Risk Factors Research Articles

Neurodevelopmental outcome at two years of age and predictive value of General Movement Assessment in infants exposed to alcohol and/or drugs during pregnancy: a prospective cohort study

BackgroundExposure to alcohol and/or other addictive drugs in pregnancy is a documented risk factor for neurological impairment. We aimed to assess neurodevelopmental outcome at two years of age in infants exposed to prenatal alcohol and/or other addictive drugs and to examine the predictive value of early motor assessment.MethodsThis was a follow-up at two years of age in the prospective cohort study Children Exposed to Alcohol and/or Drugs in Intrauterine Life (CEADIL). The exposed group comprised 73 infants recruited from primary health care and included in a hospital follow-up programme at St. Olavs Hospital, Trondheim University Hospital, Norway. The control group comprised 93 healthy, unexposed infants recruited from the maternity ward at the same hospital. All children had been assessed by physiotherapists using the General Movement Assessment (GMA) at three months of age. Presence of fidgety movements, movement character and the Motor Optimality Score – Revised (MOS-R) were used. At two years of age, the children were assessed by trained examiners using the Bayley Scales of Infant and Toddler Development – Third Edition (BSID-III), Ages & Stages Questionnaires: Social-Emotional (ASQ:SE) and the Hollingshead Two-Factor Index of Social Position (SES).ResultsThe cognitive, language and motor composite scores of BSID-III were considerably lower in the exposed group than in the control group. Mean differences adjusted for age and parental SES ranged from − 13.3 (95% confidence interval, CI: -18.6 to -8.0) to -17.7 (95% CI: -23.3 to -12.2). Suboptimal fidgety movements and monotonous movement character had high sensitivity (0.94 to 0.74), but low specificity (0.10 to 0.32), while sensitivity and specificity of the MOS-R was around 50 and 60%, respectively.ConclusionsNeurodevelopmental outcome at two years of age was poorer in a group of children exposed to alcohol and/or drugs in pregnancy compared with a control group of healthy, unexposed children. Sensitivity of suboptimal fidgety movements and monotonous movement character at three months of age for later neurodevelopmental outcome was high to acceptable, but the MOS-R had limited sensitivity.

Abstract A119: Disparities in mammography screening adherence throughout phases of the COVID-19 Pandemic: Results from the 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System

Abstract A119: Disparities in mammography screening adherence throughout phases of the COVID-19 Pandemic: Results from the 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System

Abstract A027: Ethnic variations in breast cancer risk factors distribution in Guam, HIPIMR study

Abstract A027: Ethnic variations in breast cancer risk factors distribution in Guam, HIPIMR study

Abstract A024: Exploring liver cancer risk factors by birth cohort: An electronic health record (EHR)-based epidemiologic cohort study

Abstract A024: Exploring liver cancer risk factors by birth cohort: An electronic health record (EHR)-based epidemiologic cohort study

Abstract B014: Cannabis use among cancer survivors and its association with cardiometabolic risk factors: Findings from the All of Us Research Program

Abstract B014: Cannabis use among cancer survivors and its association with cardiometabolic risk factors: Findings from the All of Us Research Program

Smoking and snus use among youth: A longitudinal analysis of risk factors and socioeconomic profile

Smoking and snus use among youth: A longitudinal analysis of risk factors and socioeconomic profile

Abstract A111: Leveraging African American women as change agents to reduce obesity-related breast cancer risk: An evaluation of a network-based pilot intervention promoting the Mediterranean diet

