Risk Factors Smoking Research Articles

Topographic Consideration on the Occurrence of Ipsilesional Facial Paresis in Lateral Medullary Infarction

Introduction: The purpose of this study was to identify course of the corticobulbar tract and factors associated with the occurrence of facial paresis (FP) in lateral medullary infarction (LMI). Methods: Patients diagnosed with LMI who were admitted to tertiary hospital were retrospectively investigated and divided into two groups based on the presence of FP. FP was defined as grade 2 or more by the House-Brackmann scale. Differences between the two groups were analyzed with respect to anatomical location of the lesions, demographic data (age, sex), risk factors (diabetes, hypertension, smoking, prior stroke, atrial fibrillation, and other cardiac risk factors for stroke), large vessel involvement on magnetic resonance angiography, other symptoms and signs (sensory symptoms, gait ataxia, limb ataxia, dizziness, Horner syndrome, hoarseness, dysphagia, dysarthria, nystagmus, nausea/vomiting, headache, neck pain, diplopia, and hiccup). Results: Among 44 LMI patients, 15 patients (34%) had FP, and all of them had ipsilesional central-type FP. The FP group tended to involve upper (p < 0.0001) and relative ventral (p = 0.019) part of the lateral medulla. Horizontally large lesion was also related to the presence of FP (p = 0.044). Dysphagia (p = 0.001), dysarthria (p = 0.003), and hiccups (p = 0.034) were more likely to be accompanied by FP. Otherwise, there were no significant differences. Conclusion: The results of present study indicate that the corticobulbar fibers innervating the lower face decussate at the upper level of the medulla and ascend through the dorsolateral medulla, where the concentration of the fibers is densest near the nucleus ambiguus.

Overnight Abstinence, Ventrostriatal-Insular Connectivity, and Tridimensional Personality Traits in Cigarette Smokers.

Personality traits contribute to the risks of smoking. The striatum has been implicated in nicotine addiction and nicotine deprivation is associated with alterations in resting state functional connectivity (rsFC) of the ventral (VS) and dorsal (DS) striatum. However, it remains unclear how striatal rsFC may change following overnight abstinence or how these shorter-term changes in inter-regional connectivity relate to personality traits. In the current study, 28 smokers completed assessments with Fagerström Test of Nicotine Dependence, Tridimensional Personality Questionnaire (TPQ), as well as resting state functional magnetic resonance imaging (fMRI) scans during satiety and after overnight abstinence. We processed imaging data with published routines and evaluated the results with a corrected threshold. Smokers showed increases in the VS-insula rsFC but no significant changes in the DS rsFC after overnight abstinence as compared to satiety. The difference in the VS-insula rsFC (abstinence minus satiety) was negatively correlated with harm avoidance. These findings highlighted striatal connectivity correlates of very short-term abstinence from smoking and how the VS-insula rsFC may vary with individual personality traits, interlinking neural markers and personality risk factors of cigarette smoking at the earliest stage of abstinence.

Incident atrial fibrillation in relation to ventilatory parameters: a prospective cohort study.

There is a paucity of data on the association between respiratory function and atrial fibrillation (AF). This study aimed to assess the relationship between forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC and incident AF. We performed an analysis of prospectively collected data from the UK Biobank. We included all participants with available spirometry and excluded those with a prior AF. Incident AF was ascertained through hospitalization and death records, and dose-response associations were assessed using multivariable Cox regression analysis with adjustment for known AF risk factors. We studied 348,219 white individuals (54.1% female) with a median age of 58.1 (IQR 50.8-63.5) years. Over a median follow-up time of 11.5 years (IQR: 11.0-12.6 years), a total of 18,188 incident AF events occurred. After standardization to sex, age, and height, the risk of AF consistently increased with decreasing FEV1 percentage predicted, FEV1 z-score, and FVC z-score. The risk of AF linearly increased with decreasing FEV1/FVC ratio, and those that had airway obstruction as defined by an FEV1/FVC ratio < 0.70 had a 23% greater risk of incident AF (aHR 1.23, 95% CI 1.19-1.28) compared to those without airway obstruction. Patients with known chronic obstructive pulmonary disease and asthma were at 40% (aHR 1.40, 95% CI 1.29-1.51) and 17% (aHR 1.17, 95% CI 1.12-1.22) increased risk of incident AF. These findings indicate that reduced ventilatory function is associated with increased risk of AF independently of age, sex, smoking, and other known AF risk factors.

