Risk Factors In Patients Research Articles

Association Between Low Serum HDL Levels and Severity of Coronary Artery Disease Among Patients with Non-ST Elevated Myocardial Infarction

Introduction: Coronary artery disease is one of the leading causes of non-communicable diseases related deaths worldwide. Decreased serum high-density lipoprotein level are associated with an increased severity of coronary artery disease. Present study aims to evaluate the association between this low HDL level and the severity of coronary artery disease assessed by SYNTAX Score in patients with non-ST elevation Myocardial infarction. Materials & Methods: This was a cross sectional study conducted in the Department of Cardiology at National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, from May 2020 to April 2021, on 170 admitted adult patients of non-ST elevated myocardial infarction undergoing coronary angiogram. Study population was divided in two groups; Group-I: Respondents with HDL level ≥ 40 mg/dl, Group-II: Respondents with HDL level < 40 mg/dl. Transthoracic echocardiography was done before coronary angiography. All coronary lesions with diameter stenosis > 50% in vessels > 1.5 mm was scored, using the SYNTAX algorithm. A low score was defined as ≤ 22, an intermediate score as 23 to 32, and a high score as ≥ 33. To determine statistical significance, Chi-square test and independent sample t-test were considered according to applicability. P value of < 0.05 was considered statistically significant. Results: Highest proportion of respondents were from age group 51 – 60 years, 48.2% and 43.5% for group-I and group-II respectively. Study population was male predominant, 88.2% among patients from group-I and 83.5% among patients from group-II. Smoking was the most prevalent risk factor for group-I patients at 58.8%. Hypertension was the most prevalent risk factor for group-II patients at 45.9%. Mean total cholesterol, low-density lipoprotein and high-density lipoprotein were higher among patients from group-I than group-II and these differences were statistically significant (p < 0.05). Mean triglycerides was higher among patients from group-II than group-I and this difference was statistically significant (p < 0.05). Triple vessel was more prevalent (36.5% vs 22.4%) among patients from group-II than group-I and this difference was statistically significant (p < 0.05). Mean SYNTAX score (SS) was higher among patients from group-II than group-I, 17.4 ± 8.6 and 11.5 ± 8.4 respectively, and this difference was statistically significant (p < 0.05). There was strong negative correlation between HDL level and Syntax score (r = - 0.299, p < 0.05). Conclusion: Present study demonstrated significant negative correlation between low serum HDL levels with severity of coronary artery disease among patients with non-ST elevated myocardial infarction. Serum HDL levels can be used as a predictor for the severity of coronary artery disease among such patients. Bangladesh Heart Journal 2024; 39(2): 138-143

Predictors of Ischemic Stroke After Acute Coronary Syndrome: A Retrospective Analysis.

Background Ischemic stroke (IS) is a fatal complication of acute coronary syndrome (ACS). Factors that speed up IS development after ACS are understudied, especially in developing countries like Pakistan. Thus, this study was designed to identify the potential risk factors of IS in patients with a preceding episode of ACS. Methodology This retrospective study was performed on 208 patients whose ACS and its consequent complications such as IS were managed in the cardiac and neurology units of Benazir Bhutto Hospital, Rawalpindi, from January 2022 to March 2023. Patients were enrolled via consecutive sampling and pre-defined inclusion and exclusion criteria. Before data collection, informed consent and ethical approval were obtained. Data were retrieved from the medical records of the patients. A self-structured proforma was applied to collect data. SPSS version 25 (IBM Corp., Armonk, NY, USA) was used for data analysis. The study variables between patients with and without IS were compared using descriptive and inferential statistics. The association between IS and its possible risk factors in patients who had previously experienced ACS was determined using multivariate logistic regression. Results Of the 208 enrolled patients, 24 (11.54%) had IS following ACS. Sedentary lifestyle (odds ratio (OR) = 3.099, 95% confidence interval (CI) = 1.025~4.219, p = 0.009), hypertension (OR = 3.060, 95% CI = 1.798~4.876, p = 0.002), diabetes mellitus (OR = 2.899, 95% CI = 1.126~4.112, p = 0.009), dyslipidemia (OR = 2.907, 95% CI = 1.332~4.254, p = 0.007), history of smoking (OR = 2.760, 95% CI = 1.234~4.122, p = 0.018), and non-adherence to ACS medication (OR = 2.966, 95% CI = 1.300~4.266, p = 0.030), were the risk factors of IS among patients with preceding ACS. Conclusions In the study population, the incidence of IS following ACS was significant. Sedentary lifestyle, hypertension, diabetes mellitus, dyslipidemia, smoking history, and non-compliance with ACS therapy all played a significant role in the development of IS in patients with prior ACS. Proper management of ACS and associated risk factors could lead to the prevention of serious complications such as IS.