Abstract BACKGROUND: Obesity is a key risk factor for breast cancer (BC) incidence, recurrence, and mortality among post-menopausal African American (AA) women. Many older AA women are likely to report fewer healthy dietary behaviors, and those who are overweight or obese are likely to share similar dietary patterns as their social networks (SNs). AA women are also likely to receive information on BC risk from their SNs. Thus, AA women who share information on healthy dietary behaviors are well-positioned to become change agents toward reducing obesity and improving BC outcomes among their SNs. This presents a novel opportunity to increase the impact of evidence-based (EB) interventions focused on reducing obesity-related BC risk. This study aimed to assess the effects of the MedDiet-SN pilot intervention among participants trained as change agents to improve obesity-related BC risk reduction behaviors for themselves and their SNs through EB information sharing. Methods: MedDiet-SN was a 10-week, pre-/post- pilot intervention promoting the uptake of the Mediterranean diet, with participant training on effective EB information sharing. A community-based participant advisory board informed the pilot. Study procedures were IRB approved. Eligible participants were AA women, ≥60 years old, overweight or obese, Chicago area residents, and with no severe health conditions. Sixteen women participated, and 30 of their SN members (age ≥18 years) were recruited through participant referral. Predictors included time from pre- to post-study and session dosage for participants, and participant EB information sharing on healthy eating for SN members. Outcomes for both groups included BC and diet knowledge, dietary change attitudes (motivation, self-efficacy), dietary behavior change, and BMI. EB information sharing on healthy eating was an additional outcome for participants. Bivariate and multivariate analyses were performed to assess outcomes. Results: In crude and adjusted time models, participants showed improved knowledge, behavior change, BMI, and EB information sharing (p<0.05). In adjusted dosage models, participants showed improved knowledge, attitudes, and EB information sharing (p<0.05). SN members showed improved attitudes and behavior change based on participant EB information sharing on healthy eating (p<0.05). In addition, there was a high concordance between participant EB information sharing and SN EB information learned (>70%). CONCLUSION: This research is innovative in that it 1) shows the effectiveness of a network-based intervention promoting healthy dietary behaviors for obesity-related BC risk reduction among AA women, 2) supports the value of scaling up interventions by leveraging participants as change agents for EB information sharing among SNs, and 3) provides a contribution to emerging research on positive intervention spillover effects to SNs. It is anticipated that results from this study will inform the development of future network-based interventions that aim to reduce obesity-related BC risk and improve health outcomes for AA women. Citation Format: Nyahne Bergeron, Mona Strahan, Patricia Hardmon, Marja Stanford- Leak, Anita Stevens, Annie Young, Devyanne Ward, Lois White, Eunhye Lee, Lisa Tussing-Humphreys, Marian Fitzgibbon, Yamilé Molina. Leveraging African American women as change agents to reduce obesity-related breast cancer risk: An evaluation of a network-based pilot intervention promoting the Mediterranean diet [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A111.

Abstract C098: CYR61 expression in prostate cancer patients at City of Hope

Abstract In the US, African-American (AA) and Hispanic/Latino (H/L) men have higher rates of advanced prostate cancer (PCa), increased PCa-specific mortality, and are more likely to undergo metastasis than non-Hispanic White (NHW) men attributed to a lack of access to early screening, and a higher prevalence of risk factors such as obesity, diet, and genetic differences. Consequently, effective treatment of advanced PCa and elimination of racial and ethnic disparities for this malignancy require the identification of mechanisms of disease progression. In PCa, the cysteine-rich angiogenic inducer 61 (CYR61) contributes to malignant cell growth through interactions with extracellular ligands, such as integrins avb3 and a6b4. In previous studies, we have found that CYR61 is upregulated in metastatic PCa cell lines and knockdown of this protein significantly reduced metastatic cell proliferation, viability, prostasphere formation, and activation of the PI3/AKT pathway, indicating a potential utilization of CYR61 inhibition in the therapy of metastatic PCa. Interestingly, we have observed that in metastatic PCa cell models, IGF1 induction increased CYR61 protein expression. However, the correlation between PCa aggressiveness and levels of CYR61 in tumor-derived tissues from patients is poorly studied. Our goal with this study is to identify possible correlations in CYR61 expression that may reflect health disparities in PCa outcomes. We used in silico analyses from whole exome paired tumor/normal DNA sequencing and tumor RNA sequencing data available on 542 PCa cases in the City of Hope POSEIDON database to determine whether gene expression of CYR61 and IGF1 was correlated with genetic ancestry, Gleason score, and tumor purity. In univariate analyses, we found that H/L PCa cases had significantly higher levels of expression of CYR61 than NHW PCa cases (p = 0.043) and that both H/L and AA PCa cases had higher IGF1 expression levels, although only significant in AA (p=0.031). We also found that PCa patients with Gleason scores of 8 and higher had significantly lower expression of IGF1 than those with Gleason scores of 7 or less (p=0.006). Both CYR61 and IGF1 expression levels were significantly lower in those with luminal B (p=0.00000000053, p=0.000009, respectively) and with basal subtypes (p=0.00035, p=0.000069, respectively compared to luminal A subtype. Tumor purity was estimated by RNA-seq based on 141 genes specific to stroma and 141 genes specific to immune cells. CYR61 expression was significantly correlated with stromal and immune infiltration. These results suggest that reduced CYR61 expression is associated with more aggressive PCa. Additional analyses are ongoing to understand the interplay of variables of race and ethnicity, age, Gleason score, and tumor purity and to investigate outcomes of biochemical recurrence and death from PCa. Citation Format: Greisha L. Ortiz-Hernandez, Yuan Chun Ding, Susan L. Neuhausen. CYR61 expression in prostate cancer patients at City of Hope [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C098.