Features of a Balanced Healthy Diet With Cardiovascular and Other Benefits.

Cardiovascular (CV) disease (CVD) remains the leading cause of death globally. Besides lack of exercise, obesity, smoking, and other risk factors, poor nutrition and unhealthy/unbalanced diets play an important role in CVD. This review examined data on all issues of the CV-health benefits of a balanced diet, with tabulation of nutritional data and health-authority recommendations and pictorial illustration of the main features of a CV-healthy diet. PubMed and Google Scholar were searched for relevant studies and reviews on diet and CV health. For a long time, there has been evidence, corroborated by recent findings, that pro-vegetarian diets have a beneficial influence on serum lipid levels, markers of inflammation and endothelial function, prooxidant-antioxidant balance, and gut microbiome, all probably contributing to reduced CV risk. Worries about the nutritional adequacy of vegetarian diets are circumvented by obtaining certain nutrients lacking or found in lower amounts in plants than in animal foods, by consuming a wide variety of healthy plant foods and through intake of oral supplements or fortified foods. Well-balanced diets, such as the Mediterranean or the Dietary-Approaches-to-Stop-Hypertension diets, provide CV-health benefits. Nevertheless, a broad variety of plant-based diets with low/minimal animal food intake may allow for the personalized and culturally adjusted application of dietary recommendations contributing to the maintenance of CV health. Universal adoption of a balanced CV-healthy diet can reduce global, CV and other mortality by ~20%. This requires world-wide programs of information for and education of the public, starting with school children and expanding to all groups, sectors, and levels.

Ateroesclerosis y lupus eritematoso sistémico

Systemic autoimmune diseases, such systemic lupus erythematosus (SLE), show an increased morbidity and cardiovascular mortality and a higher incidence of early and accelerated atherosclerosis than the general population that cannot be explained only by the presence of classic risk factors such arterial hypertension, mellitus diabetes, hypercholesterolemia, obesity or smoking, but it seems to depend on factors associated with the disease. The imbalance between vascular damage and repair plays a critical role in the initiation of atherosclerotic lesion. This balance may be broken by factors associated with chronic inflammation, oxidative stress, pharmacological treatments, altered molecules and cells involved in the repair of the endothelium. Research is ongoing to identify biomarkers that can help clinicians to predict which SLE patients are the greatest risk for cardiovascular disease.

Circulating immune cell phenotypes are associated with age, sex, CMV, and smoking status in the Framingham Heart Study offspring participants.

Understanding the composition of circulating immune cells with aging and the underlying biologic mechanisms driving aging may provide molecular targets to slow the aging process and reduce age-related disease. Utilizing cryopreserved cells from 996 Framingham Heart Study (FHS) Offspring Cohort participants aged 40 and older (mean 62 years, 48% female), we report on 116 immune cell phenotypes including monocytes, T-, B-, and NK cells and their subtypes, across age groups, sex, cytomegalovirus (CMV) exposure groups, smoking and other cardiovascular risk factors. The major cellular differences with CMV exposure were higher Granzyme B+ cells, effector cells, and effector-memory re-expressing CD45RA (TEMRA) cells for both CD4+ and CD8+. Older age was associated with lower CD3+ T cells, lower naïve cells and naïve/memory ratios for CD4+ and CD8+. We identified many immune cell differences by sex, with males showing lower naïve cells and higher effector and effector memory cells. Current smokers showed lower pro-inflammatory CD8 cells, higher CD8 regulatory type cells and altered B cell subsets. No significant associations were seen with BMI and other cardiovascular risk factors. Our cross-sectional observations of immune cell phenotypes provide a reference to further the understanding of the complexity of immune cells in blood, an easily accessible tissue.

