Primary Risk Factor Research Articles

Risk factors for in-hospital mortality in older patients with acute respiratory distress syndrome due to COVID-19: a retrospective cohort study

BackgroundAdvancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS).MethodsThis was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021.ResultsA total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67–80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71–80 [OR 1.87 (95% CI 1.33–2.64)], age > 80 [OR 8.74 (95% CI 5.34–14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003–1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50–3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52–17.60)], and use of steroids [OR 1.49 (95% CI 1.09–2.03)]. In patients over 80 years of age (n = 388), the primary risk factor associated with in-hospital mortality was the use of IMV (n = 76) [OR 6.26 (95% CI 2.67–14.69)], resulting in an in-hospital mortality rate of 89.4% (n = 68) when this therapy was implemented.ConclusionsThe primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered.

Predictors of dental arch abnormalities in children with primary dentition (part two)

Relevance. Assessing the influence of risk factors during the primary dentition period on the development of dental arch abnormalities is essential for planning preventive and therapeutic interventions, as well as encouraging compliance with these measures. The first part of this article focused on identifying predictors of malocclusion, while this second part aims to determine the predictors of dental arch abnormalities.Purpose. To identify prognostic factors (predictors) of dental arch abnormalities in children during the primary dentition period.Materials and methods. This study presents the results of a retrospective analysis of the oral health status of 123 children (55 boys and 68 girls). The initial examination took place when the children were between 4.0 and 5.5 years old (mean age 5.1 ± 0.6 years), with follow-up examinations conducted between the ages of 6.0 and 10.5 years (mean age 8.7 ± 1.3 years). The relationship between risk factors in primary dentition and the development of dental arch abnormalities in early mixed dentition was evaluated using Pearson's chi-squared test (χ2) and Welch's t-test (V). For each pair of "primary dentition risk factor – dental arch abnormality in early mixed dentition," the odds ratio with a 95% confidence interval was calculated.Results. Differentiating predisposing factors and analyzing the effects of their various combinations allowed the identification of predictor clusters in primary dentition, where the probability of developing dental arch abnormalities in mixed dentition exceeds 95%. For upper arch abnormalities, the cluster includes infantile swallowing and early extraction of deciduous molars in the lower jaw (χ2 =19.67, V=0.50); for lower arch abnormalities, the cluster consists of infantile swallowing, "lazy" chewing, sucking habits, and a deep bite in the anterior region (χ2 =16.58, V=0.67); For lower incisor crowding, the cluster includes "lazy" chewing, infantile swallowing, and a deep bite in the anterior region (χ2 =17.54, V=0.63); for diastema in the upper arch, the cluster includes an abnormal labial frenum and interdental tongue position (χ2 =19.16, V=0.49); for maxillary anterior spacing, early extraction of deciduous canines in the upper jaw is the primary factor (χ2 =16.23, V=0.46).Conclusion. Identifying and addressing predictors of dental arch abnormalities in children during the primary dentition period can significantly reduce the risk of developing pathological conditions during the mixed dentition period.

Primary and residual cardiometabolic risk factors among young adults in a Russian city

BackgroundCardiovascular diseases are a leading cause of mortality and a significant contributor to temporary and permanent disabilities worldwide. This study aimed to investigate the burden of primary and residual cardiometabolic risk factors in a sample of young adults in the Russian city of Kazan.MethodsThis case-control study used the Cardiometabolic Disease Staging (CMDS) classification system, which has been validated in several countries. The study included 191 individuals aged 25–44 years who met the inclusion criteria but did not meet any exclusion criteria. Data collection involved a patient card with questions from the World Health Organization’s STEPS instrument, face-to-face patient interviews, and a physical examination. Anthropometric assessments included height, weight, and waist circumference measurements. Body composition was evaluated using bioelectrical impedance measurements. Patients also underwent in-depth laboratory biochemical analyses.ResultsThe study cohort was comprised of 97 females (50.8%) and 94 males (49.2%). The median age of participants was 35.00 years [IQR: 30.00–39.00]. The study cohort showed an increase in all anthropometric parameters, with abdominal obesity and overweight reaching 100% in the CMDS 3. Apart from atherogenic lipids and raised blood pressure, other risk factors that precipitate residual risk and were not part of CMDS, such as insulin levels, insulin resistance, leptin values, and hyperuricemia, increased as CMDS levels increased.ConclusionsThe prevalence of cardiometabolic risk factors was high in young adults in Kazan. This study highlights the need for the early identification and management of cardiometabolic risk factors in young adults to prevent the development of cardiovascular diseases later in life.

