Risk Factors Research Articles

Vitamin-D induced neurological disorders: A review

Vitamin D inadequacy represents a pervasive global health concern, impacting an estimated 1 billion individuals. Beyond its well-established role in calcium regulation and skeletal health, contemporary investigations reveal that vitamin D serves as a crucial neuro-steroid hormone, exhibiting diverse protective and regulatory functions within the brain. Neurons and glial cells express vitamin D receptors, with particularly elevated levels found in key regions such as the hippocampus, hypothalamus, thalamus, subcortical grey nuclei, and substantia nigra. Insufficient levels of vitamin D have been associated with compromised functionality in various cerebral processes. The deficiency in serum 25-hydroxyvitamin D concentrations may be reversible, providing a potential avenue for intervention. Given the limited availability of efficacious therapeutic alternatives, beyond disease-modifying strategies, comprehensive exploration of various risk factors is imperative. Addressing these factors in the realm of neurology may contribute to ameliorating brain disorders. Associations between genetic and environmental factors and prolonged vitamin D insufficiency as a predisposing element for diverse neurological conditions necessitate thorough examination. This underscores the importance of scrutinizing the role and justification of vitamin D-based therapeutic interventions. The straightforward and cost-effective nature of such interventions may offer potential benefits in both primary and secondary prevention of a spectrum of neuropsychiatric illnesses.

Is Covid- 19 at home hospitalization a solution for better management of emerging and re-emerging infections?

Covid 19 at home hospitalization (AHH) is an attractive alternative to full hospitalization for some patients. In this context, AHH provides close monitoring of Covid-19 patients at home, as well as their families, to relieve hospital overcrowding. Objective: To demonstrate the impact of extended covid-19 at home hopitalization (AHH) in patient management and its role in absorbing the epidemic explosion, and determine the epidemiological, clinical and psychological data of patients and their families with covid-19. Materials and methods: This was a prospective, longitudinal, exhaustive study of symptomatic patients suspected of having Covid-19 and their family and friends who met the inclusion and exclusion criteria; were identified by the triage centers, the public hospital (PHE) and the HUC Batna’s hospital; and were hospitalized in the expanded Covid-19 AHH unit at the PHE in Batna during the period from August 09, 2020 to April 30, 2021. Data collection was based on a pre-established data sheet containing epidemiological, clinical and psychological data. Results: From1449 patients reported, 190 refused to answer the questionnaire and 205 could not be contacted. We were able to compile 1054 covid-19 households, corresponding to 1054 patients meeting the inclusion and exclusion criteria, with 6607 family contacts. The average age in our series was 58.02 years, with a slight male predominance (sex ratio 1.1). 53.22% of our patients had one or more risk factors, the most frequently found being advanced age, cardiovascular pathologies and diabetes. Benign casess were the most frequent, 43.6% versus 25.6% of severe forms. Care was taken early in 56.3% of cases. The outcome was favorable in 88% of cases, with 12% of our patient’s requiring hospitalization, and 0 deaths. Conclusion: The value of this expanded Covid-19 AHH unit deserves to be supported and converted into a permanent unit to manage all emerging and re-emerging infections.

Type 2 diabetes mellitus: Prevalence and risk factors associated, among patients at Franceville Amissa Bongo regional Hospital, Gabon

Introduction: To assess the type 2 diabetes mellitus prevalence and risk factors associated, among patients, at Franceville Amissa Bongo regional Hospital Gabon, A prospective and cross-sectional study was carried out between June and September 2023. Materials and Methods: Blood glucose was measured using blood drawn from each participant, according to American Diabetes Association standards. As elsewhere, correlations between type 2 diabetes mellitus prevalence and the variables obtained, were carried out using R software version 3.6.1. Odds ratios were calculated within a 95% interval, and results were considered significant when the p-value ≤ 0, 05. Results: Blood samples from 328 people, with a mean age of 48.24 ± 13.8 years, were collected for this study. The type 2 diabetes mellitus prevalence was 13.72% (95% CI: [0.10- 0.18]), (n=45). After univariate analysis, adjustment of variables by binary multivariate logistic regression, indicated female gender (Ajusted OR = 0.53; 95% CI [1.52; 39.41] p = 0.014*), cohabiting (Ajusted OR = 92.73 ; 95% CI [2.9; 29.05] p = 0.010*), inactive (Ajusted OR = 9.17; 95% CI: [1.11; 75.05] p = 0.040*), overweight/obese (Ajusted OR = 0. 017; 95% CI: [0.002; 0.18] p = 0.010*), a family history of type 2 diabetes mellitus (Ajusted OR = 50.13; 95% CI [8.87; 283.50] p = 0.000*) and high triglyceride levels (Ajusted OR = 0.03; 95% CI [0.003; 0.36] p = 0.005*), as type 2 diabetes mellitus potential risk factors, in the present study. Conclusion: The type 2 diabetes mellitus prevalence in the study population was high. Prevention and control of this disease through early detection are essential.

