Risk Variables Research Articles

The Pathognomonic ultrasonographic findings in fetus with COVID-19 infection

Aim: The main goal is to identify the pathognomonic sonographic signs for foetal SARS-CoV-2 infection and to determine whether or not transplacental SARS-CoV-2 transmission is possible. Patients and Methods: In total, 105 pregnant women with positive SARS-CoV-2 PCR swabs during the first trimester with mild or moderate infection without hospitalisation and/or oxygen support were included in this prospective comparative study, which was carried out at the ultrasound and foetal medicine unit of Ain Shams University Maternity Hospital from January 2021 to June 2023. The SARS-CoV-2 positive group was compared to the control group with inclusion and exclusion criteria. Results: In the COVID-19 group, pathognomonic ultrasonographic results were considerably more common. The COVID-19 group had a considerably higher frequency of placental calcifications and oligohydramnios. In the COVID-19 cohort, patients with positive pathognomonic ultrasonographic results had considerably higher BMIs. In the COVID-19 cohort, gestational age at infection, and BMI ≥30.0 kg/m2 were significant independent risk factors for the development of pathognomonic ultrasonographic abnormalities. Those in the control group who had positive pathognomonic ultrasonographic results were older and had higher rates of hypertension. Significant independent risk variables for the incidence of pathognomonic ultrasonographic findings in the control group included age ≥34.0 years and hypertension. Conclusion: There is no evidence of a teratogenic effect linked to maternal SARS-CoV-2 infection during the first few months of pregnancy. However, early pregnancy infection with COVID-19 is linked to pathognomonic ultrasonography findings of placental calcifications and oligohydramnios.

Determinants of Millennial Interest in Investing on Sharia Securities Crowdfunding Platforms in Indonesia

This research aims to analyze the influence of attitude variables, subjective norms, and perceived behavioral control on interest upon investing in SCF sharia as well as the influence of the variables of Islamic financial literacy, religiosity, risk and return on attitudes towards investing among the millennial generation in SCF Syariah. The research employed a quantitative approach utilizing the Structural Equation Model Partial Least Square (SEM-PLS) with primary data gathered through purposive sampling. The technique was conducted by an online method on 152 individuals from the millennial generation. Not all TPB factors significantly influence the interest to invest in Sharia Securities Crowdfunding. Attitude and Behavior Control Perception have a positive impact on the interest to invest in Sharia SCF. Subjective Norm does not have an impact on the interest to invest in Sharia SCF. Sharia financial literacy does not significantly affect attitude. Religiosity significantly affects attitude. Risk and return significantly affect attitude.

Analysis of Risk Factors for Investors in Emerging Markets

Risk management is becoming more and more dependent on the identification of risk variables for investors who wish to make investments in emerging economies. Finding risk factors for investors in emerging markets and identifying the top five risk factors in emerging markets were the two objectives of this study. To gather information from South African asset managers, this study used an online survey method, a quantitative research strategy, and online questionnaires. To analyse the data, descriptive statistics were employed. The findings indicated that the most crucial risk factors to consider when making investments in developing markets were currency, economic stability, liquidity, inflation, investment cost, hazards, and taxation. Additionally, it was shown that the top five risk factors in developing markets include inflation, currency fluctuations, hazards, liquidity, and economic stability. This study added to the body of knowledge and its significance and contribution to existing literature is that it gave investors in emerging markets fresh perspectives on risk factors to consider when investing in emerging market. The practical implication for investors is that they must consider factors identified in this study when investing in developing markets, it is advised that investors who choose to do so take into account the top five risk factors. Policymakers in emerging markets can help ensure that investors are well-informed about the risks associated with investing in emerging markets, ultimately fostering a more stable and attractive investment environment.

Male gender and aging as predictors of severe COVID-19: Studying the genetic, laboratory, radiologic and clinical findings among Egyptianadults

COVID-19 poses a serious risk, especially to the elderly. Additionally, COVID-19 has demonstrated a blatant sex-specific bias, with men exhibiting a more severe reaction and greater fatality rate. The aim of this study is to assess the genotypic and allelic frequencies of the chemokine ligand CXCL12 rs2839693 and its receptor CXCR4 rs2228014 according to age and sex. Also, to evaluate the interaction between age and sex and other risk variables affects how severe COVID-19 is.The present study conducted on 131 female and 169 male COVID-19 Egyptian patients who admitted to Assiut University Quarantine Hospital during the period from July to November 2022, the mean age of patients was 64.31±11.002 years old, patients with age > 65 years were 156 and < 65 years old were 144. Real-time PCR was used to identify the polymorphisms of CXCL12 rs2839693 and CXCR4 rs2228014 using a TaqMan test probe.No significant differences in CXCL12 rs2839693 and CXCR4 rs2228014 genotypic and allelic frequencies according to age and sex.Severe/critical illness was more prevalent in males than females. Also, severe and critical illness was more prevalent in patients with age >65years than patients with age ≤65.Of the statistics that are usually obtained upon admission, age and sex were significant indicators of the severity of the condition. Severe instances were more likely to occur in males and elders. Particular care needs to be paid to older male individuals, as well as individuals with comorbid diseases.