Risk factors and birth outcomes of preterm birth subtypes: a case-control study of singleton natural pregnancy

ObjectiveThe objective of the study was to identify the risk factors correlated with spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB), as well as to compare the pregnancy outcomes...

Anal carcinoma - exploring the epidemiology, risk factors, pathophysiology, diagnosis, and treatment

Anal carcinoma is a relatively rare tumor that accounts for approximately 2% of gastrointestinal malignancies and less than 7% of anorectal cancers. Most anal tumors originate between the anorectal junction and the anal verge. Risk factors for the disease include human papillomavirus infection, human immunodeficiency virus, tobacco use, immunosuppression, female sex, and older age. The pathogenesis of anal carcinoma is believed to be linked to human papillomavirus-related inflammation, leading to dysplasia and progression to cancer. Squamous cell carcinoma is the most common type of anal tumor, with an annual incidence of approximately 1 to 2 per 100000 persons. Treatment regarding anal cancer has emerged over time. However, chemoradiation therapy remains the mainstay approach for early localized disease. Patients with metastatic disease are treated with systemic therapy, and salvage surgery is reserved for disease recurrence following chemoradiation. This article aims to provide background information on the epidemiology, risk factors, pathology, diagnosis, and current trends in the management of anal cancer. Future directions are briefly discussed.

Resilience among older adults with multimorbidity using the Connor-Davidson scale in the Canadian Longitudinal Study on Aging: health behaviour, socio-economic, and social support predictors

ObjectiveMultimorbidity is recognized as a serious health condition faced by a majority of older adults. Research investigating adaptive responses to multimorbidity, termed multimorbidity resilience, has been growing. This paper examines protective and risk factors, with a focus on health behaviours, socio-economic resources, and social support using an established measure of resilience (Connor-Davidson Resilience Scale) among older adults, focusing on older persons with two or more concurrent chronic conditions.MethodsUsing Baseline (2011–2015), Follow-up One (2015–2018), and Follow-up Two (2018–2021) data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we tested hypotheses using 13,064 participants aged 65 years and older, who completed all waves and reported two or more of 27 chronic conditions, for the full sample of multimorbid individuals and three multimorbidity clusters: Cardiovascular/Metabolic, Musculoskeletal, and Mental Health. Associations between protective and risk factors and resilience were examined using linear regression to model the Connor-Davidson resilience scale, adjusting for illness context and social determinants of health.ResultsAmong all multimorbid individuals, the strongest associations with resilience were found for higher self-rated health, greater sleep satisfaction, better appetite, higher household income, more relatives and friends, being overweight (compared to normal weight), fewer housing problems, and fewer skipped meals. Weaker associations were found for non-smokers, less alcohol consumption, less pain, sedentary behaviour, being non-married (compared to married), and among Canadian born (compared to foreign). The analyses for the three multimorbidity clusters were largely replicated for the three multimorbidity clusters, but with some nuances depending on the cluster.DiscussionThis research provides confirmatory evidence for several protective and risk factors affecting the ability to cope and recover from multimorbidity adversity among older adults. There are consistent patterns for the multimorbidity disease clusters, but some distinct relationships arise that are worthy of attention. The implications of the findings for modifiable health behaviours and socio-economic factors are discussed for their public health and clinical relevance.