Geospatial analysis of cholera outbreak mapping of prone areas in communities in Ondo State, Southwestern, Nigeria

Cholera stands as an abrupt intestinal infection brought about by the consumption of food or water contaminated with comma-shaped bacteria, specifically Vibrio cholerae. The prime objective of this study is to employ Geospatial methodologies in the mapping of cholera occurrences within Ondo State. Geographical Information System (GIS) is utilized to chart the instances of cholera outbreaks. The pivotal aims of this endeavor encompass: · delineating the prevalence of cholera incidents across all Local Government Areas (LGA) within Ondo State; · assessing the trajectory of cholera occurrences within the research locale; · identifying the principal causes of cholera within Ondo State; · Outlining and suggesting potential strategies to counteract the incidence of cholera in the state; and · Forecasting the occurrence of cholera cases over the subsequent 5 to 10 years. Recorded instances of cholera were sourced from the ministry of health, supplemented by the use of questionnaires to amass primary data. The research leveraged both ArcGIS and SPSS as analytical tools. ArcGIS facilitated the mapping of cholera causes and plausible remedies. It is evident that Local Government Areas (LGAs) boasting larger populations recorded more cholera cases compared to their smaller counterparts. Furthermore, it is observed that the highest count of reported cholera cases across all LGAs was reached in 2014. The study establishes the potential for early diagnosis and preventive measures to obliterate the disease and integrate the resulting database into the primary health sector. It was discovered that there’s know significant differences in reported cases of cholera in all the Local Government Areas (LGA) despite the fact that the values looks similar or varies. The study recommends advancing the field of cholera mapping to unveil risk factors and preclude potential cholera outbreaks within the state. Anticipated production of risk maps will identify regions prone to future cholera attacks within the state.

Frequency and pattern of acute kidney injury in patients with acute stroke

Background and objective: Stroke is a severe disease of the nervous system resulting in disability and death of the affected individual. Acute kidney injury (AKI) which is a clinical syndrome due to sudden renal function decline is considered as an important factor that increases fatality following a stroke. Thus, this study was conducted to determine the frequency and pattern of AKI in stroke patients and the outcome of patients with stroke and AKI. Methods: This study was a descriptive cross-sectional study, carried out at the Delta State University Teaching Hospital (DELSUTH), Oghara, Delta state, which is a public tertiary health institution in Delta state in a semi-urban area in southern Nigeria. Results: The mean age of patients was 58.9 ± 14.2 years. Slightly above half (53.7%) of the patients were males. Haemorrhagic stroke was the most common type of stroke. Hypertension was the most frequent co-morbid condition (59.0%). Twenty (14.9%) had acute kidney injury, of which stage one AKI was the most dominant (75.0%). Majority of the patients (79.9%) survived. Having sepsis was a significant factor associated with the presence of AKI. None of the clinical characteristics was associated with outcome of patients. Conclusion: The frequency of AKI in stroke patients was 14.9%, with majority of the patients presenting with stage 1 AKI. Presence of sepsis was a significant risk factor for development of AKI in patients with acute stroke, while hypertension was the most prevalent comorbid condition in patients with acute stroke, thus the need for continuous screening of stroke patients for hypertension.

Epidemiological, clinical and biological profile of COVID-19 in patients hospitalized at the Avicenne Military Hospital in Marrakech