Insulin Resistance Unraveled: Hormonal Correlations in Gestational Diabetes

Background: To investigate the correlation between the variations of cortisol and insulin-like growth factor 1 (IGF-1) and sex hormone binding globulin (SHBG) levels with insulin resistance and glucolipid metabolism in gestational glucose diabetics. Methods: The study included 110 pregnant women diagnosed with gestational diabetes mellitus in the GDM group,and 130 healthy pregnant women in the control group. Data collection,examination of relevant indexes,and comparison of differences in indexes between groups were conducted. Pearson correlation analysis was utilized to identify risk variables associated with GDM development,while binary logistic regression was employed to determine risk factors for GDM development. Results: The GDM group showed significantly greater levels of FPG,HbA1c,FINS,TG,FFA,Lp-PLA2,HOMA-IR,Cortisol,and IGF-1 compared to the control group (P<0.05),but considerably lower levels of SHBG,and HOMA-β. HOMA-IR was found to be positively correlated with FPG,HbA1c,FINS,TG,FFA,Lp-PLA2,Cortisol and IGF-1,whereas,negatively correlated with SHBG. FINS and SHBG were found to be independent protective factors for GDM (OR=0.463,0.801,P<0.05),whereas,HbA1c,TG,FFA,and gestational BMI were found to be independent risk factors for GDM (OR=1.992,4.234,1.990,1.629,P<0.05). Conclusion: SHBG,IGF-1,and Cortisol are all linked to glucose-lipid metabolism indices,and aberrant serum hormone expression is a major contributor to insulin resistance.

Preeclampsia is a risk factor for Low Birth Weight (LBW) infants

<p><strong><em>Background</em></strong><em>: Infant mortality remains high and is more common in the neonatal period. Causes of neonatal death include asphyxia, sepsis, infection and LBW(LBW) in preterm and term infants. One of the factors influencing the incidence of LBW is pre-eclampsia. This is because pre-eclampsia affects the utero-placental circulation so that it affects the delivery of nutrients to the fetus, resulting in fetal nutrient deprivation and intrauterine </em><em>growth restriction<strong>. </strong></em></p><p><strong><em>Objectives</em></strong><em>: This study aims to assess the relationship between pre-eclampsia and the incidence of LBW in the Mawar Room of Dr M. Yunus Bengkulu Hospital. </em></p><p><strong><em>Methods</em></strong><em>: This study used a case-control design. The sample was all babies born in M Yunus Hospital in the years 2019-2022.The case group were LBWbabies and the control group were normal birth weight babies. The total sample size was 128 with a ratio of 1:1. Samples were collected using purposive sampling with inclusion criteria of babies born alive with complete medical records. Data analysis in this study used univariate analysis to view frequency distribution, bivariate with chi-squared test and multivariate with logistic regression using SPPS software version 24. </em></p><p><strong><em>Results</em></strong><em>: The incidence of pre-eclampsia was 13.3%, 34% age at risk, parity 37.5% garande multipara, 4imipara and multipara and most (62.5%) had primary education 47.5%. There is an association of pre-eclampsia with the incidence of LBW. There is an association of age, parity and education with the incidence of LBW, but pre-eclampsia is the most dominant factor that is the most dominant risk variable that affects the incidence of LBW. </em></p><p><strong><em>Conclusions</em></strong><em>: There is an association between pre-eclampsia, age, parity and education with the incidence of LBW. Pre-eclampsia is the most dominant factor in the incidence of LBW.</em></p>

Determining prognostic indicator for anticoagulant therapy in sepsis-induced disseminated intravascular coagulation