Chronic hepatitis B and metabolic dysfunction-associated steatotic liver disease: Metabolic risk factors are key drivers of hepatocellular carcinoma

ObjectiveChronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) are the leading causes of hepatocellular carcinoma (HCC). This study aimed to explore the impact of baseline MASLD on the risk of HCC development in patients with CHB receiving antiviral treatment. MethodsWe consecutively recruited 535 patients with CHB who initiated antiviral treatment between January 2007 and January 2023. The exclusion criteria included coexisting HDV, HCV, or HIV infection; other chronic liver diseases; extrahepatic malignancies; prior HCC; and HCC development within one year. A baseline liver biopsy was performed in 467 patients (87 %). MASLD was defined as hepatic steatosis diagnosed histologically or by imaging, combined with one cardiometabolic risk factor. The cumulative incidence of HCC and its associated factors was analyzed in patients with CHB, with and without MASLD. ResultsIn total, 535 treatment-naïve patients with CHB were included, with a median follow-up of 6.05 years. MASLD was not associated with an increased incidence of HCC in patients with CHB (HR: 1.17; 95 % CI: 0.77–1.79; p = 0.466). The cumulative incidence of HCC increased with the number of fulfilled cardiometabolic criteria (0–2 criteria vs. ≥ 3 criteria) (HR: 3.93; 95 % CI: 1.89–8.19; p < 0.001).Age (HR: 1.03, 95 % CI 1.01–1.06, p = 0.010), male sex (HR: 3.17; 95 % CI 1.34–7.53, p = 0.009), diabetes (HR: 2.81; 95 % CI 1.54–5.12, p < 0.001), and cirrhosis (HR:3.03; 95 % CI 1.57–5.5.86, p < 0.001) were independently associated with HCC development. ConclusionsIt was not MASLD, but rather the presence of multiple cardiometabolic risk factors in patients with CHB that was associated with the risk of HCC in those receiving antiviral treatment. Furthermore, older age, male sex, diabetes, and cirrhosis aggravated the risk of HCC in patients with CHB.

Importance of Dyslipidemias in Very Premature Coronary Artery Disease in India: A Registry-based Study.