Parental Socioeconomic Status and an Infant’s Risk of Hospital Admission for RSV

Abstract Background While clinical risk factors for RSV bronchiolitis are well established, data on socioeconomic risk factors is lacking. We explored the association of parental education, income, and employment status on an infant’s risk of hospitalization for RSV bronchiolitis. Methods This population-based retrospective case-control study covered all RSV-related hospital admissions of under 1-year old children in Finland between 2004 and 2018. Controls were matched by month and year of birth, sex, province of residence, and family size. Registry data were linked using unique personal identity codes. Cases and controls were compared using adjusted odds-ratios (aOR) calculated for socioeconomic outcomes including maternal and paternal education, household income, and parental employment. Results A total of 10 767 infants and 50 054 controls were included in the study. Lower parental education significantly raised the risk for RSV hospital admission in infants, the risk growing with decreasing education levels; aOR 1.03 (0.96-1.09) with post-secondary education, 1.12 (1.05-1.2) with secondary education, and 1.33 (1.2-1.47) with primary education. Combined parental income was not significant: aOR 0.97 (CI 0.91-1.05), 1.02 (CI 0.95-1.1), 1(CI 0.92-1.08) and 0.94 (CI 0.85-1.04), respectively with decreasing income level. Unemployment of both parents seemed to be a risk factor for the child’s RSV hospital admission, aOR 1.24 (1.12-1.38). Conclusions Lower parental socioeconomic status may increase the risk of an infant’s RSV hospitalization. Socioeconomic risk factors should be considered when designing RSV infection primary prevention strategies.

Typologies of Psychiatric Diagnoses Among Inpatients with Recent Suicide Attempts

Objective Psychiatric multimorbidity is a well-documented risk factor for suicide. However, diagnostic heterogeneity and patterns of comorbidity likely exists within the population of those who attempt suicide. Person-centered statistical approaches, such as latent class analysis (LCA), extract distinguishable groups differentiated by prevalence and comorbidity of psychiatric disorders. Method The present study used LCA to identify typologies of psychiatric heterogeneity in a sample of 213 inpatients (M age = 33.04 [SD = 12.67]; 57.3% female; 62.4% White; 23.9% Hispanic/Latino) with a history of suicide attempt who were recruited for a suicide prevention clinical trial. Class differences in suicide history characteristics; demographic characteristics; and cognitive-affective and behavioral risk factors, obtained from an initial evaluation involving the administration of a semi-structured diagnostic interview, suicide risk assessment, and battery of self-report measures, were explored. Results LCA identified three classes in the best-fitting solution: Depressive-High Comorbidity (n = 68), Depressive-Low Comorbidity (n = 86), and Bipolar (n = 59). The Depressive-Low Comorbidity class reported less severe suicidal ideation (p < .001), anxiety (p < .001), stress (p < .001), unlovability beliefs (p = .006), and impulsivity (p < .001). The Depressive-Low Comorbidity class also reported fewer actual attempts than the Bipolar class (p = .001) and fewer interrupted attempts than the Depressive-High Comorbidity class (p = .004). Conclusions The Depressive-High Comorbidity and Bipolar classes consistently endorsed higher levels of suicide risk factors. These findings may help to illuminate typologies of suicide attempters with unique clinical needs, which is an essential step toward personalized medicine.

Gambling disorder gender analysis: social strain, gender norms, and self-control as risk factors

IntroductionGender differences in problem gambling have attracted much attention in recent gambling literature. However, relatively little is known about how gender norms relate to social strain and self-control in predicting gambling disorder within a spousal context. This study aimed to increase knowledge about gambling disorder in Chinese married couples by assessing the three-way interaction effects between social strain, self-control, and gender norms.MethodsA total of 1,620 Chinese married couples were recruited from a representative sample of households in Hong Kong.ResultsThe results of the generalized ordered logit model revealed the self-control mitigation effect of composite strain on the propensity for gambling disorder is strong in men who accept traditional gender norms. In contrast, in women who accept traditional gender roles, self-control attenuates the effect of recent stressful life events on the propensity for gambling disorder, but self-control exacerbates the effect of negative relationships with offspring on the propensity for gambling disorder.DiscussionAlthough reinforcing self-control is a protective factor that can alleviate social strain and disordered gambling for both men and women, the prominent contribution of gender norms to the self-control exacerbation effect deserves close attention for social workers who provide services to these gambling families.