BackgroundThere is no reliable indicator that can assess the treatment effect of anticoagulant therapy for sepsis-associated disseminated intravascular coagulation (DIC) in the short term. The aim of this study is to develop and validate a prognostic index identifying 28-day mortality in septic DIC patients treated with antithrombin concentrate after a 3-day treatment.MethodsThe cohort for derivation was established utilizing the dataset from post-marketing surveys, while the cohort for validation was acquired from Japan’s nationwide sepsis registry data. Through univariate and multivariate analyses, variables that were independently associated with 28-day mortality were identified within the derivation cohort. Risk variables were then assigned a weighted score based on the risk prediction function, leading to the development of a composite index. Subsequently, the area under the receiver operating characteristic curve (AUROC). 28-day survival was compared by Kaplan–Meier analysis.ResultsIn the derivation cohort, 252 (16.9%) of the 1492 patients deceased within 28 days. Multivariable analysis identified DIC resolution (hazard ratio [HR]: 0.31, 95% confidence interval [CI]: 0.22–0.45, P < 0.0001) and rate of Sequential Organ Failure Assessment (SOFA) score change (HR: 0.42, 95% CI: 0.36–0.50, P < 0.0001) were identified as independent predictors of death. The composite prognostic index (CPI) was constructed as DIC resolution (yes: 1, no: 0) + rate of SOFA score change (Day 0 SOFA score–Day 3 SOFA score/Day 0 SOFA score). When the CPI is higher than 0.19, the patients are judged to survive. Concerning the derivation cohort, AUROC for survival was 0.76. As for the validation cohort, AUROC was 0.71.ConclusionCPI can predict the 28-day survival of septic patients with DIC who have undergone antithrombin treatment. It is simple and easy to calculate and will be useful in practice.

From Gestational Diabetes to Fatty Liver: Tracking the Journey to Prediabetes and Diabetes in Women – A Prospective Observational Study

Background: Gestational diabetes mellitus (GDM) and non-alcoholic fatty liver disease (NAFLD) are recognized risk variables for the development of prediabetes and diabetes. Understanding the combined effect of these conditions on the progression to glucose intolerance is crucial for developing effective prevention strategies. The study aimed to examine the incidence of prediabetes and diabetes in females with a history of GDM and NAFLD, in contrast to those with only one or neither condition, and to identify key risk factors related with these outcomes. Methods: 200 women were enrolled in a prospective observational study and allocated into four groups: Group A (GDM only), Group B (NAFLD only), Group C (both GDM and NAFLD), and Group D (control group with neither condition). Participants were followed for two years, with incidence rates of prediabetes and diabetes recorded. Baseline characteristics were assessed, and Cox proportional hazards models were used to identify significant risk factors. Results: The highest incidence of prediabetes and diabetes was observed in Group C, with 60% developing prediabetes and 50% developing diabetes. Group A had 40% prediabetes and 20% diabetes incidence, Group B had 36% and 24%, respectively, and Group D had 20% and 10%. Higher BMI, family history of diabetes, history of GDM, and presence of NAFLD were significant risk factors, while healthy dietary habits were protective. Conclusion: Females with a history of both GDM and NAFLD are at a considerably higher risk of developing prediabetes and diabetes. These findings underline the importance of targeted prevention and early intervention strategies in this high-risk population. Recommendations: Healthcare providers should prioritize monitoring and managing women with both GDM and NAFLD to prevent the onset of prediabetes and diabetes. Regular screening and promoting healthy lifestyle modifications are essential to mitigate these risks. Keywords: Gestational Diabetes Mellitus, Non-Alcoholic Fatty Liver Disease, Prediabetes, Diabetes, Risk Factors, Preventive Strategies

Risk factors for fibroadenoma mammae (FAM) among adult women at the South Tangerang General Hospital in Indonesia

A frequent benign breast tumor, fibroadenoma mammae (FAM), has extra stromal and epithelial components in the breast tissue. Despite not being fatal, FAM increases breast cancer risk, highlighting the necessity to recognize it. Estrogen and progesterone levels during menstruation, pregnancy, and lactation may alter FAM development. Therefore, this study examines FAM risk variables in adult women at South Tangerang Regional General Hospital, Indonesia. Adult women in General Hospital of South Tangerang City, Indonesia were studied using a case-control design with 85 cases and 85 controls. South Tangerang General Hospital recruited volunteers between December 2023 and January 2024 using purposeful sampling. FAM patients with a history of therapy were cases, while Eye Clinic patients without FAM were controls. Viral diseases, major cardiovascular problems in the past three years, and unstable weight were excluded. Multivariate analyses employed multiple logistic regression, while univariate and bivariate analyses used percentages and chi-square test. Fibroadenoma mammae (FAM) prevalence in adult women at South Tangerang General Hospital is highly correlated with age, age of menarche, family history, hormonal contraceptive use, and nutritional status. Abnormal nutrition was the largest risk factor for FAM in hospitalized adult women (aOR = 8.678, p &lt; 0.000). The study stresses the link between nutritional state and FAM, with abnormal nutritional status increasing risk. This shows how diet and nutrition affect FAM sensitivity. To reduce FAM prevalence, demographic, genetic, hormonal, and lifestyle factors must be understood and addressed due to their complex interaction. Dietary strategies that promote healthy eating may reduce FAM risk.