Genetic associations between circulating metabolic biomarkers and lung cancer in East Asians and Europeans

BackgroundMetabolic biomarkers are reported to be associated with the risk of lung cancer (LC). However, the observed associations from epidemiological studies are either inconsistent or inconclusive.MethodsThe genetic summary data of high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), triglyceride (TG), fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) and those of the LC and its histological subtypes were retrieved from previous GWASs. We performed two-sample Mendelian randomization (MR) and multivariable MR analyses to examine the associations between genetically predicted metabolic biomarkers and LC in East Asians and Europeans.ResultsIn East Asians, the inverse-variance weighted (IVW) method suggests that LDL (odds ratio [OR] = 0.799, 95% CI 0.712–0.897), TC (OR = 0.713, 95% CI 0.638–0.797), and TG (OR = 0.702, 95% CI 0.613–0.804) were significantly associated with LC after correction for multiple testing. For the remaining three biomarkers, we did not detect significant association with LC by any MR method. Multivariable MR (MVMR) analysis yielded an OR of 0.958 (95% CI 0.748–1.172) for HDL, 0.839 (95% CI 0.738–0.931) for LDL, 0.942 (95% CI 0.742–1.133) for TC, 1.161 (95% CI 1.070–1.252) for TG, 1.079 (95% CI 0.851–1.219) for FPG, and 1.101 (95% CI 0.922–1.191) for HbA1c. In Europeans, the univariate MR analyses did not detect significant association between exposures and outcomes. However, in MVMR analysis integrating circulating lipids and lifestyle risk factors (smoking, alcohol drinking, and body mass index), we found that TG was positively associated with LC in Europeans (OR = 1.660, 95% CI 1.060–2.260). Subgroup and sensitivity analysis yielded similar results to the main analyses.ConclusionsOur study provides genetic evidence that circulating levels of LDL was negatively associated with LC in East Asians, whereas TG was positively associated with LC in both populations.

Pericardial Effusion with Cardiac Tamponade Revealing Primary Hypothyroidism about 3 Cases Ousmane Diawara, M. Camara, T. Camara, F. Ekoba, M. El Jamili Published: April 21, 2023 | 9 8 DOI: 10.36347/sjmcr.2023.v11i04.050 Pages: 610-613 Downloads Abstract Cardiac tamponade revealing hypothyroidism was reported in our department in 3 cases. Clinical, electrocardiographic, echocardiographic and biological data were examined. These patients were characterized by

Cardiac tamponade revealing hypothyroidism was reported in our department in 3 cases. Clinical, electrocardiographic, echocardiographic and biological data were examined. These patients were characterized by a cardiovascular risk factor of smoking, clinically by polypneic dyspnea (25, 30 cycles/min) vs. 19 cycles/min respectively, low blood pressure (70/50, 90/60) vs. 100/75 mmhg, significantly higher heart rate (120, 135) vs. 87 beats/min, normal sinus rhythm, microvoltage, flat T wave, and clear yellowish pericardial fluid (2 of 3). Biologically, anemia with hb respectively (6g, 9g and 9.8g); Tsh (15.9µUI, 90µUI, 110µUI); T3 (0.17; 0.20; 0.26) One patient (33%) had echocardiographic evidence of tamponade without a paradoxical pulse and was successfully treated with thyroxine without pericardial drainage. Tamponade with sinus tachycardia, hypothyroidism should be strongly suspected, although an urgent pericardiocentesis should be performed.

Risk and Protective Factors for Vaping and Smoking Among High School Students in Maine

Vaping rates are rising among adolescents across the country, and smoking rates remain high. Understanding risk and protective factors associated with vaping and smoking can guide public health interventions. This study examined risk and protective factors associated with vaping and smoking among high school students in Maine. We used 2019 Maine Integrated Youth Health Survey (MIYHS) data to examine risk and protective factors for vaping and smoking among Maine high school students. Our analytic sample consisted of 17,651 Maine high school students. In addition to bivariate analyses, we used unadjusted and adjusted logistic regression models to assess risk and protective factors. Factors with the greatest effect on students' likelihood to vape, smoke, or do both were parental attitude toward adolescent smoking and depressive symptoms. Students who reported their parents feel it is a little wrong or not wrong at all if they smoked had 4.9 times higher adjusted odds of smoking and 4.6 times higher adjusted odds of vaping and smoking compared with students who said their parents feel it would be wrong or very wrong if they smoked. Students who reported depressive symptoms had 2.1 times higher adjusted odds of vaping, 2.7 times higher adjusted odds of smoking, and 3.0 times higher adjusted odds of vaping and smoking compared with students who did not report depressive symptoms. Understanding risk and protective factors for smoking and vaping among high school students can help tailor adolescent-focused vaping and smoking public health interventions to increase effectiveness.

