Ulcer Risk Research Articles

Rebleeding Risk of Acute Hemorrhagic Rectal Ulcer: A Multicenter Retrospective Study.

Objective Acute hemorrhagic rectal ulcer (AHRU) is characterized by sudden, painless, and massive bleeding from rectal ulcers. To date, few studies have analyzed the risk factors for AHRU rebleeding. In this study, we clarified the risk factors of rebleeding after initial hemostasis of AHRU through a multicenter study. Methods A total of 149 patients diagnosed with AHRU between January 2015 and May 2020 at 3 medical centers were enrolled. We retrospectively investigated the following factors: age, sex, body mass index (BMI), performance status (PS), Charlson Comorbidity Index (CCI), comorbidities, medications, laboratory examinations, endoscopic findings, view of the entire rectum on endoscopy, hemostasis method, blood transfusion history, shock, instructions for posture change after initial hemostasis, and clinical course. Results Rebleeding was observed in 35 (23%) of 149 patients. A multivariate analysis showed that significant factors for rebleeding were PS 4 [odds ratio (OR), 5.23; 95% confidence interval (CI), 1.97-13.9; p=0.001], a blood transfusion history (OR, 3.66; 95% CI, 1.41-9.51; p=0.008), low an estimated glomerular filtration rate (eGFR) levels (OR, 0.98; 95% CI, 0.97-0.99; p=0.001), poor view of the whole rectum on endoscopy (OR, 0.33; 95% CI, 0.12-0.90; p=0.030), and use of monopolar hemostatic forceps (OR, 4.89; 95% CI, 1.37-17.4; p=0.014). Conclusion Factors associated with rebleeding of AHRU were a poor PS (PS 4), blood transfusion, a low eGFR, poor view of the whole rectum on endoscopy, and the use of monopolar hemostatic forceps.

A low-cost and versatile paramagnetic bead DNA extraction method for Mycobacterium ulcerans environmental surveillance.

Buruli ulcer (BU) is a neglected tropical skin disease, with an incidence that has dramatically increased in temperate southeastern Australia over the last decade. In southeastern Australia, BU is a zoonosis with native possums the major wildlife reservoir of the causative pathogen, Mycobacterium ulcerans. Infected possums shed M. ulcerans in their excreta, and excreta surveys using PCR to screen for the presence of pathogen DNA are a powerful means to predict future areas of Buruli ulcer risk for humans. However, excreta surveys across large geographic areas require testing of many thousands of samples. The cost of commercial DNA extraction reagents used for preparing samples for PCR testing can thus become prohibitive to effective surveillance. Here, we describe a simple, low-cost method for extracting DNA from possum excreta using paramagnetic beads. The method is versatile and adaptable to a variety of other sample types including swabs collected from possum tissues and pure cultures of mycobacteria.

Causal associations between intermediate very-low-density lipoprotein cholesterol-to-total lipids ratio and peptic ulcer: A bidirectional Mendelian randomization study.