In late December 2019, a series of cases of viral pneumonia caused by a novel coronavirus emerged in Wuhan, China, and quickly spread to all continents. This coronavirus, identified in respiratory tract samples, was named SARS-CoV-2 for Severe Acute Respiratory Syndrome Coronavirus-2 by the ICTV (International Committee on Taxonomy of Viruses). The disease it causes was designated COVID-19 for Coronavirus Disease 2019 by the Word Health Organization. Most often, SARS-CoV-2 infection is responsible for a mild or moderate form, with the most typical clinical presentation being that of a febrile respiratory infection with dry cough, dyspnea, fatigue, and myalgia. Approximately 10-15% of cases are severe, and 5% are critical. Cases of reinfection have been described. Treatment for COVID-19 is currently symptomatic, relying on supportive care. The present study aims to investigate the demographic, clinical, and diagnostic aspects, as well as the study of risk factors associated with SARS-CoV-2 infection among 318 patients admitted to the Avicenne Military Hospital in Marrakech during the first wave of the pandemic. This is a retrospective descriptive and analytical study involving 318 cases of SARS-CoV-2 infection, diagnosed at the microbiology-virology department, and followed up in various non-intensive care units of the Avicenna Military Hospital in Marrakech, during the period of the first wave of the epidemic in Morocco, schematically between March 22, 2020, and July 19, 2020. For patients who developed pneumonia, 20% were diabetic and 13.3% were hypertensive. A quarter of patients with pneumonia experienced desaturation upon admission. In the multivariate logistic regression model, risk factors associated with the development of pneumonia and the various disease outcomes included advanced age and absence of a history of contact with a confirmed case. In the univariate analysis, hyperleukocytosis, neutrophilia, lymphopenia, eosinopenia, anaemia, hyperferritinaemia with elevated aspartate aminotransferase, hyponatraemia and fasting hyperglycaemia were significantly associated with a higher risk of an unfavourable outcome. Patients who presented with pneumonia on admission had an unfavourable outcome during their hospitalisation compared with patients who did not develop pneumonia. The statistically significant risk factors associated with an unfavourable outcome were advanced age (>60 years) with p <0. 001: OR=1.194; 95%IC= [1.114-1.278], absence of contact with a confirmed case (p <0.001 : OR= 43.138; 95%IC= [8.893-209.263]), presence of comorbidity (P<0.001 : OR=11. 503; 95%CI= [3,306-40,028]), mainly diabetes (P<0.001: OR=16,971; 95%CI= [4,267-67,504]) and arterial hypertension (P<0.001: OR=18,812; 95%CI= [3,977-88,954]). The study of the epidemiological, clinical and biological characteristics of COVID 19 at the Avicenne military hospital in Marrakech has enabled us to gain a better understanding of the profile of our patients with SARS-CoV-2 infection, and then to detect shortcomings in terms of prophylaxis, diagnosis and management, in order to be able to provide the necessary solutions aimed at further improving the quality of care for this population.

An article reviews of anti-cataract activity of hydroalcoholic extract of Annona squamosa leaves

Other medicines and natural remedies have been used for the treatment and health of people since ancient times. Medicinal plants are considered useful and of the most important purpose. It can be applied to botanical medicines, nutraceuticals, medicines, food products, cosmetics, etc. There is an increasing demand for. Custard apples. It is a versatile tree whose fruit is edible and a source of medicine and products. It is used as antioxidant, antidiabetic, hepatoprotective, cytotoxic activity, genotoxicity, antitumor activity, anti-inflammatory drug. Cataract is nothing but visual impairment caused by a defect in the lens. It is one of the causes of blindness worldwide; It accounts for approximately 42% of all blindness. One significant risk factor for the development of posterior subcapsular cataracts is long-term glucocorticoid usage. The preventive and therapeutic effects of many herbs such as onion, Chinese cinnamon and ginkgo, which have protective properties against cataracts, have been reported. This review demonstrates the therapeutic potential of custard apple leaf extract as an anti-cataract effec

A healthy habitual score for dietary intake is associated with primary dysmenorrhea among adolescent school girls

Background: Primary dysmenorrhea is one of the most common gynecological complaints among adolescent and young females in their reproductive age that affects their daily activities and social life. Nutritional habits are considered as risk factor for primary dysmenorrhea. ‘Thus the aim of our study was to assess the relation between healthy habits score for dietary intake and prevalence of primary dysmenorrhea. Methods: The present study was conducted on 432 adolescent school girls (218 girls with nil to mild dysmenorrhea and 214 girls with moderate to severe dysmenorrhea). Healthy habitual scores (HHS) was calculated from 5 modifiable dietary intake habits considering high risk habit as ‘0’ and low risk habit as ‘1’ giving a composite score ranging from 0 to 5. We classified the healthy life style score into three category: 0-2 as low; 3 as medium and 4-5 as high. Correlation between HHS and its components with incident of primary dysmenorrhea were evaluated. HHS and risk of primary dysmenorrhea were evaluated using logistic regression analysis. The significance level of the all the tests were considered at a level of 0.05. Results: Significant correlation was obtained between incident of primary dysmenorrhea and all tested habits. Magnitude of correlation was higher for HHS than individual habit. Among tested habitual factors sugar intake, skipping breakfast and frequency of junk food intake was positively correlated where as negative correlation was obtained between primary dysmenorrhea and dietary intake of vit-E and calcium. Considering low HHS as reference group odd ratio significantly low in medium and high HHS groups. Thus risk of primary dysmenorrhea was more among adolescent girls those led unhealthy dietary habits like take more sugar, frequently take junk foods and skipping breakfast and take vit-E and calcium below recommended amount. Conclusion: Avoiding of Junk food, skipping breakfast and intaking of vit-E and calcium as per recommended amount and restricting sugar intake is recommended as a healthy dietary habit to minimize the risk of primary dysmenorrhea.