41 cases of chronic obstructive pulmonary disease caused by occupational irritating chemicals

Objective: To analyze the case characteristics of Chronic obstructive pulmonary disease caused by occupational irritant chemicals (OI-COPD). To provide basis for revising its diagnostic criteria. Methods: From June to December 2021, we investigated the information of OI-COPD patients confirmed by Shandong Institute of Occupational Health and Prevention of Occupational Diseases, Guangxi Zhuang Autonomous Region Institute of Occupational Disease Prevention and Control, Qingdao Central Hospital affiliated to Qingdao University and other diagnostic institutions in the past five years, a total of 41 cases. The basic information of OI-COPD cases, occupational risk factors exposure information, medical history, smoking history and clinical symptoms were analyzed retrospectively. The measurement data were tested for normal distribution, which was described by x±s, and compared between groups by t test; Those who do not conform to the normal distribution are described by the median [M (Q(1), Q(3)) ] and analyzed by nonparametric test; The counting data were expressed in frequency and rate (% ), and the comparison between groups was tested. Results: Of the 41 cases, 33 were male and 8 were female. The age of the patient diagnosed with OI-COPD was (49.5±10.3) years old, and the minimum age was 30 years old; Among them, 8 patients had a definite long-term smoking history (more than 5 years) ; The exposure duration of occupational risk factors was (18.6±10.3) years, of which 3 patients had exposure duration of less than 5 years; The occupational risk factors leading to OI-COPD include acids and acid-forming compounds, bases, aldehydes, nitrogen oxides, chlorine and its compounds, etc. The exposure level of occupational risk factors is related to the degree of COPD airflow restriction (χ(2)=6.17, P <0.05). 18 patients with diagnosis age <50 years old were diagnosed as early-onset COPD. The incidence of respiratory symptoms in the early diagnosis COPD group was lower than that in the non-early diagnosis COPD group, and the FEV1% pred was significantly higher than that in the non-early diagnosis COPD group. The difference was statistically significant (P<0.01 ) . Conclusion: The exposure level of occupational risk factors may be the risk factor affecting the degree of COPD airflow restriction. With the increase of the exposure level of COPD patients, the proportion of respiratory symptoms will also increase accordingly.

Cardiovascular risk profiles in patients with inflammatory bowel disease differ from matched controls from the general population.

Inflammatory bowel disease (IBD) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). We compared cardiovascular disease (CVD) risk factors and 10-year risk in IBD patients to the general population. In this cross-sectional study, consecutive IBD patients ≥45 years were included. History of ASCVD and CVD risk factors (smoking, hypertension, overweight, hypercholesterolaemia, diabetes, and metabolic syndrome) were assessed. The Systematic COronary Risk Evaluation (SCORE2) algorithm was used to estimate 10-year CVD risk. One to four age/sex-matched controls were derived from the prospective population-based Rotterdam Study cohort. In total, 235 IBD patients were included {56% women, median age 59 years [interquartile range (IQR) 51-66]} and matched to 829 controls [56% women, median age 61 years (IQR 56-67)]. Inflammatory bowel disease patients experienced ASCVD events more often compared with matched controls [odds ratio (OR) 2.01, 95% confidence interval (CI) 1.23-3.27], specifically heart failure (OR 2.02, 95% CI 1.02-4.01) and coronary heart disease (OR 2.01, 95% CI 1.7-3.13). Inflammatory bowel disease patients showed lower odds of overweight (OR 0.48, 95% CI 0.35-0.66) and hypercholesterolaemia (OR 0.45, 95% CI 0.31-0.65) and higher odds of hypertension (OR 1.67, 95% CI 1.19-2.32), as well as higher waist circumference (+4 cm, P = 0.006) and triglyceride levels (+0.6 mmol/L, P < 0.001) as compared with controls. Mean 10-year CVD risk was 4.0% [standard deviation (SD) ±2.6] in 135 IBD patients vs. 6.0% (SD ±1.6) in 506 controls. The increased CVD risk in IBD is discrepant with the 10-year CVD risk estimate. Systematic COronary Risk Evaluation may underestimate CVD risk in IBD patients due to differing CVD risk profiles compared with the general population, including a lower prevalence of hypercholesterolaemia and overweight and a higher prevalence of hypertension, abdominal obesity, and hypertriglyceridaemia.