Insights into the Sex-Related Effects of Dietary Polyphenols and Metabolic Disruptors on Inflammatory and (Neuro) Endocrine Pathways in Obesity: The HEAL Project

Background: this study was performed under the umbrella of the Health Extended Alliance for Innovative Therapies, Advanced Lab Research, and Integrated Approaches of Precision Medicine (HEAL ITALIA) partnership and funded under the National Recovery and Resilience Plan, Mission 4 Component 2 Investment 1.3, and by the European Union. Objectives: the overall objective of the HEAL project is to identify innovative and effective therapeutic approaches to reduce disease burden. The present research falls within Spoke 7: Prevention Strategies: Integrated and gender medicine approaches for prevention strategies based on environmental, lifestyle, and clinical biometric data. Obesity represents a primary risk factor worldwide for the onset of numerous life-threatening diseases, including metabolic, cardiovascular, and neurological diseases. Environmental and gender-related factors influence obesity development. However, the molecular mechanisms underlying the effects of those agents on different organs of the human body are not fully understood yet. Methods: here, we present a study protocol aimed at shedding light on (i) the complex interplays among adipose tissue, brain and gut in obesity, and (ii) the effects of specific dietary components and environmental metabolism-disrupting compounds on those interactions. To this purpose, we combined ex vivo, in vitro, and in vivo approaches to gain additional knowledge about the molecular mechanisms underlying connections between organs. Conclusions: the data provided by this study will contribute to defining new targets for therapeutic and/or preventive interventions, thereby allowing more personalized approaches to nutrition.

A Comprehensive Protocol for Microbead-Induced Ocular Hypertension in Mice.

Glaucoma is a common optic neuropathy characterized by degeneration of retinal ganglion cells (RGCs). Elevated intraocular pressure (IOP), that is, ocular hypertension, is the primary modifiable risk factor for glaucoma and the primary characteristic of most preclinical glaucoma models. Extensive genotype and phenotype diversity at relatively low cost and high accessibility makes laboratory mice an excellent preclinical model for glaucoma. The microbead occlusion model was introduced in 2010 as an inducible model of ocular hypertension in mice and is now one of the most extensively utilized models of rodent glaucoma. Subsequent modifications of the microbead model increased the magnitude and duration of IOP elevation, primarily through modification of injection materials. Despite its popularity, accessibility of the model is hindered by procedural consistency between users. Here we outline an updated and comprehensive protocol for execution of the microbead model that is focused on improving surgical and outcome measure consistency and on enabling single experimenter execution.

Current status of modifiable risk factors for cardiovascular disease in Korean women.

Hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking are the primary modifiable risk factors contributing to the increasing morbidity and mortality rates from cardiovascular disease (CVD) among Korean women. Significant sex-related differences exist in the prevalence, awareness, treatment, and control of these risk factors, highlighting the importance of age- and sex-specific approaches to the management and prevention of CVD. Notably, the prevalence of hypertension and diabetes mellitus increases with age, with a higher prevalence in elderly women compared to men. Dyslipidemia and obesity are also trending upward, particularly in postmenopausal women, highlighting the impact of menopause on cardiovascular risk. The present review advocates for improved diagnostic, therapeutic, and educational efforts to mitigate the risk of CVD among Korean women, with the goals of reducing the overall burden of the disease and promoting better cardiovascular health outcomes.

