strategies.

A Deep Learning-based Model to Predict Limb Amputation in Peripheral Vascular Trauma

The objective of this study is to develop an accurate neural network (NN)-based approach to predict limb amputation in patients who sustain blunt traumatic peripheral vascular injury. The 2019 National Trauma Data Bank (NTDB) was queried for International Classification of Disease, Tenth Edition (ICD-10) codes corresponding to blunt peripheral vascular trauma. A total of 15,438 patients were used to train a NN, of which 335 received a traumatic amputation. The neural network was trained using the following input variables: age, sex, Injury Severity Scale (ISS), presenting Glasgow Coma Scale (GCS), packed red blood cells (RBCs) used in the first 4 hours of presentation, heart rate, and presenting systolic blood pressure (SBP). The primary outcome of our study was the area under the receiver-operator characteristics curve (AUC) of our NN with secondary outcomes including the normalized importance ratio of variables used to train the NN. The NN accurately predicted amputation in patients who sustained blunt peripheral vascular injury with an AUC of 0.78. There were no significant differences in age between the amputation and limb salvage cohorts. There was a higher prevalence of males in the amputation cohort in addition to a higher ISS, lower GCS, increased amount of packed RBCs in the first 4 hours of presentation, and a lower presenting SBP. Our NN found ISS followed by blood transfusion requirements to be most predictive of traumatic amputation. A NN-based approach can accurately predict. Additionally, presenting ISS and transfusion requirements within the first 4 hours were found to have the highest predictive value. Furthermore, NN can be utilized as an innovative predictive adjunct in the management of critical trauma.

Predicting Mortality in Blunt Abdominal Aortic Trauma- a Novel Approach Utilizing Neural Networks

The aim of this study was to develop an accurate neural network (NN)-based approach to predict in-hospital mortality in patients who sustain blunt traumatic aortic injury (BTAI). Secondary objectives include identifying factors that may play a contributory role in mortality. The 2019 National Trauma Data Bank (NTDB) was queried for International Classification of Diseases, Tenth Edition (ICD-10) codes corresponding to blunt abdominal aortic trauma. Patients with no signs of life upon presentation were excluded from this study. A total of 113 patients were used to train a NN using the following input variables: age, sex, Injury Severity Scale (ISS), presenting Glasgow Coma Scale (GCS), packed red blood cells (RBCs) used in the first 4 hours of presentation, and presenting systolic blood pressure (SBP). The primary outcome of our study was the area under the receiver-operator characteristics curve (AUC), sensitivity, and specificity of our NN with secondary outcomes including the normalized importance ratio of variables used to train the NN. The NN accurately predicted mortality in patients who sustained BTAI with an AUC of 0.93 (Fig), sensitivity of 72%, and specificity of 89%. There were no significant differences in age between the mortality and survival cohorts. There was a higher prevalence of males in the mortality group in addition to a higher ISS, lower GCS, increased number of packed RBCs in the first 4 hours of presentation and a lower presenting SBP. Our NN found transfusion requirements to be the most predictive of mortality followed by ISS. A NN-based approach can accurately predict mortality in BTAI. Additionally, transfusions requirements within the first 4 hours and presenting ISS were found to have the highest predictive value. Furthermore, NN can be utilized as an innovative predictive adjunct in the management of critical trauma.