COPD awareness among the Syrian community: population-based study

Chronic obstructive pulmonary disease (COPD) is a common disease and among the top causes of mortality worldwide but can be prevented and treated. This study aims to estimate the awareness of COPD among the Syrian population. A cross-sectional anonymous self-administered online survey was conducted by using Google Forms on Social Media platforms. The questionnaire included demographic, smoke-related and COPD-related questions. This study included 1607 participants with 930 (57.8%) females, 40% aging 21–25 years old, more than 90% being university students/graduates and 67.8% living in cities. Around half were either active smokers or had second-hand smoke exposure. After excluding participants in health-related fields who were 950 participants, only 25.4% of the remaining had ever heard of the term COPD. Knowing about COPD was not associated with reported smoking habits. No significant differences in awareness were seen between city and countryside dwellers, governate groups, genders, or age groups. Being in a health-related field was a major factor of being aware of COPD. COPD awareness in Syria is low, even amongst the well-educated group. Moreover, COPD risk factors of smoking and exposure to indoor and outdoor pollutants are common. Raising awareness is crucial in the Syrian community as COPD is highly prevalence.

The Impact of Smoking on Microbiota: A Narrative Review

Cigarette smoke is a classic risk factor for many diseases. The microbiota has been recently indicated as a new, major player in human health. Its deregulation-dysbiosis-is considered a new risk factor for several illnesses. Some studies highlight a cross-interaction between these two risk factors-smoke and dysbiosis-that may explain the pathogenesis of some diseases. We searched the keywords "smoking OR smoke AND microbiota" in the title of articles on PubMed®, UptoDate®, and Cochrane®. We included articles published in English over the last 25 years. We collected approximately 70 articles, grouped into four topics: oral cavity, airways, gut, and other organs. Smoke may impair microbiota homeostasis through the same harmful mechanisms exerted on the host cells. Surprisingly, dysbiosis and its consequences affect not only those organs that are in direct contact with the smoke, such as the oral cavity or the airways, but also involve distant organs, such as the gut, heart, vessels, and genitourinary tract. These observations yield a deeper insight into the mechanisms implicated in the pathogenesis of smoke-related diseases, suggesting a role of dysbiosis. We speculate that modulation of the microbiota may help prevent and treat some of these illnesses.

Gender Differences in High-risk CAS through Radial Access

AIMS: Transradial (TR) carotid artery stenting (CAS) has been established as an acceptable alternative to carotid endarterectomy, especially in patients with a high risk for surgery. The purpose of this study was to evaluate the gender differences of radial access CAS in high-risk patients. MATERIALS AND METHODS: This was a prospective analysis which included 54 consecutive patients in the period from December 2020 to January 2022. According to the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy study for high-risk CAS, patients with at least one anatomic or comorbid factor associated with increased surgical risk were included in the study. Subjects were divided into two groups according to sex. Follow-up assessments included neurological exams, 12-lead electrocardiogram, and duplex ultrasound (DUS). The primary endpoint was 30-day composite rate of stroke, death, and myocardial infarction. Secondary endpoints included procedure success, access site complications according to Early Discharge after TR Stenting of Coronary Arteries (EASY) score classification, target lesion revascularization, and in-stent restenosis evaluated with DUS. RESULTS: The study population was predominantly male 37 (61.1%) and females were 17 (38.9%). Mean age in the women group was 64.4 ± 7.43 years, and in men, it was 69.1 ± 8.01 years (p = 0.0223). From risk factors for coronary artery disease, hypertension and smoking were more frequent in the male group and hyperlipidemia and diabetes in the female group. Most of the male patients were symptomatic compared to the female group (p = 0.0151). Procedural success was obtained in all cases. Transient vasospasm induced by the distal protection device was present in one male patient. No 30-day major adverse events were recorded between the two groups. Minor access site bleeding complications according to EASY score (Easy type 1) were recorded in 4 patients (3 males vs. 1 female). There were no cases of hand ischemia after procedure or follow-up. None of the patients had in-stent restenosis &gt;70% on DUS during 1-year follow-up. CONCLUSION: Results from this study demonstrate no gender-related differences in radial access CAS for high-risk patients.