Central Venous Catheter Migration Into Pleura Diagnosed by Transesophageal Echocardiography.

Central venous catheter (CVC) tip migration is a well reported delayed complication of these vascular access devices with left-sided internal jugular or subclavian vein placement being the primary risk factor for this complication. We report a case of left internal jugular CVC migration and its diagnosis made by the heretofore unreported use of intraoperative transesophageal echocardiography in this context. Moreover, we describe risk factors for CVC migration along with its diagnosis and management.

Risk Factors Associated with Gastritis among Adult Patients Attending at Capital Hospital in Mogadishu- Somalia

Background: Gastritis, an inflammatory disorder affecting the lining of the stomach, is a prevalent health concern across the globe, particularly in developing regions like Somalia. This study aims to investigate the primary risk factors linked to gastritis among adults receiving care at Capital Hospital in Mogadishu.  Methods: An unmatched case-control study was executed from June 1 to July 30, 2024, involving 63 adult participants, with 21 patients diagnosed with gastritis through endoscopic procedures and 42 controls. A semi- structured questionnaire was employed to gather data on socio-demographic characteristics, dietary patterns, lifestyle habits, medical histories, and medication usage. Statistical analysis was performed using SPSS version 26.  Results: The investigation revealed a gastritis prevalence of 78.8%, with acute cases constituting 48.9% and chronic cases 29.9%. Female participants were identified as having a protective effect against gastritis (Adjusted Odds Ratio [AOR]=0.05, p=0.023), whereas the routine use of non-steroidal anti-inflammatory drugs (NSAIDs) significantly raised the risk (Crude Odds Ratio [COR]=5.03, p=0.041). Interestingly, the presence of Helicobacter pylori was associated with a reduced risk of developing gastritis (COR=0.11, p=0.032). Other lifestyle and dietary factors did not show significant correlations.  Conclusions: The results underscore the protective influence of gender and the associated risks of NSAID intake regarding gastritis among Somali adults. The unexpected finding of H. pylori infection linked to lower gastritis risk deserves further exploration. There is an urgent need for targeted public health strategies to address the effects of gastritis in Somalia.

Warmer Temperatures Are More Predictive Than Solar Radiation for the Number of Skin Cancer Removal Procedures.

Solar radiation is the primary risk factor for skin cancer, with personal exposure influenced by environmental and behavioral factors. At higher temperatures, behavioral changes increase solar radiation exposure. Examine the relationships between solar radiation, ambient temperature, age, and skin cancer. For the contiguous United States, we obtained the state mean global horizontal irradiance (GHI), daily maximum temperature, and number of skin cancer removals in the Medicare population. For skin cancer removals, we defined more sun-exposed skin as the head, neck, hands, and feet, and less sun-exposed skin as the trunk, arms, and legs. By comparing the temperature thresholds 17°C, 20°C, 24°C, 27°C, 31°C, and 34°C, we found that the annual number of days above 24°C was the strongest temperature-related predictor of skin cancer removals. Multivariable linear regression showed that the number of days above 24°C predicted more skin cancer removals for all body locations and less sun-exposed skin (p = 0.008 and p = 0.003, respectively), while GHI did not (p = 0.1 and p = 0.8, respectively). GHI only predicted more skin cancer removals for more sun-exposed skin (p = 0.02). More days above 24°C was a better predictor of skin cancer removals than GHI for all skin locations and less sun-exposed skin, suggesting that the behavioral changes occurring at warmer temperatures are more predictive of skin cancer removals than solar irradiance. Due to rising global temperatures, skin cancer incidence may further increase. Temperature-related behavioral changes represent a potential target for skin cancer prevention efforts.