Association of NOTCH3 Variant Risk Category With 2-Year Clinical and Radiologic Small Vessel Disease Progression in Patients With CADASIL.

Pathogenic variants in NOTCH3 are the main cause of hereditary cerebral small vessel disease (SVD). SVD-associated NOTCH3 variants have recently been categorized into high risk (HR), moderate risk (MR), or low risk (LR) for developing early-onset severe SVD. The most severe NOTCH3-associated SVD phenotype is also known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aimed to investigate whether NOTCH3 variant risk category is associated with 2-year progression rate of SVD clinical and neuroimaging outcomes in CADASIL. A single-center prospective 2-year follow-up study was performed of patients with CADASIL. Clinical outcomes were incident stroke, disability (modified Rankin Scale), and executive function (Trail Making Test B given A t-scores). Neuroimaging outcomes were mean skeletonized mean diffusivity (MSMD), normalized white matter hyperintensity volume (nWMHv), normalized lacune volume (nLV), and brain parenchymal fraction (BPF). Cox regression and mixed-effect models, adjusted for age, sex, and cardiovascular risk factors, were used to study 2-year changes in outcomes and differences in disease progression between patients with HR-NOTCH3 and MR-NOTCH3 variants. One hundred sixty-two patients with HR (n = 90), MR (n = 67), and LR (n = 5) NOTCH3 variants were included. For the entire cohort, there was 2-year mean progression for MSMD (β = 0.20, 95% CI 0.17-0.23, p = 7.0 × 10-24), nLV (β = 0.13, 95% CI 0.080-0.19, p = 2.1 × 10-6), nWMHv (β = 0.092, 95% CI 0.075-0.11, p = 8.8 × 10-20), and BPF (β = -0.22, 95% CI -0.26 to -0.19, p = 3.2 × 10-22), as well as an increase in disability (p = 0.002) and decline of executive function (β = -0.15, 95% CI -0.30 to -3.4 × 10-5, p = 0.05). The HR-NOTCH3 group had a higher probability of 2-year incident stroke (hazard ratio 4.3, 95% CI 1.4-13.5, p = 0.011), and a higher increase in MSMD (β = 0.074, 95% CI 0.013-0.14, p = 0.017) and nLV (β = 0.14, 95% CI 0.034-0.24, p = 0.0089) than the MR-NOTCH3 group. Subgroup analyses showed significant 2-year progression of MSMD in young (n = 17, β = 0.014, 95% CI 0.0093-0.019, p = 1.4 × 10-5) and premanifest (n = 24, β = 0.012, 95% CI 0.0082-0.016, p = 1.1 × 10-6) individuals. In a trial-sensitive time span of 2 years, we found that patients with HR-NOTCH3 variants have a significantly faster progression of major clinical and neuroimaging outcomes, compared with patients with MR-NOTCH3 variants. This has important implications for clinical trial design and disease prediction and monitoring in the clinic. Moreover, we show that MSMD is a promising outcome measure for trials enrolling premanifest individuals.

Clinical characteristics and prognosis analysis of gastric cancer patients with bone metastasis