Aortic Intramural Hematoma Mimicking Acute Coronary Syndrome

Type A Aortic intramural haematoma (IMH), a variant form of classic aortic dissection, has been accepted as an increasingly recognised and potentially fatal entity of acute aortic syndrome.It is a very dangerous, fatal, and emergency condition. It is very important to recognize the symptoms of acute aortic syndrome related to appropriate management Case Illustration A 52 year old man patient suffered from chest pain with moderate intensity while he was working at home. It was sharp , tear-like sensation, in the middle of the chest radiated to the back, accompanied with cold sweating, and did not relieve by rest. Because of this condition he brought to hospital. From examination at Emergency room, he had cardiomegaly, aortic dilatation. From the Electrocardiography an st elevation at V1-V2 and T inverted V4-V6 precordial lead,I aVL extremities lead and slightly elevated cardiac enzymes with risk factors for active smoking and uncontrolled hypertension. Initially he was suspected of having acute coronary syndrome with differential diagnose acute aortic syndrome. To exclude the diagnose he had underwent cardiac catheterization, the cardiologist in charge suspicious this patient with aortic dissection because of trapping contrast durante procedure and coronary minor disease. For a better diagnosis, transtransthoracic echocardiography and Aortic Computed Tomography angiography was performed on the patient which confirmed the evidence of dissection. After being diagnosed, we treat the patient as an acute aortic syndrome and we stabilize the patient's condition. The patient was planned for cardiac surgery Discussion Acute aortic syndrome, which includes Acute Aortic Dissection, Intramural Hematoma and penetrating aortic ulcer, is difficult to diagnosed. Aortic intramural hematoma, which is one of the acute aortic syndromes, is characterized by the presence of a hematoma in the medial layer of the aortic wall without the appearance of an intimal tear. The incidence of intramural hematoma differs slightly from that of aortic dissection syndrome. Patients with intramural hematomas often occur in older patients, more often with aortic aneurysms The patient receive treatment aggressively to control blood pressure by administering a non-dihydropyridine calcium channel blocker intravenously and then beta blocker, angiotensin II receptor blockers, was also needed. Acute aortic syndrome, where an intramural aortic hematoma can present with varying symptoms of varying severity, which can lead to misdiagnosis and delay in cases of life-threatening disease. In the case of our patient, who had strong cardiac risk factors, His initial presentation described an acute myocardial infarction; the diagnosis was made after CT scan was performed and the patient remained stable Conclussion Complaints of chest pain due to symptoms of acute aortic syndrome are very important to be recognized immediately because they need proper management. Complaints in this syndrome have similarities with complaints in acute coronary syndrome, pulmonary embolism and others. Patients with aortic intramural hematoma are at high risk for developing periaortic hematoma and hemorrhagic pericardial effusion. In patients with an intramural aortic hematoma, Stanford A, the most appropriate management is surgical technique. Initial management of blood pressure control, heart rate and anti-pain can be given. In this case, the choice of a combination of surgery with endovascular may be a logical choice of therapy