Do Personalized Nutrition Interventions Improve Dietary Intake and Risk Factors in Adults With Elevated Cardiovascular Disease Risk Factors? A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Dietary modifications can improve cardiovascular disease (CVD) risk factors. Personalized nutrition (PN) refers to individualized nutrition care based on genetic, phenotypic, medical, behavioral, and/or lifestyle characteristics. PN may be beneficial in improving CVD risk factors, including diet. However, this has not been reviewed previously. The aim was to evaluate the effectiveness of PN interventions on CVD risk factors and diet in adults at elevated CVD risk. Six databases were searched for randomized controlled trials published between 2000 and 2023 that tested the impact of PN interventions on CVD risk factors in people at elevated risk. Risk of bias was assessed using the Academy of Nutrition and Dietetics Quality Criteria checklist. Data synthesis of eligible articles included participant characteristics, intervention details, and change in primary CVD risk factor outcomes, including blood pressure (BP), plasma lipids, and CVD risk score, and secondary risk factors, including anthropometric outcomes and diet quality. Random-effects meta-analyses were conducted to explore weighted mean differences (WMDs) in change or final mean values for studies with comparable data (studies with dietary counseling interventions) for outcomes including BP, blood lipids, and anthropometric measurements. Of 7676 identified articles, 16 articles representing 15 studies met the inclusion criteria. Studies included between 40 and 563 participants and reported outcomes for CVD risk factors, including hyperlipidemia (n = 5), elevated BP (n = 3), overweight/obesity (n = 1), and multiple risk factors (n = 6). Risk of bias was low. Results suggested potential benefit of PN on systolic BP (WMD: -1.91; 95% CI: -3.51, -0.31 mmHg) and diastolic BP (WMD: -1.49; 95% CI: -2.39, -0.58 mmHg) and dietary intake in individuals at high CVD risk. Results were inconsistent for plasma lipid and anthropometric outcomes. Results were promising for PN interventions that used dietary counseling on CVD risk factors in at-risk individuals. However, further evidence for other personalization methods is required, including improving methodological quality and longer study duration in future PN interventions. OpenScience Framework (https://doi.org/10.17605/OSF.IO/SHVWP).

Independent and interactive effects of particulate matter and meteorological factors on hand, foot and mouth disease in Fuyang.

Previous research has demonstrated the influence of environmental factor on the occurrence of infectious diseases. However, there is insufficient and conflicting evidence regarding the association between Hand, foot and mouth disease (HFMD) and environmental variables, particularly the interaction of environmental variables. This study aims to investigate the individual and interactive effects of particulate matter (PM) and meteorological factors on HFMD incidence in Fuyang. The generalized additive models were combined with distributed lag non-linear models to assess the individual effects between PM and meteorological factor on HFMD incidence in Fuyang. Subsequently, a product term was incorporated into the model to investigate the interaction between PM and meteorological factors. Temperature and PM2.5 were identified as the two primary risk factors for HFMD, with relative risks (RR) of 1.586(1.493,1.685) and 1.349(1.325,1.373), respectively. Furthermore, PM exhibited a synergistic effect with meteorological factors. For instance, the RR values for PM2.5 in relation to HFMD were 1.029 (95% CI: 1.024-1.035) and 1 0.117 (95% CI: 1 0.108 - 11 0.127) under different temperature group categories. Notably, HFMD predominantly affects children under the age of five years old and infants aged between zero to one year old demonstrate heightened susceptibility to environmental variables. The results showed that both PM and meteorological factors were risk factors for HFMD, with evidence of an interaction between these variables. These findings have important implications for local HFMD incidence prediction and the development of effective prevention strategies.