Previous epidemiologic investigations have consistently demonstrated a strong association between the ratio of cholesterol to total lipids in medium very-low-density lipoprotein (VLDL) and the occurrence of peptic ulcers (PU). However, the precise causal relationship between these factors remains ambiguous. Consequently, this study aims to elucidate the potential correlation between the ratio of cholesterol to total lipids in medium VLDL and the incidence of peptic ulcer. To investigate the ratio of cholesterol to total lipids in medium very-low-density lipoprotein (VLDL) association with PU via genetic methods, guiding future clinical research. Genome-wide association study (GWAS) datasets for the ratio of cholesterol to total lipids in intermediate VLDL and peptic ulcer were retrieved from the IEU OpenGWAS project (https://gwas.mrcieu.ac.uk). For the forward Mendelian randomization (MR) analysis, 72 single nucleotide polymorphisms (SNPs) were identified as instrumental variables. These SNPs were selected based on their association with the ratio of cholesterol to total lipids in intermediate VLDL, with peptic ulcer as the outcome variable. Conversely, for the inverse MR analysis, no SNPs were identified with peptic ulcer as the exposure variable and the ratio of cholesterol to total lipids in intermediate VLDL as the outcome. All MR analyses utilized inverse variance weighted (IVW) as the primary analytical method. Additionally, weighted median and MR-Egger methods were employed as supplementary analytical approaches to assess causal effects. Egger regression was used as a supplementary method to evaluate potential directional pleiotropy. Heterogeneity and multiplicity tests were conducted using the leave-one-out method to evaluate result stability and mitigate biases associated with multiple testing. The genetically predicted ratio of cholesterol to total lipids in medium VLDL was significantly associated with an elevated risk of peptic ulcer (IVW: OR = 2.557, 95%CI = 1.274-5.132, P = 0.008). However, no causal association of peptic ulcer with the ratio of cholesterol to total lipids in medium VLDL was observed in the inverse Mendelian randomization analysis. In conclusion, our study reveals a significant association between the ratio of cholesterol to total lipids in medium VLDL and an elevated risk of peptic ulcers. However, further validation through laboratory investigations and larger-scale studies is warranted to strengthen the evidence and confirm the causal relationship between these factors.

Adherence to wearing prescribed footwear in people at risk of diabetes-related foot ulcers.

Adherence to wearing prescribed footwear is paramount in reducing the risk of developing diabetes-related foot ulcers, but adherence is often lower than optimal. This study aimed to investigate predictors of footwear adherence and variations in adherence and activity in people at risk of diabetes-related foot ulceration. Sixty people at high foot ulcer risk were included. We measured the proportion of weight-bearing acitivity time the prescribed footwear was worn for seven days. Multiple linear regression and analysis of variance were used. Mean overall adherence was 63%. Adherence was lower at home than away from home (59% vs. 74%), while activity was higher at home (2.2 vs. 1.2h/day). Adherence was similar across activities (61%-63%). No variable predicted the overall adherence. Higher Hba1c predicted lower adherence at home (β=-0.34, p=0.045, R2=11.6%). More daily steps predicted lower adherence away from home (β=-0.30, p=0.033, R2=9.3%). Adherence and activity were highest in mornings (71%, 1.1h) and afternoons (71%, 1.5h), and lower in evenings (40%, 0.8h) and at nights (9%, 0.1h). Adherence was similar on weekdays and weekend days (63% vs. 60%), but activity was higher on weekdays (3.4 vs. 3.0h). Adherence levels and predictors thereof differed between adherence at home and away from home, so we suggest to treat them as different concepts. Due to the low explained variance, future studies should focus on other predictors such as psychological variables.

Multidimensional-Based Prediction of Pressure Ulcers Development and Severity in Hospitalized Frail Oldest Old: A Retrospective Study.

In recent times, growing uncertainty has emerged regarding the effectiveness of standard pressure ulcer (PU) risk assessment tools, which are suspected to be no better than clinical judgment, especially in the frail and comorbid elderly population. This study aimed to identify the primary clinical predictive variables for PU development and severity in hospitalized older adults, utilizing a multidimensional frailty assessment, and compare them with the Braden scale. The population consisted of 316 patients, admitted to the Geriatric Unit and Transitional Care of San Bartolomeo Hospital in Sarzana (Italy) during the period 21/02/22-01/07/22. The collected information included both anamnestic and laboratory data. A comprehensive geriatric assessment was performed, including also anthropometric and physical performance measurements. Multivariate logistic analysis was used, both in a binary classification test and in the subsequent ordinal classification test of severity levels. The final performance of the model was assessed by ROC curve estimation and AUC comparison with the Braden scale. Within the population, 152 subjects (48%) developed PU at different levels of severity. The results showed that age, Braden scale (subscales of mobility and friction/shear), Barthel scale, Mini Nutritional Assessment, hemoglobin, and albumin are predictors associated with the development of PU (AUC 85%). The result is an improvement over the use of the Braden scale alone (AUC 75%). Regarding the identification of predictive factors for PU severity, 4AT also emerges as potentially relevant. Assessing the subject's nutritional status, physical performance, and functional autonomies enables the effective integration of the Braden scale in identifying patients most susceptible to developing PU. Our findings support the integration of a comprehensive set of methodologically robust frailty determinants into traditional risk assessment tools. This integration reflects the mutual interplay between patients' frailty, skin frailty, and PU development in very old hospitalized patients.