MP12-14 RURAL DISPARITIES IN PENILE CANCER: A MULTI-INSTITUTIONAL, STATEWIDE REVIEW IN WEST VIRGINIA

You have accessJournal of UrologyCME1 Apr 2023MP12-14 RURAL DISPARITIES IN PENILE CANCER: A MULTI-INSTITUTIONAL, STATEWIDE REVIEW IN WEST VIRGINIA David Zekan, Luke O'Connor, Mary Novak, Amr Elbakry, Brian Wiseman, Ahmad Haffar, Andrew Williams, Nathan Hale, Adam Luchey, and Ali Hajiran David ZekanDavid Zekan More articles by this author , Luke O'ConnorLuke O'Connor More articles by this author , Mary NovakMary Novak More articles by this author , Amr ElbakryAmr Elbakry More articles by this author , Brian WisemanBrian Wiseman More articles by this author , Ahmad HaffarAhmad Haffar More articles by this author , Andrew WilliamsAndrew Williams More articles by this author , Nathan HaleNathan Hale More articles by this author , Adam LucheyAdam Luchey More articles by this author , and Ali HajiranAli Hajiran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Disparities exist amongst HPV-related cancer outcomes in urban versus rural populations, including squamous cell carcinoma (SCC) of the penis. West Virginia presents a unique opportunity for analysis in underserved areas with few tertiary care centers and large distances and travel time between centers. This study seeks to examine differences in penile cancer presentation (including TNM stage, grade, pertinent risk factors, presenting symptoms and duration), treatment, and outcomes between rural and urban populations in West Virginia. Identification is crucial to provide earlier intervention and improve outcomes in an underserved population. METHODS: Following IRB approval, 89 patients with biopsy-proven SCC of the penis treated at Charleston Area Medical Center (CAMC) and West Virginia University over a fourteen-year period (2007-2022) were studied retrospectively. Distance and travel time from care centers were collected, and patients were stratified into urban and rural groups according to the US Census Bureau definition. T-stage, clinical node positivity, grade, risk factors, primary tumor size and location, and treatment modality and timing were analyzed. Appropriate statistical tests were performed using SPSS. RESULTS: Patients living increased travel times from the respective centers were more likely to undergo radical penectomy as primary therapy (p=0.03), although advanced stage (pT2 or greater) and clinical nodal status did not vary with travel time. Those living in counties classified as “urban” had higher BMI on average (p=0.004) and were more likely to present with a lesion on the penile shaft (p=0.06). No difference exists in stage or grade at diagnosis, other risk factors (smoking status, circumcision), primary tumor size, clinically palpable lymph nodes, radiation and chemotherapy, symptom duration, or timing of therapy based on distance or travel time or when stratified based on rural/urban county of residence. CONCLUSIONS: Patients further from tertiary care centers in terms of travel time are more likely to undergo radical penectomy as definitive therapy for penile cancer. This was not significant when analyzed by distance from tertiary care center, as may be expected in a rural state where distance and travel time can vary markedly. Also, this did not occur due to higher risk disease based on pT stage. When stratified based on census definitions, rural patients had lower BMI and presented less often with disease of the penile shaft, suggesting they may opt for a definitive radical penectomy due to difficulties with healthcare access. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e139 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Zekan More articles by this author Luke O'Connor More articles by this author Mary Novak More articles by this author Amr Elbakry More articles by this author Brian Wiseman More articles by this author Ahmad Haffar More articles by this author Andrew Williams More articles by this author Nathan Hale More articles by this author Adam Luchey More articles by this author Ali Hajiran More articles by this author Expand All Advertisement PDF downloadLoading ...

PROGNOSTIC IMPLICATION OF HIGH SENSITIVITY C-REACTIVE PROTEIN IN ACUTE CORONARY SYNDROME PATIENTS

Aim: An observational cross sectional study for assessing the levels of High sensitivity creactive protein in patients with acute coronary syndrome and study its prognostic implication. Methods: All the patients presenting with clinical,ECG and 2D – echocardiographic evidence of acute myocardial infarction admitted in department of medicine. Results: A study of 48 patients with acute coronary syndrome of both sex were taken as sample.36 patients were diagnosed as ST elevation MI(STEMI) and 12 patients were diagnosed as Non-ST elevation MI(NSTEMI).Out of 36 STEMI patients,20 patients were male and 16 were female.Out of 12 NSTEMI patients,6 were male and 6 were female.Among male patients with STEMI ,85% had risk factor of smoking,alcohol,diabetes mellitus or systemic hypertension,whereas in females it was 81%.Among NSTEMI males had risk of 83% and females it was 60%.In patients with STEMI,8% had normal EF,25% had Moderate EF and 50% had low EF.The correlation between the prognosis and values of HS-CRP of patients with extensive AWMI is found to be statistically significant.(ppatients with extensive AWMI is found to be statistically significant.(p&lt;0.05). Conclusion: The levels of HS-CRP correlate with several cardiovascular risk factors such as smoking,diabetes mellitus and hypertension.Elevated levels of hs-CRP is related to the presence of plaque rupture ,which provokes acute coronary syndrome.Therefore, in a resource limited country like India, evaluation of hs-CRP would be considered as the best modality over optical coherence tomography and intravascular ultrasound.This suggests that the assessment of HS-CRP levels may enable the physician in detecting the prognosis of acute coronary syndrome patients,plan effective reperfusion therapy and also assess long term complications.