Machine learning based tuberculosis (ML-TB) health predictor model: early TB health disease prediction with ML models for prevention in developing countries

Background Tuberculosis (TB) remains one of the top infectious killers in the world and a prominent fatal disease in developing countries. This study proposes a prototypical solution to early prevention of TB based on its primary symptoms, signs, and risk factors, implemented by means of machine learning (ML) predictive algorithms. Further novelty of the study lies in the uniqueness of patient dataset collected from three top-ranked hospitals of Sindh, Pakistan, via a self-administered survey patient-records that comprises a set of questions asked by the doctors treating TB patients in real-time. A total of 1,200 survey patient-records were evenly distributed among all three hospitals, viz. ICT Kotri, LUMHS Jamshoro, and Civil Hospital Hyderabad. Methods To develop the required prototypes, the research made use of five distinct benchmark ML algorithms: decision tree (DT), Gaussian naive Bayes (GNB), logistic regression classifier (LRC), adaptive boosting (AdaBoost), and neural network (NN), whose performance was evaluated by considering various performance metrics, i.e., accuracy, precision, recall, F1 score, and confusion matrix. Results The experimental results, graphically visualized and systematically discoursed, demonstrate that early detection of TB classifiers, including DT, GNB, LRC, AdaBoost, and NN, attained accuracy rates of 92.11%, 89.04%, 90.35%, 93.42%, and 92.98%, respectively. These results indicate effective diagnosis of TB disease by each implemented ML algorithm.

Streptococcus suis-Associated Meningitis in a Southern Region of Vietnam.

Streptococcus suis is the most common and severe cause of meningitis in Vietnam, but the recent data about epidemiological characteristics and sequelae are still inadequate. We performed a retrospective study to describe the epidemiology, clinical characteristics, and outcomes of patients with S. suis-associated meningitis. A retrospective study was carried out by searching records from the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, between January 2016 and January 2020. All data concerning epidemiological, clinical, and subclinical characteristics and treatment results were collected and analyzed. Over the study period, 153 cases were included in this study, with 95 cases occurring in the 2016-2017 period. The median age of all patients was 52 years (range, 29-90 years), and 70.6% of patients were male. Fifty-two patients (34%) were farmers, and the Mekong Delta was the region with the highest number of cases (60.1%). The most frequent manifestation of infection was fever (151/153, 98.7%), followed by hearing loss (64/153, 41.8%), and one patient (0.7%) died. All isolates remained susceptible to ceftriaxone, penicillin, vancomycin, and levofloxacin, whereas 99.2% of isolates were resistant to tetracycline. Occupational exposure to pigs and the consumption of contaminated food have been identified as primary risk factors associated with this zoonosis, and our study found no significant changes in epidemiological factors compared with past data. The Mekong Delta continues to be the most affected region for S. suis meningitis in southern Vietnam, with S. suis serotype 2 remaining the most relevant agent.

The Role of Nutrition in the Nursing Management of Pressure Ulcers in Adult Community Settings: A Systematic Review Protocol.

The aging population drives a growing demand for care, particularly in Europe. It is estimated that approximately 1.5-2 million individuals have a chronic wound. Among these, pressure ulcers (PUs) are one of the most prevalent complications in vulnerable individuals. Malnutrition is a primary risk factor, yet it can be mitigated through proper nutrition and adequate community support. The community nurse plays a crucial role in managing chronic conditions and nutrition through constant and professional monitoring. This article presents a comprehensive systematic review (SR) protocol to examine the role of community nursing of nutritional intervention of frail population with wound care. A SR will be conducted according to international standards and reported following the PRISMA Guidelines for SRs. The search will be conducted in PubMed/Medline, Scopus, Embase, and CINAHL, supplemented by grey literature sources. The methodological quality and risk of bias will be assessed using the Critical Appraisal Skills Programme (CASP) framework. The protocol has been registered in the Open Science Framework (OSF). It is anticipated that the findings of this SR will provide new evidence on the relationships between nutritional nursing interventions and wound care management primarily in the community setting.