Premature coronary artery disease (CAD) is an important cause of death in India. To identify risk factors in patients with premature CAD, we performed a registry-based study. Consecutive patients admitted for percutaneous coronary intervention (PCI) from October 2020 to June 2021 were recruited. The patients were classified into three groups-group I (very premature CAD < 40 years), group II (premature CAD 40-59 years), and group III (nonpremature CAD > 60 years). Major risk factors were determined, and intergroup comparison was performed. A total of 627 patients were enrolled (men 541, women 86). Group I had 79 (12.4%), group II had 420 (66.9%), and group III had 128 (20.4%) patients. The prevalence of risk factors in groups I, II, and III, respectively, were-CAD family history in 45.1, 41.1, and 26.6% (p = 0.005), current smoking/tobacco use in 29.1, 21.0, and 10.2% (p = 0.002), hypertension in 31.6, 43.6, and 59.4% (p < 0.001), and diabetes in 22.8, 34.3, and 46.1% (p < 0.001). High total cholesterol (>170 mg/dL) was present in 50.0, 38.0, and 29.9% (p = 0.005), nonhigh-density lipoprotein (HDL) cholesterol (>100 mg/dL) in 76.9, 64.4, and 54.5% (p = 0.001), low-density lipoprotein (LDL) cholesterol (>70 mg/dL) in 85.9, 76.8, and 76.4% (p = 0.167), triglycerides (>150 mg/dL) in 56.4, 45.3, and 33.1% (p = 0.001), and very low density lipoprotein (VLDL) cholesterol (>30 mg/dL) in 24.4, 10.4, and 9.4% (p = 0.005). Age- and sex-adjusted odds ratios (OR) and 95% confidence intervals (CI) for smoking/tobacco use in groups I and II compared to group III, respectively, were 3.17 (1.60-6.27) and 2.59 (1.51-4.46); high total cholesterol 2.39 (1.29-4.13) and 1.42 (0.92-2.17); high non-HDL cholesterol 2.70 (1.45-5.03) and 1.48 (0.99-2.20); and high triglycerides 2.57 (1.44-4.58) and 1.64 (1.08-2.49). Important coronary risk factors in very premature and premature CAD in India are a family history of CAD, any tobacco use, and dyslipidemias (raised total, LDL, non-HDL, and VLDL cholesterol and triglycerides).

Risk factors for patients with tracheal stenosis: a systematic review and meta-analysis.

To systematically evaluate potential risk factors for tracheal stenosis and to provide a reference for the prevention and management of patients with this condition. Databases were searched to identify studies of the risk factors for tracheal stenosis, from their inception to October 2023, then a meta-analysis was performed. The study was registered with PROSPERO under the registration number CRD42023428906. Ten studies of a total of 2525 patients were included. The meta-analysis showed that tracheotomy, diabetes, the duration of intubation, the duration of mechanical ventilation, respiratory tract infection, a high incision, and a ratio of intratracheal tube cuff diameter (C)/transverse diameter at the level of the clavicle (T) >150% were risk factors for the development of tracheal stenosis. Measures such as shortening the duration of mechanical ventilation and intubation, reducing and avoiding tracheotomy after prolonged intubation, early tracheotomy in patients with obesity who require prolonged mechanical ventilation, appropriate choices of incision location and catheter, the maintenance of appropriate C/T, the prevention of respiratory infection, and the control of diabetes mellitus should limit the risk of tracheal stenosis.

Patient and implant-related risk factors for implant failure of one-stage lateral sinus floor elevation: A 2- to 10-year retrospective study.

This retrospective study aimed to evaluate the early and late implant failure rates of one-stage lateral sinus floor elevation (LSFE)and to identify the patient and implant-related risk factors associated with these failures. All patients treated with one-stage LSFE from January 2014 to December 2021 were evaluated for inclusion. A total of 618 patients with 936 implants met the inclusion criteria. Clinical and radiographic information about patient and implants was collected. Univariate and multivariate Cox proportional hazards frailty regression models were performed to identify risk factors for early and late implant failure. The cumulative implant survival rate was 95.62% (95% CI 93.90%-97.68%), with 16 early implant failures and 25 late implant failures. The Cox analysis indicated that ≤3 mm residual bone height (RBH) was associated with a higher early failure rate. For late implant failure, smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors. Narrow sinus ostium, long infundibulum, and flat thickening of Schneiderian membrane might be non-independent risk factors for late implant failure. No significance was found in other variables, including age, periodontitis history, implant characteristics (position, diameter, length, protrusion length, marginal bone loss), surgeon experience, healing time, opposing dentition, and prosthesis. One-stage LSFE is a predictable treatment for patients with atrophic maxilla. ≤3 mm RBH increased the risk of early implant failure, while smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors for late implant failure.