Pressure ulcer prevention for people with long-term neurological conditions (LTNCs) who self-manage care and live at home

AimTo develop a Theory of Change (ToC) pathway to facilitate the development of a multi-component intervention package supporting pressure Ulcer (PU) risk identification and management, in partnership with people with Long Term Neurological Conditions (LTNC) who self-manage care and live at home, their informal carers and PAs. MethodsA participatory approach, with extensive input from those whose lives are the focus of the research, was used throughout the 4 interlinked work packages (WP):•WP1 – Development of two co-operative Inquiry Groups (CIGs)•WP2 - Semi-structured interviews and/or app participation•WP3– Professional and strategic stakeholder engagement•WP4–Systems mapping and Theory of Change (ToC pathway developmentIterative data analysis was undertaken with emerging findings from each WP informing subsequent stages of the study. FindingsOverall, 74 participants contributed across the 4 WPs, incorporating 31 Service Users (SU), 8 carers, 9 Personal Assistants (PAs) and 26 professional stakeholders. We identified 8 key themes related to PU prevention, incorporating, learning, safe routines, third sector and peer support, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and supporting roles. The findings indicate systemic and professional barriers which hamper people's ability to self-care and seek help. ConclusionsThe study highlights the complexities and impact of managing PU prevention activities at home for people with LTNC and areas of learning for health professionals and systems. By understanding these complexities we developed a systems map, identified resource requirements and illustrated a Theory of Change (ToC) pathway, to underpin future work to develop and user test an interactive, multi-component intervention.

Nurse understaffing associated with adverse outcomes for surgical admissions.

Nurses play a crucial role in maintaining the safety of surgical patients. Few nurse staffing studies have looked specifically at surgical patients to examine the impact of exposure to low staffing on patient outcomes. A longitudinal patient analysis was conducted in four organizations in England using routine data from 213 910 admissions to all surgical specialties. Patients' staffing exposures were modelled as counts of understaffed registered nurse and nurse assistant days in the first 5 inpatient days. Understaffing was identified when staffing per patient-day was below the mean for the ward. Cox models were used to examine mortality within 30 days of admission and readmission within 30 days of discharge. Generalized linear models were used to investigate duration of hospital stay and occurrence of hospital-acquired conditions. Increased exposure to registered nurse understaffing was associated with longer hospital stay and increased risk of deep vein thrombosis, pneumonia, and pressure ulcers. This was also true for nurse assistant understaffing, but the effect sizes tended to be smaller. In the Cox models, there were similarly increased hazards of death for registered nurse understaffing (HR 1.09, 95% c.i. 1.07 to 1.12) and nurse assistant understaffing (HR 1.10, 1.08 to 1.13), whereas the effect size of registered nurse understaffing for readmission (HR 1.02, 1.02 to 1.03) was greater than that seen with nurse assistants (HR 1.01, 1.01 to 1.02). Understaffing by both registered nurses and nursing assistants is associated with increased risks of a range of adverse events, and generally larger effects are seen with registered nurse understaffing.

Case Study of Implementation of Adverse Event Prevention Program: Decubitus Ulcer in Bedrest Patient with Stroke in the ICU Room with S.S.K.I.N Approach

Patient safety is one of the aspects of providing excellent service for patients in hospitals, especially in the ICU. One method of managing patient safety is to prevent pressure ulcers in the ICU. The aim of this study is to explain the management of pressure ulcer prevention in the ICU for bedridden stroke patients using an intervention approach with form chart media. The research method used in this study is a case study design that includes assessment processes, data analysis, diagnostic rehabilitation, intervention, implementation, and evaluation. We collected data through observation, interviews, and physical examinations. We carried out the intervention in two shifts. We measured the risk of pressure ulcers using the Braden scale, provided health education to the family, and ensured the nurse correctly filled out the form. The obstacle to increasing the number of nurses is the workload and the feeling that human resources are still insufficient. There are no signs of pressure sores on the patient's back. In the implementation of the pressure ulcer prevention program using the skin approach, family involvement is necessary to ensure the program continues without adding to the workload of nurses in the ICU. Conclusion: Modifications to the formchart and family involvement in the program are necessary for the implementation of the pressure ulcer prevention program using formchart media in the ICU.