Early diagnosis of stroke risk factors in high school students in Makassar, South Sulawesi, Indonesia

The number of stroke patients in Indonesia is ranked as the first country to experience the most strokes in all of Asia. The prevalence of stroke in Indonesia reaches 8.3 out of 1000 population. This prevalence rate increases with increasing age. Indonesian national data shows that stroke is the highest cause of death, at 15.4%, with approximately 750,000 strokes per year in Indonesia and 200,000 recurrent strokes. People who are physically inactive (those who exercise less than three times per week, each for 30 minutes) have an almost 50% increased risk of stroke compared to those who are active. Physical inactivity can lead to weight problems and increased blood pressure and is associated with diabetes, all of which are important risk factors for stroke. Inactivity also contributes to the onset of early atherosclerosis and other cardiovascular diseases, such as heart attacks. This study is an analytical observational study with a cross sectional design to see and observe the risk factors for stroke that exist in school children in Makassar city. Data processing was carried out using computer application programs and SPSS version 22.0 with data analysis methods using the Chi Square Test with the Yate's Correlation formula in SPSS called Continuity Correction and Risk. The number of respondents studied was 896 people. Hypertension is a major risk factor for health problems in society, especially in socioeconomic transition. Hypertension is a primary risk factor for the onset of heart disease and stroke. Doing physical activity will prevent us from various diseases, by doing adequate physical activity we can suppress the increase in blood sugar levels, cholesterol levels, and avoid obesity and strengthen the heart. All of which are risk factors for stroke. So thus by doing adequate physical activity we can avoid stroke. There is a relationship between gender, obesity, hypertension, family history of disease, stress, physical activity, risky diet and smoking on stroke risk factors and there is no relationship between age and knowledge with stroke risk factors.

Gene therapy for fat-1 prevents obesity-induced metabolic dysfunction, cellular senescence, and osteoarthritis

Obesity is one of the primary risk factors for osteoarthritis (OA), acting through cross talk among altered biomechanics, metabolism, adipokines, and dietary free fatty acid (FA) composition. Obesity and aging have been linked to cellular senescence in various tissues, resulting in increased local and systemic inflammation and immune dysfunction. We hypothesized that obesity and joint injury lead to cellular senescence that is typically associated with increased OA severity or with aging and that the ratio of omega-6 (ω-6) to omega-3 (ω-3) FAs regulates these pathologic effects. Mice were placed on an ω-6-rich high-fat diet or a lean control diet and underwent destabilization of the medial meniscus to induce OA. Obesity and joint injury significantly increased cellular senescence in subcutaneous and visceral fat as well as joint tissues such as synovium and cartilage. Using adeno-associated virus (AAV) gene therapy for fat-1, a fatty acid desaturase that converts ω-6 to ω-3 FAs, decreasing the serum ω-6:ω-3 FA ratio had a strong senomorphic and therapeutic effect, mitigating metabolic dysfunction, cellular senescence, and joint degeneration. In vitro coculture of bone marrow-derived macrophages and chondrocytes from control and AAV8-fat1-treated mice were used to examine the roles of various FA mediators in regulating chondrocyte senescence. Our results suggest that obesity and joint injury result in a premature "aging" of the joint as measured by senescence markers, and these changes can be ameliorated by altering FA composition using fat-1 gene therapy. These findings support the potential for fat-1 gene therapy to treat obesity- and/or injury-induced OA clinically.

Surgical Site Infections: Risk Factors for Multiple Antibiotic Resistance in Abdominal Surgery