Prediction of transfusion risk after total knee arthroplasty: use of a machine learning algorithm

IntroductionTotal knee arthroplasty (TKA) carries a significant hemorrhagic risk, with a non-negligible rate of postoperative transfusions. The blood-sparing strategy has evolved to reduce blood loss after TKA by identifying the patient's risk factors preoperatively. In practice, a blood count is often performed postoperatively but rarely altering the patient's subsequent management. This study aimed to identify the preoperative variables associated with hemorrhagic risk, enabling the creation of a machine-learning model predictive of transfusion risk after total knee arthroplasty and the need for a complete blood count. HypothesisBased on preoperative data, a powerful machine learning predictive model can be constructed to estimate the risk of transfusion after total knee arthroplasty. Material and methodsThis retrospective single-centre study included 774 total knee arthroplasties (TKA) operated between January 2020 and March 2023. Twenty-five preoperative variables were integrated into the machine learning model and filtered by a recursive feature elimination algorithm. The most predictive variables were selected and used to construct a gradient-boosting machine algorithm to define the overall postoperative transfusion risk model. Two groups were formed of patients transfused and not transfused after TKA. Odds ratios were determined, and the area under the curve evaluated the model's performance. ResultsOf the 774 TKA surgery patients, 100 were transfused postoperatively (12.9%). The machine learning predictive model included five variables: age, body mass index, tranexamic acid administration, preoperative hemoglobin level, and platelet count. The overall performance was good with an area under the curve of 0.97 [95% CI 0.921 - 1], sensitivity of 94.4% [95% CI 91.2 - 97.6], and specificity of 85.4% [95% CI 80.6 - 90.2]. The tool developed to assess the risk of blood transfusion after TKA is available at https://arthrorisk.com. ConclusionThe risk of postoperative transfusion after total knee arthroplasty can be predicted by a model that identifies patients at low, moderate, or high risk based on five preoperative variables. This machine learning tool is available on a web platform that is accessible to all, easy to use, and has a high prediction performance. The model aims to limit the need for routine check-ups, depending on the risk presented by the patient. Level of evidenceII; diagnostic study

Correlation of MRI brain findings with executive dysfunction and vascular risk factors in elderly patients with cognitive impairment

Objectives: The primary objective of the present study was to investigate the relationship between gray matter changes, white matter changes and executive function among older Indian adults with vascular risk factors. Methods: This hospital based observational analytical study was conducted in a tertiary care health facility located in the north-western region of India for a duration of one year between October 2021 and September 2022 among patients between 60 and 90 years of age presenting to the outpatient sections of Department of Neurology with executive dysfunction. We assessed the vascular risk factors, evaluated executive function, and then the patients underwent brain MRI on a 1.5T MRI scanner. Results: The proportion of patients with dorsolateral atrophy was significantly higher (p&lt;0.001) among patients with executive dysfunction (83.10%). Hypertension significantly contributed to predict the atrophy of temporal lobe and parietal lobe (p&lt;0.05). Hyperintensity of periventricular area was found significantly higher among executive dysfunction patients (85.92%). Elevated HbA1c levels and smoking significantly contributed to predict the white matter hyperintensity of basal ganglia (p&lt;0.05). The present study also found that hypertension and alcohol use significantly predicted white matter hyperintensity in the frontal area (p&lt;0.05). Conclusion: Specific white matter hyperintensity loci and grey matter volume loss were closely associated with executive dysfunction in elderly. It is understood that modifying and treating vascular risk factors can prevent progression of executive dysfunction and these findings emphasize the complex nature of the relationship between vascular risk factors, cognitive impairment, and brain structure.

P.364: Increased psychosocial risk factors in pediatric liver transplant patients transplanted for fulminant liver failure.

P.364: Increased psychosocial risk factors in pediatric liver transplant patients transplanted for fulminant liver failure.

Clinical Characteristics and Prognosis of Early-Onset Hepatocellular Carcinoma: A Retrospective Cohort Study Based on Population Data.