Comprehensive strain assessment and mortality after acute myocardial infarction: a retrospective observational study based on the Essen Coronary Artery Disease registry

Background and aimsCurrent ESC guidelines on the management of patients after acute myocardial infarction only include the evaluation of left ventricular (LV) function by assessment of the ejection fraction in...

"New mining schemes, same old problems?"; Risk factors and health challenges in underground community mining in Ghana

Abstract Ghana's small-scale mining sector has long been a cornerstone of its economy and a vital source of livelihood for many communities. However, the sector is plagued by significant challenges, including environmental degradation, health and safety risks, and illegal practices. In response, the Ghanaian government introduced the Community Mining Scheme (CMS), a new mining model designed to promote local community participation in artisanal small-scale gold mining (ASGM). This study examines the workplace risk factors and associated health challenges faced by ASGM miners under the CMS, drawing on interviews with fifty underground CMS miners in Ghana. Our findings reveal that miners continue to face numerous health and safety challenges, including inadequate lighting, poor ventilation, exposure to noise and odors, unsupported or poorly supported loose materials, non-use of personal protective equipment (PPE), high dust levels, and unsafe blasting practices. Additionally, health concerns such as skin rashes, musculoskeletal injuries, and the risk of mercury poisoning persist. These challenges mirror those reported in the literature on unregulated and illegal ASGM in Ghana, indicating that existing issues remain unresolved under the CMS. To prevent the undermining of this initiative, it is crucial to adopt progressive practices, such as localized coping strategies and the recruitment of trained professionals to lead ASGM operations within the CMS. Enhancing miners' risk perception through targeted outreach and awareness campaigns is also essential. Further recommendations for mitigating safety risks and health challenges are discussed in the article.

Moderate to severe anemia at admission increases the risk of complications in patients over 60 years with hip fracture

BackgroundAnemia frequently occurs in patients with hip fractures and represents a risk factor that can potentially be altered. To evaluate the association between admission anemia and complications in older hip fracture patients while exploring the potential impact of anemia on complications from the perspective of overall, operation and non-operation.MethodsThis retrospective study enrolled in-patients over 60 years old with hip fractures from January 2020 to November 2023. At admission, anemic patients were identified as having a hemoglobin level below 12 g/dL in females and 13 g/dL in males. Anemia was further classified as mild, moderate, or severe. Data encompassing demographics, comorbidities, medications, information on fracture and surgery, and complications were collected.ResultsA total of 462/679 patients had anemia, including 348, 105, and 9 with mild, moderate, and severe anemia, respectively. A total of 281 individuals experienced complications, including 212 and 69 with and without operation, respectively. Multivariate regression analysis identified anemia as a greater risk for acute heart failure (OR = 2.056, p = 0.037, 95% CI 1.043–4.052) than non-anemia. Moderate to severe anemia was a significant risk factor for any complication (OR = 1.584, p = 0.028, 95% CI 1.050–2.390), ≥ 2 (OR = 2.364, p = 0.001, 95% CI 1.443–3.872) or 3 (OR = 2.311, p = 0.022, 95% CI 1.131–4.720) complications, delirium (OR = 2.301, p = 0.018, 95% CI 1.156–4.579), venous thromboembolism (OR = 2.031, p = 0.042, 95% CI 1.025–4.025), and acute heart failure (OR = 2.095, p = 0.016, 95% CI 1.145–3.834), compared with mild to non-anemia. Similar results were observed in operated patients, while anemia and its severity were not associated with complications in non-operated patients.ConclusionModerate to severe anemia caused complications in elderly hip fracture patients, but it was not observed in non-operated individuals. These findings would support orthopedic physicians’ hierarchical management of anemic patients.