The Effect of Dimple Insole Design on the Plantar Temperature and Pressure in People with Diabetes and in Healthy Individuals.

An increase in plantar pressure and skin temperature is commonly associated with an increased risk of diabetic foot ulcers. However, the effect of insoles in reducing plantar temperature has not been commonly studied. The aim was to assess the effect of walking in insoles with different features on plantar temperature. Twenty-six (F/M:18/8) participants-13 with diabetes and 13 healthy, aged 55.67 ± 9.58 years-participated in this study. Skin temperature at seven plantar regions was measured using a thermal camera and reported as the difference between the temperature after walking with an insole for 20 m versus the baseline temperature. The mixed analyses of variance indicated substantial main effects for the Insole Condition, for both the right [Wilks' Lambda = 0.790, F(14, 492) = 4.393, p < 0.01, partial eta squared = 0.111] and left feet [Wilks' Lambda = 0.890, F(14, 492) = 2.103, p < 0.011, partial eta squared = 0.056]. The 2.5 mm-tall dimple insole was shown to be significantly more effective at reducing the temperature in the hallux and third met head regions compared to the 4 mm-tall dimple insole. The insoles showed to be significantly more effective in the diabetes group versus the healthy group, with large effect size for the right [Wilks' Lambda = 0.662, F(14, 492) = 8.037, p < 0.000, Partial eta-squared = 0.186] and left feet [Wilks' Lambda = 0.739, F(14, 492) = 5.727, p < 0.000, Partial eta-squared = 0.140]. This can have important practical implications for designing insoles with a view to decrease foot complications in people with diabetes.

Pressure-Relieving Effect of Different Insole Top Covers in People with Diabetes at High Risk of Foot Ulceration.

Pressure-relieving footwear helps prevent foot ulcers in people with diabetes. The footwear design contributes to this effect and includes the insole top cover. We aimed to assess the offloading effect of materials commonly used as insole top cover. We measured 20 participants with diabetes and peripheral neuropathy for in-shoe peak pressures while walking in their prescribed footwear with the insole covered with eight different materials, tested in randomized order. Top covers were a 3 mm or 6 mm thick open or closed-cell foam or a 6 mm thick combination of open- and closed-cell foams. We re-assessed pressures after one month of using the top cover. Peak pressures were assessed per anatomical foot region and a region of interest (i.e., previous ulceration or high barefoot pressure). Walking comfort was assessed using a 10-point Likert scale. Mean peak pressure at the region of interest varied between 167 (SD:56) and 186 (SD:65) kPa across top covers (p < 0.001) and was significantly higher for the 3 mm thick PPT than for four of the seven 6 mm thick top covers. Across 6 mm thick top covers, only two showed a significant peak pressure difference between them. Over time, peak pressures changed non-significantly from -2.7 to +47.8 kPa across top cover conditions. Comfort ratings were 8.0 to 8.4 across top covers (p = 0.863). The 6 mm thick foams provided more pressure relief than the 3 mm thick foam during walking in high-risk people with diabetes. Between the 6 mm thick foams and over time, only small differences exist. The choice of which 6 mm thick insole top cover to use may be determined more by availability, durability, ease of use, costs, or hygienic properties than by superiority in pressure-relief capacity.

Causal effect of obesity and adiposity distribution on the risk of pressure ulcers and potential mediation by type 2 diabetes mellitus: insights from multivariable mendelian randomization and mediation analysis.