Objectives: To investigate the clinical characteristics and prognosis of bone metastasis of gastric cancer, analyze the influencing factors of bone metastasis and the effects of different treatment methods, and provide a basis for early detection and treatment optimization of bone metastasis of gastric cancer. Methods: A total of 142 gastric cancer patients with bone metastasis admitted to the First Hospital of Lanzhou University from January 2011 to December 2021 were enrolled, including 60 cases of simple bone metastasis and 82 cases of bone metastasis combined with extraosseous metastasis. 142 patients with stage Ⅲgastric cancer without distant metastasis and 142 gastric cancer patients with visceral metastasis admitted to this hospital during the same period were also enrolled for comparison. Logistic regression analysis was used to determine the influencing factors of bone metastasis, and the Cox proportional hazards regression model was used to evaluate the influencing factors of overall survival (OS) of patients with bone metastasis. Results: Among the 142 patients with bone metastasis, poorly differentiated adenocarcinoma was the main type (123 cases), and 45 patients had simultaneous bone metastasis. Rib metastasis (100 cases), spine metastasis (88 cases), and pelvis metastasis (84 cases) were more common. A total of 110 patients had multiple bone metastasis, and 82 patients had extraosseous metastasis. Results of the stage Ⅲ gastric cancer group, the visceral metastasis group, the bone metastasis group, and the bone metastasis with extraosseous metastasis group were compared. There were significant differences in age, degree of differentiation, Borrmann type, alkaline phosphatase, lactate dehydrogenase, serum calcium, alanine aminotransferase, aspartate aminotransferase, creatine kinase isoenzyme, lymphocyte, hemoglobin, platelet, CEA, CA19-9, and CA724 (all P<0.05). Multivariate logistic regression analysis showed that Borrmann type was an independent protective factor of bone metastasis of gastric cancer (type 3: OR=0.07, 95%CI: 0.01-0.64, P=0.018). Alkaline phosphatase (OR=2.54, 95% CI: 1.07-6.01, P=0.034), serum calcium (OR=2.71, 95% CI: 1.15-6.41, P=0.023), creatine kinase isoenzyme (OR=16.33, 95% CI: 1.83-145.58, P=0.012), platelet (OR=10.08, 95% CI:1.89-53.85, P=0.007), and CA19-9 (OR=2.40, 95% CI: 1.14-5.05, P=0.021) were independent risk factors of bone metastasis of gastric cancer. The median OS of the stage Ⅲ gastric cancer group, the visceral metastasis group, the bone metastasis group, and the bone metastasis with extrabony group were 47, 13, 18, and 6 months, respectively, and the difference was statistically significant (P<0.001). The median OS of patients with bone metastasis only who underwent primary tumor surgery was 33 months, better than 6 months of patients without surgery (P=0.048). Multivariate Cox regression analysis showed that extraosseous metastasis (HR=2.45, 95% CI: 1.56-3.85, P<0.001) and decreased hemoglobin (HR=1.54, 95%CI: 1.02-2.34, P=0.042) were independent risk factors of OS of gastric cancer patients with bone metastasis. Conclusions: The prognosis of gastric cancer patients with bone metastasis alone is significantly better than that of other stage Ⅳ patients. For such patients, surgery on the primary site combined with chemotherapy after full evaluation may prolong the survival time.

An Attractive Target: Do Perceptions of Physical Attractiveness Shape Victimization Risks in Women’s Prisons?

ABSTRACT Emerging research suggests that physical attractiveness may yield outcomes beyond preferential treatment, such as increasing the vulnerability to victimization during adolescence. Despite growing awareness of individual and institutional victimization risk factors during incarceration, research has yet to consider the role of physical attractiveness. Drawing on survey data collected from 223 women across two Pennsylvania prisons, this article investigates whether perceptions of physical attractiveness operate as protective or risk factors for victimization experienced while incarcerated. Logistic regression results show a significant positive association between interviewer-assessed perceptions of physical attractiveness and incarcerated women’s self-reported resident-on-resident victimization. Dominance analysis results indicate that perceptions of physical attractiveness ranked nearly as high as histories of abuse in predicting incarcerated women’s risk of victimization. This study uncovers an unintended consequence of physical attractiveness for imprisoned women, demonstrating their heightened susceptibility to in-prison victimization.

Increases in drug-related infant mortality in the United States.

We explored temporal trends in drug-related infant deaths in the United States (U.S.) from 2018 to 2022. We used data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER). A total of 295 drug-involved infant deaths were identified from 2018 to 2022 (provisional mortality data for year 2022) based on the underlying cause of death. In the U.S. from 2018 to 2022, there was a significant 2.2-fold increase in drug-involved infant mortality. The observed increases were higher in non-Hispanic White and Black infants. The findings show that drug-involved infant deaths were more likely to occur in the postneonatal period, defined as ages 28-364days (81.4 %) compared to the neonatal period. The most prevalent underlying causes of death included assault (homicide) by drugs, medicaments and biological substances (35.6 %) followed by poisoning dueto exposure to narcotics and psychodysleptics (hallucinogens) (15.6 %). The most common multiple causes of drug-involved infant deaths were psychostimulants with abuse potential of synthetic narcotics. Drug-related infant mortality has increased significantly from 2018 to 2022. These increases are particularly evident among White and Black infants and occurred predominantly in the postneonatal period. These findings require more research but also indicate the need to address drug-involved infant deaths as preventable clinical and public health issues. Effective strategies to reduce drug-involved infant deaths will require preventing and treating maternal substance use disorders, enhancing prenatal care access, and addressing broader social and behavioral risk factors among vulnerable maternal and infant populations.