The incidence of young patients diagnosed with hepatocellular carcinoma (HCC) is projected to rise. This study aimed to investigate the distinctive characteristics of adolescent and young adult (AYA) patients with HCC and identify the risk factors that impact their survival. This study included 1005 AYA patients and 55,435 older adult (OA) patients with HCC, using data from the Surveillance, Epidemiology, and End Results database. Propensity score matching was used to adjust for baseline differences in patient characteristics. The Kaplan-Meier curve and log-rank test are utilized to compare the overall survival between the two groups. The Cox proportional hazards regression model was used for subgroup analysis to identify risk factors for overall survival in AYA patients. AYA patients exhibited a higher proportion of advanced clinical stage (49.15% vs 37.57%, P < 0.001) and fibrolamellar hepatocellular carcinoma (14.13% vs 0.09%, P < 0.001), but a lower incidence of alpha-fetoprotein positivity (32.04% vs 45.32%, P < 0.001) and cirrhosis (8.86% vs 18.32%, P < 0.001). The subgroup analysis results indicated that AYA patients had a more favorable prognosis than OA patients in most subgroups. Undifferentiated carcinoma emerged as the predominant risk factor for AYA patients (Hazard Ratio [HR], 6.08 [2.53-14.62]), whereas partial hepatectomy was determined to be the most advantageous factor (HR, 0.29 [0.23-0.37]). AYA patients with HCC exhibit more aggressive characteristics but demonstrate a better prognosis compared to the OA group, necessitating personalized surveillance and treatment.

Mortality risk factors for adult trauma patients treated with halo brace for cervical spine fracture

Introduction and objectivesHalo braces treat upper cervical spine fractures and serve as the most rigid form of external immobilization. Recently, halo braces have lost favor due to known complications and advances in surgical stabilization. This study aims to determine the contemporary incidence for use of halo braces and identify risk factors associated with mortality in trauma patients undergoing halo brace for cervical spine fractures. Materials and methodsThe 2017–2019 Trauma Quality Improvement Program Database was queried for patients ≥18 years-old with a cervical spine fracture undergoing halo brace. Patients sustaining penetrating trauma and severe torso injuries (abbreviated injury scale >3 for the abdomen or thorax) were excluded. Bivariate and multivariable logistic regression analyses were performed. ResultsFrom 144,434 patients with a cervical spine fracture, 272 (0.2%) underwent halo brace and 14 (5%) of these died. Those who died were older (73.5 vs. 53 years-old, p = 0.011) and had higher rates of hypertension (78.6% vs 33.1%, p < 0.001) and chronic kidney disease (14.3% vs. 1.2%, p < 0.001). Glasgow Coma Scale ≤8 (46.2% vs. 8.2%, p < 0.001) and cervical spinal cord injury (71.4% vs. 21.3%, p < 0.001) were more common in patients who died. In addition, those who died more often sustained respiratory complications (7.1% vs. 0.4%, p = 0.004) and sepsis (7.1% vs. 0.4%, p = 0.004). On multivariable logistic regression analysis, only Glasgow Coma Scale ≤8 (OR 19.77, 3.04–128.45, p = 0.002) was associated with increased mortality. ConclusionsOnly 5% of cervical spine fracture patients undergoing halo brace died. Respiratory complications and sepsis were more common in those who died. On multivariable analysis only Glasgow Coma Scale ≤8 remained an independent associated risk factor for mortality.

The Effect of Vitamin D Deficiency Treatment on Lipid Profile and C-reactive Protein in Patients with Ischemic Heart Disease: Double-blind Randomized Clinical Trial.

Atherosclerosis is the main process in coronary artery stenosis, which is exacerbated by vitamin D deficiency. This study aims to investigate the relationship between vitamin D deficiency treatment, lipid profile, and C-reactive protein (CRP) in ischemic heart disease (IHD). This is a double-blind, randomized clinical trial involving 44 IHD patients with hypovitaminosis, aged 40-65 years, who were referred to Chamran Specialty Heart Hospital, Isfahan, Iran. Participants were randomly divided into two groups: The intervention group received weekly doses of 50,000 units of vitamin D3 for 5 weeks, while the placebo group received a control substance. CRP and serum lipid profiles, including total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), were assessed before and after the intervention. Trial registration number: IRCT20200905048622N1. The mean age of the IHD patients was 57.84 ± 9.66 years, and among all 44 patients, 40 patients (91%) were male In the intervention group receiving vitamin D3, serum levels of HDL (P = 0.048) and 25-hydroxyvitamin D (25(OH)D) (P < 0.001) increased, while serum level of TG (P = 0.008) decreased significantly. In the placebo group, HDL level (P = 0.007) was increased and alanine transaminase (ALT) (P = 0.05) was significantly decreased. The results showed that the correlation between serum 25(OH)D treatment and CRP level was not significant. Vitamin D supplementation in IHD patients led to notable improvements in lipid profiles, including increased HDL-C levels and decreased TG levels. These findings hold potential clinical implications for healthcare professionals in managing risk factors in IHD patients.