Oral cancer in young adults: incidence, risk factors, prognosis, and molecular biomarkers

Oral cancer in young adults: incidence, risk factors, prognosis, and molecular biomarkers

Orthostatic blood pressure phenotypes prevalence in type 2 diabetes mellitus

ABSTRACT Background and aims Orthostatic hypotension (Ohypo) and hypertension (Ohyper) have emerged early markers for high risk of cardiovascular events. Data on the prevalence and risk factors of Ohypo and Ohyper in patients with type 2 diabetes (T2D) are scarce. Methods: Within the framework of the Brazilian Diabetes Study, this is an observational, cross-sectional study. The diagnosis of Ohypo was based on drops in systolic blood pressure (SBP) ≥20mmHg or diastolic blood pressure (DBP) ≥10mmHg when transitioning from sitting to standing. Ohyper was defined by either a SBP increase ≥20mmHg during this transition or a sustained elevation to 140mmHg in otherwise normotensive individuals. Results: The study population (n = 900) had a mean age of 57 ± 8 years, 57% male and the median T2D duration was 8 years. Sitting SBP and DBP were 140 ± 20 mmHg and 82 ± 11 mmHg, respectively. Of the total sample, 108(12%) had Ohypo and 83(9%) had Ohyper. Each 1-year increase in age was associated with 3.7% higher odds of orthostatic hypotension (OHypo). Additionally, each 1 mmHg increase in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) corresponded to a 3.0%, 5.5%, and 5.4% increase in the odds of OHypo, respectively. Ohyper risk did not associate with age but showed an inverse relationship with sitting BP values. Conclusions: Ohypo and Ohyper are common occurrences in patients with T2D. Advanced age significantly elevates the risk of developing Ohypo, whereas sitting BP emerges as an independent risk factor for both Ohypo and Ohyper.

Clinical characteristics and prognostic factors of pulmonary and extrapulmonary cryptococcosis

BackgroundCryptococcosis is progressively acknowledged among people, irrespective of the human with or without immunodeficiency virus (HIV). This change in epidemiology has been recorded in recent years, prompting closer examination and a broader understanding of the disease manifestations and risk factors.MethodsThe data of cryptococcal infections in China during 11 years were retrospectively analyzed. According to the position of infection, the patients were categorized into the pulmonary infection group and extrapulmonary infection group. The composition of the two groups was compared, and the potential risk factors of disseminated infection were analyzed. Logistic regression was used to analyze the prognostic risk factors of the disease.ResultsA total of 165 patients were enrolled. 113 (68.5%) were male, and the age was 47.49 (18–82) years. 101 cases (61.2%) had a normal immune function and 64 cases (38.8%) had impaired immune function. 45 patients had extrapulmonary infection, involving the central nervous system, bone and joint, skin and bloodstream, and 120 patients had simple pulmonary infection. The mortality of the extrapulmonary infection group (48.9%) was significantly higher than that of the pulmonary infection group (0.8%). According to univariate logistic regression analysis, immune status (hazard ratio [HR], 4.476; 95% confidence interval [CI], 1.725–11.618; P = 0.002), infection position ([HR], 113.826; [CI], 14.607-886.967; P < 0.001), white blood cell count, ([HR],1.209;[CI], 1.054–1.386; P = 0.007), hemoglobin ([HR], 0.970; [CI], 0.955–0.986; P < 0.001), platelet count ([HR], 0.993; [CI], 0.987–0.999; P = 0.026), neutrophil percentage ([HR], 1.115; [CI], 1.065–1.168; P < 0.001), lymphocyte percentage ([HR], 0.875; [CI], 0.827–0.927; P < 0.001), neutrophil-to-lymphocyte Ratio (NLR) ([HR], 1.144; [CI], 1.072–1.221; P < 0.001), monocyte percentage ([HR], 0.752; [CI], 0.618–0.915; P = 0.004) were related to the prognosis. Multivariate logistic regression analysis showed that the infection position was remained related to the prognosis with statistical significance ([HR], 0.018; [CI], 0.001–0.384; P = 0.001).ConclusionExtrapulmonary infection of Cryptococcosis is an important risk factor for prognosis. High levels of neutrophils and NLR, and low levels of lymphocytes and monocytes may lead to disseminated infection of Cryptococcosis. Further studies are needed to reduce the occurrence rate of extrapulmonary infection and mortality.