Thirst symptoms in patients with heart failure: An integrative review.

To identify the risk and protective factors affecting thirst symptoms in patients with heart failure (HF) and intervention strategies to alleviate thirst symptoms. An integrative review. A total of 61 articles were retrieved. Screening yielded a total of 21 articles which were appraised for quality. The quality of studies was assessed using the Mixed Methods Appraisal Tool. Ten electronic databases were searched in October 2023, including Embase, Pubmed, CINAHL, Cochrane, Web of Science, Wiley, CNKI, VIP, CBM and WanFang. In addition, we searched grey databases and manually searched reference lists of included and relevant reviews. In total, 1644 articles were retrieved, of which 21 were included. Eight studies addressed the factors. Six themes emerged as risk factors, including demographics, severity of disease, psycho-environmental, medication, fluid restriction and homeostasis. Conversely, an increase in fluid intake, a high score of sodium restriction diet attitude and using ARB were identified as protective factors. Thirteen studies focus on intervention strategies. Five unique intervention strategies were identified, including Traditional Chinese Medicine, mint-related interventions, sour-flavour interventions, improved water restriction and cluster nursing strategy. This finding identified the factors associated with thirst symptoms in patients with HF, especially concerning the elaboration of risk factors, which suggests that healthcare professionals should focus on the risk factors for thirst in patients with HF and consciously avoid the occurrence of these risk factors. Additionally, there are considerable cultural differences in interventions, therefore, to increase adherence during symptom management, careful selection of appropriate intervention strategies based on the requirements and preferences of patients is required. While there are some therapies, there aren't enough high-quality empirical investigations. Thus, multi-centre, large-sample studies are also required in subsequent research to demonstrate the interventions' effectiveness. The nurse must notice the symptoms of thirst in HF to slow down the disease's progression and improve the patient's physical and emotional well-being. The review complies with the PRISMA guidelines for reporting systematic reviews. No patient or public contribution.

Acute colonic pseudo-obstruction in polytrauma patients.

Acute colonic pseudo-obstruction (ACPO) is characterized by severe colonic distension without mechanical obstruction. It has an uncertain pathogenesis and poses diagnostic challenges. This study aims to explore risk factors and clinical outcomes of ACPO in polytrauma patients, and contributing information to the limited literature on this condition. This retrospective study, conducted at a Level 1 Trauma Centre, analysed data from trauma patients with ACPO admitted between July 2009 and June 2018. A control cohort of major trauma patients was utilized. Data review encompassed patient demographics, abdominal imaging, injury characteristics, analgesic usage, interventions, complications, and mortality. Statistical analyses, including logistic regression and correlation coefficients, were employed to identify risk factors. There were 57 cases of ACPO, with an incidence of 1.7 / 1000 patients, rising to 4.86 in major trauma. Predominantly affecting those over 50 years of age (75%) and males (75%), with motor vehicle accidents (50.8%) and falls from height (36.8%) being the commonest mechanisms. Noteworthy associated injuries included retroperitoneal bleeds (RPB) (37%), spinal fractures (37%), and pelvic fractures (37%). Analysis revealed significant associations between ACPO and Shock Index >0.9, Injury Severity Score > 18, opioid use, RPB, and pelvic fractures. A caecal diameter of ≥12 cm had a significant association with caecal ischemia or perforation. This study underscores the significance of ACPO in polytrauma patients, demonstrating associations with risk factors and clinical outcomes. Clinicians should maintain a high index of suspicion, particularly in older patients with RPB, pelvic fractures, and opioid use. Early supportive therapy, vigilant monitoring, and timely interventions are crucial for a favourable outcome. Further research and prospective trials are warranted to validate these findings and enhance understanding of ACPO in trauma patients. Prognostic and Epidemiological, Level IV.