Feeling unwell of passenger travel by small vehicles and associated risk factors in the North Shewa Zone, Oromiya, Ethiopia

The current study investigated how and why sociocultural structures, situational conditions, and personal behavioural factors cause passengers to feel ill when travelling by minibuses, drawing on ideas from the social construction theory of illness. A significant objective was to investigate associated risk variables that influence passengers’ feelings of illness related to the social environment, addressing their beliefs, meanings, practices, and behaviours. A survey method was used to obtain data from 384 passengers for the study. The results of logistic regression indicated that feeling ill when travelling by minibuses differed from passenger to passenger; then, they had their own set of practical and emotional challenges that had no known medical reason. Compared with male and older passengers, female and younger passengers were more likely to feel ill. Furthermore, stress and role-set effects increased passengers’ experiences of feeling ill more than did passengers who had no stress prior to the trip and who had only one role. Additionally, passengers who travelled intermittently, utilized suppression techniques to lessen travel discomfort, and fastened seat belts were less likely to experience symptoms of illness. Passengers who travelled on unsafe roads and used alcohol before travel, on the other hand, were more likely to feel ill than those who travelled on safer roads and did not use alcohol before the trip. The findings suggest that passengers should be aware of predisposing conditions that result in illness, be able to rest before travelling, and use all suppressive methods to reduce or prevent illness while travelling by small buses.

Differential impacts of clinical, anatomical, and procedural factors on early and late mortality following open thoracoabdominal aortic repair: a retrospective observational study

BackgroundThe operative outcomes of thoracoabdominal aortic aneurysms (TAAAs) are challenged by high operative mortality and disabling complications. This study aimed to explore the baseline clinical, anatomical, and procedural risk factors that impact early and late outcomes following open repair of TAAAs.MethodsWe reviewed the medical records of 290 patients who underwent open repair of TAAAs between 1992 and 2020 at a tertiary referral center. Determinants of early mortality (within 30 days or in hospital) were analyzed using multivariable logistic regression models, while those of overall follow-up mortality were explored using multivariable Cox proportional hazards models and landmark analyses.ResultsThe rates of early mortality and spinal cord deficits were 13.1% and 11.0%, respectively, with Crawford extent II showing the highest rates. In the logistic regression models, older age (P < 0.001), high cardiopulmonary bypass (CPB) time (P < 0.001), and low surgical volume of the surgeon (P < 0.001) emerged as independent factors significantly associated with early mortality. During follow-up (median, 5.0 years; interquartile range, 1.1–7.6 years), 82 late deaths occurred (5.7%/patient-year). Cox proportional hazards models demonstrated that older age (P < 0.001) and low hemoglobin level (P = 0.032) were significant risk factors of overall mortality, while the landmark analyses revealed that the significant impacts of low surgical volume (P = 0.017), high CPB time (P = 0.002), and Crawford extent II (P = 0.017) on mortality only remained in the early postoperative period, without significant late impacts (all P > 0.05).ConclusionThere were differential temporal impacts of perioperative risk variables on mortality in open repair of TAAAs, with older age and low hemoglobin level having significant impacts throughout the postoperative period, and low surgical volume, high CPB time, and Crawford extent II having impacts in the early postoperative phase.

A neuro-fuzzy security risk assessment system for software development life cycle

This study aims to protect software development by creating a Software Risk Assessment (SRA) model for each phase of the Software Development Life Cycle (SDLC) using an Adaptive Neuro-Fuzzy Inference System (ANFIS) model. Software developers discovered and validated the risk variables affecting each SDLC phase, following which relevant data about risk factors and associated SRA for each SDLC phase were collected. To create the SRA model for SDLC phases, risk factors were used as inputs, and SRA was used as an output. The formulated model was simulated using 70 % and 80 % of the data for training, while 30 % and 20 % were used for testing the model. The performance of the SRA models using the test datasets was evaluated based on accuracy. According to the study findings, many risk variables were discovered and confirmed for the requirement, design, implementation, integration, and operation phases of SDLC 11, 8, 9, 4, and 6, respectively. The SRA model was formulated using the risk factors using 2048, 256, 512, 16, and 64 inference rules for the requirement, design, implementation, integration, and operation phases, respectively. The study concluded that using the SRA model to assess security risk at each SDLC phase provided a secured software development process.