The Effects of Economic Deterioration Due to COVID-19 to Alcohol and Tobacco Consumption Behaviors of Adolescents in South Korea: A Nationwide Analysis

Coronavirus disease 2019 (COVID-19) pandemic has greatly impacted health, culture, and the economy. Although it has had little direct effect on children and adolescents, its indirect effect on them has been significant. In this study, we aim to evaluate the alcohol and tobacco consumption behaviors of adolescents and the economic determination of their families due to COVID-19.We collected data from the Korea Youth Risk Behavior Survey, which is an annual cross-sectional national representative survey published by the Korea Disease Control and Prevention Agency in South Korea. We considered, in particular, the survey conducted in middle and high school students in 2020.The number of subjects was 54,948 with 28,353 male students and 26,595 female students. The drinking rate was higher in male students and female students in the group with severe economic deterioration compared to the group without deterioration (odd ratio [OR], 1.355; 95% confidence interval [95% CI], 1.175-1.563; OR, 1.199; 95% CI, 0.987-1.457). The smoking rate was higher in male students and female students in the group with severe economic deterioration (OR, 1.435; 95% CI, 1.180-1.745; OR, 1.809; 95% CI, 1.331-2.457). The secondhand smoking rate at home was higher in male students and female students in the group with severe economic deterioration (OR, 1.397; 95% CI, 1.239-1.574; OR, 1.440; 95% CI, 1.263-1.641).The economic deterioration due to COVID-19 is a risk factor for alcohol drinking, smoking, and secondhand smoking among adolescents. Our study results suggest the need to pay more attention to youth health management in the event of sudden economic impacts.

Assessment of Knowledge of and Attitude Toward Oral Cancer Among the Outpatient Population in a Tertiary Care Rural Hospital.

Introduction Lack of knowledge and awareness about oral cancer and its risk factors and negligence of the early warning signs play a crucial role in raising the incidence of the disease. Therefore, the aim of this present study is to assess the awareness of oral cancer among the local population regarding the prevalence, etiology, early signs of oral cancer, and treatment options available for the same. Materials and methods The study was approved by the institutional ethics committee. A cross-sectional study was done on 158 patients from 15-70 years. The questionnaire comprised closed-ended questions to assess the subject's awareness, knowledge, and attitude toward the prevalence, causative factors, early signs that suggest oral cancer, and treatment options available for oral cancer. Results The study population consisted of 61% females and 39% males; the participants were aged between 15 and 70 yearsand the majority of thembelonged to the 46-60-year age group (39.2%). Most of the participants (46%) had completed secondary education. Thirty-two point nine percent (32.9%) had not heard about oral cancer, 43.7% considered tobacco chewing and smoking risk factors, but only 25.8% were aware of early signs of oral cancer. Individuals who were unaware of oral cancer were educated. Conclusion This is a simple method to understand the participants'knowledge of oral cancer and its risk factors. Based on the results, we can identify the populations that are unaware of oral cancer, and they can be educated regarding early screening, prevention, and control.

Ethnic differences in right ventricular structure and function in urbanized hypertensive patients in the Gornaya Shoriya region

Aim of this study was to compare right ventricular echocardiography parameters in urbanized hypertensive patients of the Shor and non-indigenous ethnic groups in the Mountain Shoria region. The study included patients with arterial hypertension: 58 Shors and 50 non-indigenous urbanized residents, comparable in age, and divided by ethnicity and gender into 4 groups: Shors men (n = 20), Shors women (n = 38) , non-indigenous men (n = 15) and non-indigenous women (n = 35). All underwent echocardiographic examination, and the right heart parameters were studied. Shor men with arterial hypertension had the lowest values ​​of the pulmonary artery index (p = 0.05), the right atrium dimensions (p = 0.04), and the highest values ​​of the blood flow velocity in the right ventricle, et' (p = 0.05) and st' (p = 0.05) in comparison with non-indigenous men. Shor women have the lowest values Et/At ratios (p = 0.05). RV diastolic dysfunction was detected mainly in women compared with men (23.1% and 1.9%, p = 0.0014), somewhat more often in Shors. Ethnicity was one of the factors associated with the right ventricular diastolic dysfunction presence (p = 0.002). Among the factors associated with the RV diastolic dysfunction were risk factors (smoking, obesity), blood pressure, gender, ethnicity, and left ventricular parameters (diastolic dysfunction and the myocardial mass increase). Thus, our study established the influence of ethnic differences on the right heart echocardiographic parameters in Shors and Caucasians with arterial hypertension. The effect of sex on RV diastolic dysfunction was a lot bigger compared to the effect of ethnicity. The revealed differences should improve the assessment of the right heart structure and function in patients with arterial hypertension from small ethnic groups, which will help to improve the diagnosis and treatment of such patients.