The prevalence and possible risk factors of gaming disorder among adolescents in China

Abstract Background Nowadays, moderate gaming behaviors can be a pleasant and relaxing experiences among adolescents. However, excessive gaming behavior may lead to gaming disorder (GD) that disruption of normal daily life. Understanding the possible risk factors of this emerging problem would help to suggest effective at preventing and intervening. This study aimed to investigate the prevalence of GD and analyze its possible risk factors that adolescents with GD. Methods Data were collected between October 2020 and January 2021. In total, a sample of 7901 students (4080 (52%) boys, 3742 (48%) girls; aged 12–18 years) completed questionnaires regarding the Gaming-Related Behaviors Survey, Gaming Disorder Symptom Questionnaire-21 (GDSQ-21); Behavioral Inhibition System and Behavioral Activation System Scale (BIS/BAS Scale); Emotion Regulation Questionnaire (ERQ); Short-form Egna Minnenav Barndoms Uppfostran for Chinese (s-EMBU-C); and Adolescent Self-Rating Life Events Checklist (ASLEC). Results The prevalence of GD was 2.27% in this adolescent sample. The GD gamers were a little bit older (i.e., a higher proportion of senior grades), more boys, with more gaming hours per week in the last 12 months, with more reward responsiveness, maternal rejecting and occurrence of negative life events (e.g., interpersonal relationships, being punished and bereavement factors). Conclusion These possible risk factors may influence the onset of GD. Future research in clinical, public health, education and other fields should focus on these aspects for provide target prevention and early intervention strategies.

Bone marrow lesion and 5-year incident joint surgery in patients with knee osteoarthritis: a retrospective cohort study

BackgroundIt is beneficial for society to discover the risk factors associated with surgery and to carry out some early interventions for patients with these risk factors. Few studies specifically explored the relationship between bone marrow lesions (BMLs) and long-term incident joint surgery.ObjectiveTo investigate the association between BML severity observed in knee osteoarthritis (OA) patients’ first MRI examination and incident knee surgery within 5 years. Additionally, to assess the predictive value of BMLs for the incident knee surgery.DesignRetrospective cohort study.MethodsWe identified patients diagnosed with knee OA and treated at our institution between January 2015 and January 2018, and retrieved their baseline clinical data and first MRI examination films from the information system. Next, we proceeded to determine the Max BML grades, BML burden grades and Presence BML grades for the medial, lateral, patellofemoral, and total compartments, respectively. Multi-variable logistic regression models examined the association of the BML grades with 5-year incident knee surgery. Positive and negative predictive values (PPVs and NPVs) were determined for BML grades referring to 5-year incident knee surgery.ResultsTotally, 1011 participants (knees) were found eligible to form the study population. Within the 5 years, surgery was performed on 74 knees. Max BML grade 2 and grade 3 of medial, patellofemoral and total compartments were strongly and significantly associated with incident surgery. None of the BML grades from lateral compartment was associated with incident surgery. The PPV was low and NPV was high for BMLs.ConclusionsBMLs found in the first MRI examination were associated with 5-year incident joint surgery, except for those allocated in lateral compartments. The high NPVs imply that patients without BMLs have a low risk of requiring surgery within 5 years.

Risk factors associated with breakage of tibio-fibular syndesmotic screws.

This retrospective study aimed to investigate the factors associated with the breakage of tibio-fibular syndesmotic screws (SS). 69 patients with unstable AO-Weber Type 44-B ankle fractures who underwent three cortex SS (3.5mm ø) fixation were included. Patients were followed for at least one year (mean, 18.3 ± 7.6months). At the final follow-up, patients with broken (Group I) and intact (Group II) SS were compared regarding age, gender, height, weight, body mass index, fracture type, SS length, location, and orientation. Multivariate logistic regression was used to identify the independent risk factors associated with SS breakage. The sensitivity, specificity, cut-off value, and area under the ROC curve were analyzed. A stepwise backward logistic regression analysis revealed that age was the only independent predictor for SS breakage (OR = 0.938, 95% CI = 0.904-0.973, R2 = 0.270). ROC curve analysis demonstrated that patients younger than 36years were associated with seven times increased risk of SS breakage [Odds ratio (95% CI), 7.042 (2.251-22.031)]. Age under 36years was the only significant risk factor for SS breakage. The higher incidence of breakage of the syndesmotic screw can be informed to patients younger than 36.

Analysis of causes and prognostic impact of tube occlusion during hyperthermic intraperitoneal chemotherapy for appendiceal pseudomyxoma peritonei