INTRODUCTION. Multidrug-resistant (MDR) organisms are increasingly becoming a major surgical site infection (SSI); however, the clinical outcomes and risk factors associated with resistant pathogens in general surgery remain poorly understood.THE AIM of the present research is to study the risk factors and consequences of infections in patients with SSI caused by antibiotic resistant pathogens with MDR.MATERIAL AND METHODS. A single-center, retrospective case-control study was carried out. The results of the examination and treatment of 50 patients with SSI + MDR, who made up the main group, and two control groups — non-MDR SSI and no SSI, 50 patients each, were analyzed. A total of 38 risk factors were used: pre- and surgical criteria, clinical, biochemical, instrumental data, postoperative complications and treatment features. The microbial landscape was studied in SSI+MDR. Single- and multivariate analysis was carried out, binary and multinomial logistic regression was performed. P-values <0.05 were considered significant at 95% CI.RESULTS. Significant risk factors were as follows: previous hospitalization, previous antibiotic therapy, terms of preoperative stay of the patient in the department, emergency surgery, class of surgery, decrease in the ratio of ALP/ ALPI, MEI and EMFC (p<0.01); elevated ASA score, obesity, low levels of plasma proteins and albumin, (p<0.05). Among the pathogens, there were more gram-negative enterobacteria (61%) than gram-positive ones (30.5%). Escherichia coli (36.3%) was the most commonly found bacterium, followed by Enterococcus faecium (9.09%), Morganella morganii (7.58%), Staphylococcus aureus (6%), and Pseudomonas aeruginosa (6%). In SSSI, Staphylococcus spp. prevailed. (>80%); in DSSI — Echerichia, Acinetobacter (>70%); and in OSSSI — Enterobacter spp., Acinetobacter and Citrobacter (>90%). SSI+MDR were characterized by serious surgical complications (Clavien Dindo Classification grade 3–5), wound dehiscences and OSSSI, reoperations (p<0.05).CONCLUSION. 1. The primary risk factors for multiple antibiotic resistance were as follows: previous hospitalization, previous antibiotic therapy, the duration of the patient’s preoperative stay in the department, emergency surgery, surgery class, reduced ALP/ALPI ratio, MEI and EMFC. In addition to the above, the following were also of great importance: increased ASA score, obesity, low plasma proteins, albumin.2. When identifying risk factors for multiple antibiotic resistance in surgical patients, the development of severe postoperative complications, sepsis and multiple organ failure can be predicted.3. Perioperative medical and preventive measures require a multidisciplinary approach involving the microbiologist, pharmacologist, immunologist, nutrition specialist, and other expert consultants.

MODELING HYPERTENSION DISEASE RISK IN INDONESIA USING MULTIVARIATE ADAPTIVE REGRESSION SPLINE AND BINARY LOGISTIC REGRESSION APPROACHES

In the pursuit of the Sustainable Development Goals (SDGs), health-related challenges, especially hypertension, remain a significant global issue. The third goal of the SDGs aims to improve the quality of life and well-being of all individuals, but hypertension is a serious problem that can hinder these goals. Often referred to as the "silent killer" by the World Health Organization (WHO), hypertension is exacerbated by low awareness. Globally, more than 1.28 billion adults suffer from hypertension, with most cases in lower to middle-income countries, including Indonesia. Indonesia has an alarming rate of hypertension incidence, ranking fifth highest in the world. Riset Kesehatan Dasar (Riskesdas) 2023 and the Indonesia Family Life Survey (IFLS) are critical for understanding hypertension risk factors in Indonesia. The IFLS data, obtained from www.rand.org, includes observations from October 2014 to April 2015, totalling 85 observations. Despite being over 10 years old, this dataset was selected because it remains the most recent comprehensive data available from RAND, representing 83% of the Indonesian population. The IFLS is conducted every 7-8 years, with the next wave of data expected soon. Most studies on hypertension globally and in Indonesia use parametric regression methods. However, a research gap exists as no studies have used Multivariate Adaptive Regression Splines (MARS) on IFLS data to analyze hypertension risk factors. This study addresses this gap by comparing binary logit regression and MARS. The analysis shows the Apparent Error Rate (APPER) for MARS is 84.706%, while for binary logistic regression it is 80%, indicating MARS is better at classifying hypertension data in Indonesia. Using MARS offers a novel approach to understanding hypertension risk factors in Indonesia. Despite the data's age, it remains relevant as primary causes and risk factors for hypertension have not changed, making the findings valuable for current health policy and strategies.

Correlation Between Quantitative Cage Pressure Measurements and Surgeons' Qualitative Tactile Assessments During Extraction in Lumbar Lateral Interbody Fusion: A Cadaveric Study.