Previous observational studies have identified a link between obesity, adiposity distribution, type 1 Diabetes Mellitus (T1DM), type 2 Diabetes Mellitus (T2DM), and the risk of pressure ulcers (PUs). However, the definitive causality between obesity and PUs, and potential DM mediators remains unclear. Univariable, multivariable, and mediation Mendelian randomization (MR) analyses were conducted to explore the mediating role of T1DM or T2DM in the association between obesity, adiposity distribution, and PUs. Instrumental variables for obesity and adiposity distribution, including Body Mass Index (BMI), waist circumference, hip circumference, trunk fat mass, whole body fat mass, trunk fat percentage, and body fat percentage, were selected from two genome-wide association studies (GWAS). In univariable MR analysis, BMI, hip circumference, and obesity were associated with PUs using inverse variance weighted (IVW) regression. These findings were further corroborated by the replication cohorts and meta-analysis (BMI: OR = 1.537, 95% CI = 1.294-1.824, p < 0.001; Hip circumference: OR = 1.369, 95% CI = 1.147-1.635, p < 0.001; Obesity: OR = 1.235, 95% CI = 1.067-1.431, p = 0.005), respectively. Even after adjusting for confounding factors such as T1DM and T2DM, BMI and hip circumference remained statistically significant in multivariable MR analyses. T2DM may mediate the pathogenesis of BMI-related (OR = 1.106, 95% CI = 1.054-1.160, p = 0.037) and obesity-related PUs (OR = 1.053, 95% CI = 1.034-1.973, p = 0.004). These findings provide insights for the prevention and treatment of PUs, particularly in patients with obesity or DM.

Effect of different inner pressures of air insoles and walking durations on plantar pressure time integral

Air insoles have provided insights for reducing the risk of diabetic foot ulcers (DFU). The pressure time integral (PTI) is an effective assessment that considers the time effect in various physical activities. We investigated the interactions between three different insole inner pressures (80, 160, and 240 mmHg) and two walking durations (10 and 20 min). The big toe (T1), first metatarsal head (M1), and second metatarsal head (M2) were investigated in 13 healthy participants. One-way analysis of variance (ANOVA) showed that the effects of each insole inner pressure significantly differed (P < 0.05) with a 10 min walking duration. The PTI values resulting from 80 mmHg in M2 (38.4 ± 3.8, P = 0.002) and 160 mmHg in M1 (44.3 ± 4.3, P = 0.027) were lower than those from 240 mmHg. Additionally, the paired t test showed that the effects of each walking duration were also considerably different at 160 mmHg. The PTI at 10 min was lower than that at 20 min in M1 (44.31 ± 4.31, P = 0.015) and M2 (47.14 ± 5.27, P = 0.047). Thus, we suggest that walking with a pressure of 160 mmHg for 10 min has a lower risk of DFU.

The effects of air and transportation noise pollution-related altered blood gene expression, DNA methylation, and protein abundance levels on gastrointestinal diseases risk

IntroductionAir pollution and transportation noise pollution has been linked to gastrointestinal (GI) diseases, but their relationship remains unclear. MethodsWe extracted the significantly modulated genes and CpG sites related to air pollution (PM2.5, PM10, and NOx) and transportation noise pollution (aircraft, railway, and traffic road noise) from previous published studies. Genome-wide methylation analysis and colocalization analysis with these CpG sites and GWAS data of GI diseases were performed to disentangle the relationship between pollution-related blood DNA methylation (DNAm) alterations and GI diseases risk. Summary-based Mendelian randomization (SMR) analysis assessed the impact of pollution-related genes on GI diseases risk across methylation, gene expression, and protein levels. Enrichment analysis investigated the implicated biological pathways and immune cell types. ResultsDNAm at cg00227781 [CD300A] (modulated by NOx exposure) and cg19215199 [ZMIZ1] (modulated by PM2.5 exposure) was significantly linked to increased noninfective enteritis and colitis risk, while cg08500171 [BAT2] (modulated by NOx exposure) is significantly associated with an increased gastroesophageal reflux disease (GERD) risk. Colocalization analysis provides strong evidence supporting a shared causal variant between these associations. Multi-omics levels SMR analysis revealed that pollution-modulated lower DNAm at 5 specific CpG sites were associated with increased expression of 4 genes (IL21R, EVPL, SYNGR1, and WDR46), subsequently increasing the risk of GERD, ulcerative colitis, and gastric ulcer. 7 circulating proteins coded by pollution-modulated genes were observed to be associated with 6 GI diseases risk. Enrichment analysis implicates immune and inflammatory responses, MAPK signaling, and telomere maintenance in these pollution-induced effects. ConclusionWe identified potential links between air and transportation noise pollution-related gene methylation, expression, and protein abundance with GI diseases risk, possibly revealing new therapeutic targets.