Effect of depression treatment on health behaviors and cardiovascular risk factors in primary care patients with depression and elevated cardiovascular risk: data from the eIMPACT trial.

Depression is an independent risk factor for cardiovascular disease (CVD), but it is unknown if successful depression treatment reduces CVD risk. Using eIMPACT trial data, we examined the effect of modernized collaborative care for depression on indicators of CVD risk. A total of 216 primary care patients with depression and elevated CVD risk were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed over 12 months. Incident CVD events were tracked over four years using a statewide health information exchange. The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). The likelihood of an incident CVD event did not differ between the intervention (13/107, 12.1%) and usual care (9/109, 8.3%) groups (p = 0.39). Successful depression treatment alone is not sufficient to lower the heightened CVD risk of people with depression. Alternative approaches are needed. ClinicalTrials.gov Identifier: NCT02458690.

Socioeconomic Risk Factors in Neurocysticercosis.

NCC is responsible for around 30% of active epilepsy in endemic countries such as India. Knowing socioeconomic factors associated with NCC can help in decreasing the incidence of this disease. We intend to study socioeconomic risk factors in NCC patients and how these factors are different from patients without NCC. Consecutive 100 adult patients of NCC presenting to neurology services with probable NCC (symptomatic or asymptomatic) along with age- and sex-matched controls were interviewed with preset proforma and then data was compiled and analyzed statistically. The NCC group had significantly more people with lesser education level (53%) as compared to control group (42%) (P = 0.002), lower socioeconomic status, poor hand hygiene practices, and use of contaminated vegetables (40% NCC group, 1% control group, P < 0.0001). Open defecation practice was also more among NCC cases. Lower education and socioeconomic status, poor hand hygiene, and eating undercooked contaminated vegetables are modifiable factors that are more prevalent in patients of NCC compared to controls. Social interventions aiming at these will help to reduce NCC patients in our country.

Serum LOXL2 is Elevated and an Independent Biomarker in Patients with Coronary Artery Disease.

Arterial stiffness is associated with accelerated progression of atherosclerosis and plaque rupture. Lysyl oxidase-like 2 (LOXL2) plays a vital role in inflammatory responses, matrix deposition and arterial stiffness. This study assessed the correlation between the serum LOXL2 concentration and disease severity, inflammation, and endothelial dysfunction of coronary artery disease (CAD). The study included 143 CAD patients and 150 non-CAD patients who underwent coronary angiography. Medical records, demographic and clinical baseline parameters were collected. Serum LOXL2 levels were measured using an ELISA kit. CAD patients had higher serum LOXL2 levels than non-CAD patients, and LOXL2 levels were associated with severity of coronary lesions. Serum LOXL2 level was positively correlated with low-density lipoprotein cholesterol (LDL-C) (r=0.161, P=0.054), systolic blood pressure (SBP) (r=0.175, P=0.036), high-sensitivity C-reactive protein (hs-CRP) (r=0.177, P=0.035), intima-media thickness (IMT) (r=0.190, P=0.023), and brachial-ankle pulse wave velocity (baPWV) (r=0.203, P=0.015), while negatively associated with high-density lipoprotein cholesterol (HDL-C) (r=-0.191, P=0.023) and flow-mediated dilation (FMD) (r=-0.183, P=0.028) in CAD patients. Multivariate logistic regression showed that LOXL2 is independently correlated with LDL-C (OR=3.380; 95% CI=1.258-9.082; P=0.016), hs-CRP (OR=10.988; 95% CI=1.962-61.532; P=0.006), TC (OR=2.229; 95% CI=1.005-4.944; P=0.049), IMT (OR=72.719; 95% CI=2.313-2286.008; P=0.015), and baPWV (OR=1.002; 95% CI=1.001-1.004; P=0.005) in CAD patients. The receiver operating characteristic (ROC) curve showed that the best cut-off for CAD as serum LOXL2 is 275.35 pg/mL, with sensitivity and specificity of 77.6% and 84%, respectively. Our data demonstrated that LOXL2 could be a potential biomarker and independent risk factor for CAD patients.