A cadaveric study. Measuring the pressure exerted on lumbar lateral interbody fusion (LLIF) cages and examining its correlation with qualitative assessment of tactile feedback related to pullout strength during cage extraction to determine the optimal cage height. No data exists on the relationship between the surgeon's tactile feedback related to pullout strength during the LLIF cage extraction and the cage pressures measured during surgery. We used four cadavers to insert the original stress-measuring cages at the L2/3 to L4/5 levels (12 intervertebral spaces) using the oblique lumbar lateral approach. The intervertebral disc height (IDH) was measured before cage insertion. These stainless-steel stress-measuring cages were designed with the same shape as standard cages and included a built-in load cell to measure the stress applied. The cage heights were set at 8, 10, and 12 mm and they were inserted sequentially from 8mm, with stress measurements taken at each step. Four spine surgeons qualitatively evaluated the extraction strength using three rating categories ("loose," "appropriate," and "hard to extract"). After cage removal, endplate damage (ED) and anterior longitudinal ligament injury (ALLI) were checked. The anterior part of the vertebral body was dissected to expose the ALL and it is checked for obvious injuries. Additionally, a surgical probe is used to check for ED and ALLI. The measured cage pressures were 45, 120, and 191 N for the "loose," "appropriate," and "hard to extract" ratings, respectively (P < 0.001). ED was observed in five intervertebral spaces, whereas no ALLI was noted. The average maximum pressure when ED occurred was 127 N. The primary risk factor for ED was identified as the difference between the height of the inserted cage and IDH, with a cut-off value of 4.5mm. The appropriate extraction strength corresponded to a cage pressure of 120 N. A cage pressure ≥127 N posed a risk for ED. ED incidence was high when the difference between the IDH and the height of the inserted cage exceeded 4.5mm. Level Three.

Investigating the Interrelationship between the Desire for a Cohesive Community and Opioid Abuse: A Neuropsychological Study of Demon Copperhead

Abstract Foregrounding the increasing global crisis of opioids as the “leading cause of deaths in fatal overdoses,” the World Drug Report 2023, published by the United Nations Office on Drugs and Crime (UNODC), mentioned that in 2021 more than 80,000 people died due to opioid overdose in the United States of America. The Centers for Disease Control and Prevention (CDC), the national public health protection agency in the United States, has reported that “the predicted number of drug overdose deaths showed an increase of 0.5% from the 12 months ending in December 2021 to the 12 months ending in December 2022, from 109,179 to 179,680” (“Provisional Data”). Although the trajectory of opioid use disorders (OUDs) has affected different sociodemographic groups in the country since its first wave in the 1990s, teenagers in poverty-stricken rural areas are more vulnerable to such addiction (Keyes et al.). Poor parental guidance, impoverishment, troubled childhoods, detrimental familial structure, scarce opportunities, and accessibility to opioids are often considered to be the primary risk factors for unprivileged teenagers to develop a psychic reliance on opioids for engendering a perpetual sense of contentment. According to the incentive sensitization theory, the persistent desire to transcend physical and psychical limitations for a sense of relief, triggered by chronic drug misuse, often evokes a sense of “wanting” or incentive salience, a compulsive inclination towards drug-associated stimuli (Berridge and Robinson, “Drug Addiction” 22). This intense desire of “wanting” often generates a perpetual sensitization of the mesolimbic systems in the brain which is also activated by mental representations of drug-associated cues (Robinson and Berridge 3139). Focusing on drug-induced changes in the brain such as hypersensitization and neuroadaptation, this study analyzes Barbara Kingsolver’s Demon Copperhead, a modern reimagining of David Copperfield by Charles Dickens. The selected text addresses primarily some pertinent socio-political crises, such as the poor foster care system, poverty, and the engrossing opioid endemic in Southern Appalachia. However, this study attempts to analyze the precarious state of some characters, who become addicted to opioids seeking recognition from peer groups and perpetual psychic stability, in the selected text from a neuropsychological perspective.