A Review of Antiulcer Activity of Some Medicinal Plants

Peptic ulcer is a gastrointestinal disorder and with increased prevalence. Peptic ulcer is breaking of endothelial lining of stomach and exposing underlying tissues. Peptic ulcer occurs due to high secretion of acid and reduced defensive factors in stomach and duodenum. It is imbalance between aggressive and defensive factors. Non-steroidal anti-inflammatory drugs and Helicobacter pylori infection also increases the risk of peptic ulcer. Indiscriminate use of synthetic drugs leads to adverse effects and concomitant use of antibiotics potentiates drug-drug interaction thus search of drugs from natural sources especially herbs is need of hour. several herbal medicines have been evaluated for its antiulcer efficacy using several ulcer inducing models in laboratory animals. Present study aims at review of gastroprotective and ulcer healing potential medicinal herbs and compilation of data. This article is only restricted to antiulcer efficacy of the medicinal plants. This review presents information about the anti-ulcer efficacy of medicinal plants and various antiulcer models used to screen them. Keywords: Peptic ulcer, Gastric ulcer, Gastroprotective activity, Phyllanthus urinaria, Adiantum lunulatum, Ulcer healing activity

Exploration of predictive risk factors for diabetic foot in patients with diabetes in Beijing: analysis of 5-year follow-up data of patients with diabetes mellitus in a single center in Beijing.

Large-scale prospective cohort studies on diabetic foot ulcers risk factor screening in China are limited. Therefore, this prospective cohort study aimed to explore the predictive risk factors for diabetic foot ulcers to provide clinicians with concise and effective clinical indicators for identifying a high-risk diabetic foot and guiding the prevention of diabetic foot ulcers. Patients with diabetes who visited the Department of Endocrinology of Peking University First Hospital from October 2017 to December 2018 were selected as research participants by convenience sampling. A total of 968 patients were included. After enrollment, a dedicated person collected and recorded all baseline data. A dedicated telephone follow-up was conducted every 12-24 months to evaluate whether the endpoint event had occurred. All patients were followed up for an average of 61 (57-71) months, with 95% of them followed up for more than 60 months. According to the occurrence of endpoint events, they were divided into the DFU and non-DFU groups. The data between the two groups were analyzed using independent-sample t-test, Wilcoxon rank sum test, and chi square test. We used univariate and multivariate logistic regression analysis to analyze the factors that affected the occurrence of diabetic foot ulcers. After the 5-year follow-up, the incidence of diabetic foot was 25.83%. Multivariate logistic regression analysis revealed that body mass index (odds ratio: 1.046; 95% confidence interval: 1.001-1.093), abnormal pinprick sensation (odds ratio: 4.138; 95% confidence interval: 1.292-13.255), history of fungal foot infection (odds ratio: 2.287; 95% confidence interval: 1.517-3.448), abnormal 128-Hz tuning fork test (odds ratio: 2.628; 95% confidence interval: 1.098-6.294), and HbA1c≥ 8% (odds ratio: 1.522; 95% confidence interval: 1.014-2.284) were independent predictors of diabetic foot. Our study highlights clinically relevant indicators that may help to prevent the occurrence of diabetic foot and guide timely interventions.

Impact of the COVID pandemic on melanoma thickness and ulceration: a meta-analysis.