BackgroundAppendiceal pseudomyxoma peritonei (PMP), a rare tumor from mucinous appendiceal origins, is treated with Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). However, tubing blockages during HIPEC treatment pose a common challenge, impeding the smooth progression of therapy. Few studies to date have explored the incidence and risk factors of tube occlusion during HIPEC in patients with appendiceal PMP, as well as its adverse impact on postoperative complications.MethodsFrom October 2017 to June 2023, a total of 80 patients with appendiceal PMP undergoing combined CRS and HIPEC were included in this study. Tubing blockage events were strictly defined, with patients experiencing blockages during HIPEC treatment allocated to the study group, while those with unobstructed perfusion were assigned to the control group. A comparative analysis was conducted between the two groups regarding post-HIPEC health assessments and occurrence of complications. Risk factors for luminal occlusion during closed HIPEC procedures were identified through univariate and multivariate analysis of data from 303 HIPEC treatments.ResultsTubing blockages occurred in 41 patients (51.3%). The study group experienced prolonged gastrointestinal decompression time (4.1 ± 3.0 vs. 2.5 ± 1.7 days, P = 0.003) and prolonged time to bowel movement (6.1 ± 2.3 vs. 5.1 ± 1.8 days, P = 0.022) compared to the control group. There was no significant difference in the incidence of complications between the two groups. The 1-year survival rate postoperatively was 97%, and the 3-year survival rate was 81%, with no association found between tubing blockage and poorer survival. Additionally, In 303 instances of HIPEC treatment among these 80 patients, tube occlusion occurred in 89 cases (89/303, 29.4%). Multivariable logistic regression analysis revealed age, diabetes, hypertension, and pathology as independent risk factors for tube occlusion.ConclusionTubing blockages are a common occurrence during HIPEC treatment, leading to prolonged postoperative gastrointestinal functional recovery time. When patients are elderly and have concomitant hypertension and diabetes, along with a histological type of low-grade mucinous tumor, the risk of tube occlusion increases. However, this study did not find a significant correlation between tubing blockage and the incidence of postoperative complications or overall patient survival.

Cryopreserved bone flaps from decompressive craniectomies: a microbiological analysis.

Surgical site infection (SSI) is a serious complication after cranioplasty. Due to the relatively frequent occurrence of post-cranioplasty SSI, the utility of autologous bone flap swab cultures surrounding cryopreservation as a reliable predictor has been the subject of an ongoing debate. This bicentric study aims to contribute to this topic by conducting an in-depth analysis of bone flaps obtained via decompressive craniectomies. This study had three major aims: assessments of 1) bacterial contamination of bone flaps after decompressive craniotomy, 2) impact of cryoconservation on contamination rates and 3) potential effectiveness of anti-infective treatment to reduce the germ load prior to cranioplasty. Cryopreserved bone flaps from two centers were used. Microbiological cultivations of swabs prior to and after cryopreservation were taken and assessed for aerobic and anaerobic growth over a 14-day incubation period. Additionally, in a subset of bone flaps, swab testing was repeated after thorough rinsing with an anti-infectant (octenidine-phenoxyethanol) followed by saline. All 63 bone flaps (patients median age at surgery: 59years) were obtained via decompressive craniectomies. Swabs done prior to cryopreservation revealed a 54% infection rate with Propionibacterium acnes being the most common microorganism in 65% of those cases. After thorough disinfection of the preserved bone flaps, all but one case showed no bacterial growth in swab testing. Furthermore, no relevant risk factors for bacterial contamination could be identified. This retrospective study showed the common presence of bacterial growth in cryopreserved bone flaps before and after freezing. Rinsing with octenidine-phenoxyethanol and saline effectively prevented bacterial growth in a notable percentage of cases, suggesting a potential strategy to reduce contamination. However, persistent bacterial growth in some cases underscores the need for further research to optimize antiseptic measures during autologous cranioplasty.

Classification of isolated versus multiple birth defects: An automated process for population-based registries.

Epidemiologic studies of birth defects often conduct separate analyses for cases that have isolated defects (e.g., spina bifida only) and cases that have multiple defects (e.g., spina bifida and a congenital heart defect). However, in some instances, cases with additional defects (e.g., spina bifida and clubfoot) may be more appropriately considered as isolated because the co-occurring defect (clubfoot) is believed to be developmentally related to the defect of interest. Determining which combinations should be considered isolated can be challenging and potentially resource intensive for registries. Thus, we developed automated classification procedures for differentiating between isolated versus multiple defects, while accounting for developmentally related defects, and applied the approach to data from the Texas Birth Defects Registry (1999-2018 deliveries). Among 235,544 nonsyndromic cases in Texas, 89% of cases were classified as having isolated defects, with proportions ranging from 25% to 92% across 43 specific defects analyzed. A large proportion of isolated cases with spina bifida (44%), lower limb reduction defects (44%), and holoprosencephaly (32%) had developmentally related defects. Overall, our findings strongly support the need to account for isolated versus multiple defects in risk factor association analyses and to account for developmentally related defects when doing so, which has implications for interpreting prior studies.