Patient demographic characteristics and risk factors associated with sun protection behaviours in specialist melanoma clinics.

We investigated the association between sun protection behaviours and demographic and melanoma risk characteristics of patients attending Australian melanoma specialist clinics. This may assist in targeting and tailoring melanoma prevention patient education for people at high-risk and specific population subgroups. A cross-sectional analysis of questionnaire data collected from participants attending the dermatology clinics at two major melanoma centres in Sydney, Australia between February 2021 and September 2023. The primary outcome was Sun Protection Habits (SPH) index (a summary score measured as habitual past month use of sunscreen, hats, sunglasses, a shirt with sleeves that covers the shoulders, limiting midday sun exposure and seeking shade, using a Likert scale). The primary analysis considered the SPH index and its component items scored as continuous. Data from 883 people were analysed. Factors associated with less frequent sun protection behaviours overall included male gender, no personal history of melanoma, lower perceived risk, lower calculated 10-year risk of developing melanoma, and no private health insurance. People aged >61 years reported lower use of sunscreen but higher use of hats and sleeved-shirts compared with people in the younger age group. There was no difference in overall sun protection behaviours according to family history of melanoma, country of birth or by lifetime melanoma risk among people without a personal history of melanoma. These findings highlight the potential for targeting high-risk individuals with less frequent use of sun protection for patient education, public health messaging and ultimately improving sun protection behaviours.

Trends and predictors of laparoscopic compared with open emergent inguinal hernia repair

BackgroundLaparoscopic emergent inguinal hernia repair remains controversial despite studies suggesting it is safe and feasible. Variables associated with laparoscopic compared with open emergent inguinal hernia repair are currently not well described. This study aims to investigate patient characteristics and risk factors associated with laparoscopic emergent inguinal hernia repair. MethodsThe American College of Surgeons National Surgical Quality Improvement database was queried for adult patients (age ≥18 years) who had undergone emergent inguinal hernia repair between 2015 and 2021. The relationships between demographic variables and laparoscopic compared with open emergent inguinal hernia repair were evaluated using univariate and multivariate analyses. ResultsA total of 8,215 patients were included in this analysis. Use of laparoscopic emergent inguinal hernia repair increased from 9% in 2015 to 23% in 2021. Female patients (odds ratio, 1.84, P < .001) and patients aged ≤65 years (odds ratio, 1.25, P = .005) were more likely to undergo laparoscopic repair. Black (odds ratio, 0.73, P = .003) and Hispanic (odds ratio, 0.72, P = .006) patients and patients with greater American Society of Anesthesiologists classification (odds ratio, 0.86, P = .037), ascites (odds ratio, 0.39, P = .039), and preoperative dialysis requirement (odds ratio, 0.45, P = .017) were less likely to undergo laparoscopic repair. Aside from a decreased likelihood of readmission in patients who underwent laparoscopic surgery (odds ratio, 0.696, P = .024), there was no difference in other postoperative outcomes, despite a laparoscopic approach being associated with greater rates of concomitant procedures compared with an open approach (24% vs 18%, P < .001). ConclusionsFemale sex, younger age, and lower American Society of Anesthesiologists class were associated with a greater likelihood of laparoscopic surgery. Black and Hispanic patients and patients with ascites and dialysis requirements were less likely to undergo laparoscopic repair. Laparoscopic inguinal hernia repair can be safely performed in an emergent setting.