The global healthcare sector faced immense challenges due to the COVID-19 pandemic. Oncologists noted reduced cancer screening, which impacted melanoma diagnosis and treatment, leading to concerns about delayed care and poorer outcomes. This review analyzes how the pandemic influenced melanoma ulceration risk and Breslow thickness index through a meta-analysis of published studies. Following PRISMA guidelines, we conducted a systematic review of literature from January 2021 to December 2022 on cutaneous melanoma before and during the COVID-19 pandemic. Upon screening 1854 manuscripts, the review led to 13 studies meeting inclusion standards. The quality assessment followed MINORS and Newcastle-Ottawa Scale criteria. Regarding ulceration, post-COVID ulceration surpassed pre-COVID levels significantly, with a risk ratio of 1.31 and an estimated odds ratio of 1.41, indicating a 44% rise post-COVID. As for Breslow thickness, studies show a rising trend in the Breslow index post-COVID, but less significantly, with an effect size of 0.08 regarding the meta-analysis model (P = 0.02) with a pre-COVID mean Breslow of 1.56 mm and post-COVID of 1.84 mm. This meta-analysis concluded that post-COVID ulceration rates significantly surpassed pre-COVID levels. Considering that ulcerated melanomas usually undergo sentinel lymph node biopsy and are more likely to benefit from adjuvant therapies, this indicates important implications, as many patients might have missed the opportunity to start therapy appropriately, regardless of their Breslow thickness status.

The association between primary ovarian insufficiency and increased multimorbidity in a large prospective cohort (Canadian Longitudinal Study on Aging)

ObjectiveTo describe the prevalence of multimorbidity among individuals with premature ovarian insufficiency (POI) and early menopause, in comparison to average age of menopause. DesignProspective cohort SubjectsThis prospective cohort encompassed female postmenopausal individuals from the Canadian Longitudinal Study on Aging (CLSA). The CLSA collected cross-sectional data from 50,000 community-dwelling Canadians aged 45 to 85 between 2010 and 2015. ExposureThe primary exposure was primary ovarian insufficiency (defined by onset of menopause younger than 40 years). Comparators included average age of menopause (age 46 to 55 years), early menopause (40-45 years), late onset menopause (56-65 years), and those who underwent a hysterectomy. Main outcome measuresThe primary outcome was multimorbidity, which was defined as two or more chronic conditions. The secondary outcome was severe multimorbidity (defined as three or more chronic conditions) as well as frequencies of specific chronic conditions among a comprehensive list of 15 individual conditions. We assessed the association between multimorbidity and age at menopause using logistic regression and odds ratios, with confidence intervals set at 95%. Odds ratios were adjusted for known predictors of multimorbidity, including age, menopause hormone therapy (MHT), education, ethnicity, self-reported loneliness, living alone, BMI, smoking habits, nutritional risk, social participation, and physical activity. ResultsA total of 12,339 postmenopausal participants were included, of which 374 (3.0%) experienced POI and 1396 (11.3%) experienced early menopause. The prevalence of multimorbidity was 64.8% and 51.1% among those with POI and early menopause respectively. In contrast, only 43.9% of individuals with average age of menopause (age 46 to 55 years) had multimorbidity. The OR for multimorbidity in the POI population was 2.5 (95% CI 2.0-3.1) in comparison to those who underwent the average age of menopause. This relationship was maintained after adjustment for confounders (aOR 2.0, 95% CI: 1.5-2.5). The prevalence of severe multimorbidity was also double in the POI group in comparison in the average age group (39.2% versus 21.1%). There was significantly increased risk of ischemic heart disease (aOR 2.8, 95% CI: 1.7-4.7), gastric ulcers (aOR 1.6, 95% CI: 1.1-2.3) and osteoporosis (aOR 1.6, 95% CI: 1.2-2.1) in the POI group. ConclusionsIndividuals with POI and early menopause experience increased multimorbidity in comparison to those undergoing menopause at an average age. This trend persists even after adjusting for significant multimorbidity risk factors.

Risk assessment of esophageal ulceration following left atrial radiofrequency linear ablation.

Esophageal safety following radiofrequency (RF) left atrial (LA) linear ablation has not been established. To determine the esophageal safety profile of LA linear RF lesions, we performed systematic esophagogastroduodenoscopy in all patients with intraesophageal temperature rise (ITR) ≥ 38.5°C. Between December 2021 and July 2023, a total of 200 consecutive patients with atrial tachyarrhythmia (ATA) underwent linear ablation with posterior dome (roof or floor) or posterior mitral isthmus line transection. Patients with ITR ≥ 38.5°C were scheduled for esophageal endoscopy ~3 weeks after ablation. Patient and ATA characteristics, procedural parameters, endoscopy findings and ablation lesion data were collected and analyzed. One hundred thirty-threeout of 200 (67%) patients showed ITR ≥ 38.5°C during LA linear ablation. ITR (with maximal temperature of 45.7°C) was more frequently observed during floor line ablation (82% of cases). ITR was less observed during roof line ablation (34%) and posterior mitral isthmus ablation (4%). Endoscopy, performed in 115 patients after 24 ± 10 days, showed esophageal ulceration in four patients (two patientsKansas City classification [KCC] 2a and two patients KCC 2b). No patient showed esophageal perforation or fistula. Temperature rise during LA linear ablation is frequent and ulceration risk exists, particularly when floor line is performed. Safety measures are needed to avoid potential severe complications like esophageal perforation and fistula.

Comparison of the Effectiveness Lateral Position 30 Degrees and 90 Degrees on Decubitus Events in Stroke Patients

Aims: Stroke is the second leading cause of death and disability globally, characterized by sudden neurological deficits. Pressure ulcers, caused by prolonged bed rest, can be managed non-pharmacologically through immobilization and routine tilting to prevent decubitus. To compare the effectiveness of the lateral position with an inclination of 30 and 90 degrees on the risk of decubitus in stroke patients, in this study the control group was tilted 90 degrees and the intervention group was tilted 30 degrees. Method: The sampling method is non-probability sampling with purposive sampling, a sample of 22 patients. Results: Data analysis using Reapeted Measurement Anova resulted in a value in the experimental group resulting in a sum of square value of 24.9, f value 14.3, P &lt; 0.001, while in the control group a sum of square value of 76.5, f value 26.8, P &lt; 0.001 was obtained, so it can be concluded that the lateral position with an inclination of 90 degrees and 30 degrees has the same effect, namely providing a significant influence on reducing the risk of decubitus. Conclusions: The study reveals that stroke patients aged 56-65 have a higher risk of pressure ulcers, with low-weight patients at higher risk. Early lateral position intervention and nutrition can significantly reduce the risk of decubitus, highlighting the importance of early wound healing.

Braden score predicts 30-day mortality risk in patients with ischaemic stroke in the ICU: A retrospective analysis based on the MIMIC-IV database.

Ischaemic stroke remains a significant global health challenge, associated with high mortality rates. While the Braden Scale is traditionally employed to assess pressure ulcer risk, its potential to predict mortality among the intensive care unit (ICU) patients with ischaemic stroke has not been thoroughly investigated. This study evaluates the predictive value of the Braden Scale for 30-day mortality among patients with ischaemic stroke admitted to ICU. We conducted a retrospective analysis of 4710 adult patients with ischaemic stroke from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The association between the Braden Scale scores and 30-day mortality was assessed using receiver operating characteristic (ROC) curve analysis, Cox regression models and Kaplan-Meier survival estimates. Patients with Braden Scale scores ≤ 15.5 showed significantly higher 30-day mortality rates (p-value < 0.001; hazard ratio (HR): 2.08, 95% confidence interval (CI): 1.71-2.53). The area under the ROC curve (AUC) was 0.71, demonstrating good predictive performance. Multivariate analysis confirmed the Braden Scale as an independent predictor of mortality, after adjusting for age, gender and comorbidities. The Braden Scale effectively identifies high-risk ischaemic stroke patients in ICU settings, endorsing its integration into routine assessments to facilitate early intervention strategies. Integrating the Braden Scale into routine ICU evaluations can enhance mortality risk stratification and improve patient care tailoring.