Prevention and Management of Infectious Complications in Retrograde Intrarenal Surgery: A Comprehensive Review.

Retrograde intrarenal surgery (RIRS) is a minimally invasive procedure increasingly used to treat renal stones and other intrarenal pathologies due to its reduced risk of complications, shorter recovery time, and lower postoperative pain compared to more invasive surgical techniques. However, despite its advantages, RIRS is associated with a significant risk of infectious complications, ranging from simple urinary tract infections (UTIs) to severe systemic infections such as urosepsis, which can lead to increased morbidity, prolonged hospitalization, and, in severe cases, mortality. This review aims to summarize the current knowledge on preventing and managing infectious complications associated with RIRS. By exploring the pathophysiology of these infections, identifying patient and procedural risk factors, and evaluating evidence-based strategies for prevention and management, this review provides comprehensive insights into minimizing infection risks in RIRS. A thorough literature review was conducted, examining studies and clinical trials that address the incidence, risk factors, prevention strategies, and management protocols for infections in RIRS. This review also assesses current guidelines from professional organizations and recent infection control technologies and practices advancements. The review identifies multiple risk factors contributing to infections in RIRS, including patient-specific factors such as comorbidities and procedural factors like the duration of surgery and use of instrumentation. Effective prevention strategies include preoperative antibiotic prophylaxis, stringent aseptic techniques during surgery, and careful postoperative monitoring. The review also highlights the importance of a multidisciplinary approach involving urologists, infectious disease specialists, and microbiologists in managing complex cases of infection. Infectious complications remain a significant concern in RIRS, necessitating a comprehensive approach to prevention and management. By adhering to evidence-based guidelines and utilizing a multidisciplinary strategy, healthcare professionals can significantly reduce the incidence of infections, thereby improving patient outcomes and the overall safety of RIRS. Future research should focus on advancing infection control technologies and developing novel prophylactic and therapeutic approaches to further enhance the safety and effectiveness of RIRS.

Central neck dissection: updates on indications and surgical technique

This article aims to describe the indications, pertinent anatomy, and surgical technique of the central neck dissection (CND) as it pertains to carcinomas of the thyroid gland. Further discussed are major complications of the procedure and factors considered in surgical decision making. Therapeutic CND is strongly recommended and widely performed in patients with clinically or radiographically evident nodal disease; however, elective/prophylactic CND requires an informed decision that should be based upon patient specific disease and risk factors. If able, CND should be performed concurrently at the time of thyroidectomy to minimize risk of injury to critical structures such as the recurrent laryngeal nerve and parathyroid glands. When indicated, CND performed by a skilled surgeon reduces the risk of locoregional recurrence and is associated with low overall morbidity.

Development of machine learning-based models for predicting risk factors in acute cerebral infarction patients: a clinical retrospective study

ObjectivesThe aim of this study was to develop machine learning-based models for predicting acute cerebral infarction (ACI) in patients.MethodsWe extracted the data of ACI patients and non-ACI patients (as control) from two hospitals. The Lasso algorithm was employed to select the most crucial features associated with ACI. Five machine learning algorithms-based models were trained, which was performed with 10-fold cross-validation. Then, the area under the receiver operating characteristic curve (AUC), accuracy, and F1-score were calculated in the training models. Accordingly, the training models with excellent performance was selected as the final predictive model. The relative importance of variables was analyzed and ranked.ResultsA total of 150 patients were diagnosed with ACI (50.00%), with a higher proportion of males (70.67% vs. 44.00%) compared to the non-ACI patients. The logistic regression model exhibited a good performance in predicting ACI in the training set, as evidenced by its highest AUC, accuracy, sensitivity, and F1-score. Furthermore, feature importance analysis showed that blood glucose, gender, smoking history, serum homocysteine, folic acid, and C-reactive protein were the top six crucial variables of the logistic regression.ConclusionsIn our work, the ACI risk prediction model developed by the logistic regression exhibited excellent performance. This could contribute to the identification of risk variables for ACI patients and enables clinicians timely and effective interventions.