Investigation of the Electrokinetic Potential of Granules and Optimization of the Pelletization Method Using the Quality by Design Approach.

The preparation of pellets using a high-shear granulator in a rapid single-step is considered a good economic alternative to the extrusion spheronization process. As process parameters and material attributes greatly affect pellet qualities, successful process optimization plays a vital role in producing pellet dosage forms with the required critical quality attributes. This study was aimed at the development and optimization of the pelletization technique with the Pro-CepT granulator. According to the quality by design (QbD) and screening design results, chopper speed, the volume of the granulating liquid, binder amount, and impeller speed were selected as the highest risk variables for a two-level full factorial design and central composite design, which were applied to the formula of microcrystalline cellulose, mannitol, and with a binding aqueous polyvinylpyrrolidone solution. The design space was estimated based on physical response results, including the total yield of the required size, hardness, and aspect ratio. The optimized point was tested with two different types of active ingredients. Amlodipine and hydrochlorothiazide were selected as model drugs and were loaded into an optimized formulation. The kinetics of the release of the active agent was examined and found that the results show a correlation with the electrokinetic potential because amlodipine besylate can be adsorbed on the surface of the MCC, while hydrochlorothiazide less so; therefore, in this case, the release of the active agent increases. The research results revealed no significant differences between plain and model drug pellets, except for hydrochlorothiazide yield percent, in addition to acceptable content uniformity and dissolution enhancement.

Influence Analysis the Technology Acceptance Model Approach on User Satisfaction and Repurchase on the KAI Access Application Using the SEM Method

The KAI Access application is a transportation service application from PT Kereta Api Indonesia. From a survey conducted by researchers, there is application dissatisfaction by users. This study aims to determine the effect of five TAM variables on user satisfaction and repurchase. In accordance with the research objectives, several TAM variables will be used, namely actual use, perceived ease of use, perceived usefulness, perceived risk, and perceived trust. It will also be known the effect of TAM variables on application user satisfaction, and repurchase of train tickets by application. After analyzing with SEM coherently, the results show that the actual use variable has a C.R. value of 6.095, has a positive and significant value on application user satisfaction. With a C.R. value of 7.668, the perceived usefulness variable has a significant positive value on application user satisfaction. With a C.R. value of 6.763, the perceived risk variable has a significant positive value on application user satisfaction. The perceived trust variable in the application has a C.R. value of 6.094 and has a significant positive value on application user satisfaction. With a C.R. value of 7.434, the application user satisfaction variable has a positive and significant value on the repurchase of train tickets through the application.

Efficacy of Xuebijing injection for the treatment of acute lung injury: A meta-analysis of randomized controlled trials

BackgroundManagement guidelines for acute lung injury (ALI) are extremely limited. Xuebijing, a traditional Chinese medicine, exerts therapeutic effects in patients with ALI; however, supportive evidence is currently insufficient. Material and methodsA systematic literature search of seven electronic databases for randomised controlled trials assessing the efficacy of Xuebijing injections in patients with ALI, published from inception to March 31, 2024, was performed. The Risk of Bias assessment tool recommended by The Cochrane Collaboration was used for quality evaluation. Review Manager version 5.3 (R Foundation for Statistical Computing, Vienna, Austria) was used for analysis. Dichotomous variables are expressed as relative risk (RR) and continuous variables as standardised mean difference (SMD). Heterogeneity was assessed using the I2 statistic and a funnel plot was used to visually assess publication bias. ResultsSixteen studies comprising 1327 patients were included. Xuebijing injection improved oxygenation index (SMD 1.08 [95 % confidence interval (CI) 0.79–1.38]), reduced the incidence of acute respiratory distress syndrome (RR 0.56 [95 % CI 0.42–0.74) and all-cause mortality (RR 0.48 [95 % CI 0.34–0.67]), and decreased serum tumor necrosis factor-alpha (SMD -1.33 [95 % CI -1.50 to −1.17]) and interleukin-6 levels (SMD -1.35 [95 % CI -1.52 to −1.17]). The funnel plot indicated no publication bias. ConclusionXuebijing injection may be an effective treatment for ALI. However, this needs to be further confirmed in well-designed, large-sample, randomised controlled trials.

Clinical characteristics and risk factors for poor outcomes of invasive pneumococcal disease in pediatric patients in China

BackgroundInvasive pneumococcal disease (IPD) is a significant health concern in children worldwide. In this study, we aimed to analyze the clinical features, antibiotic resistance, and risk variables for poor outcomes in patients with IPD in Hangzhou.MethodsA retrospective single-centre study was performed using the pediatric intensive care (PIC) database from 2010 to 2018. The clinical characteristics, laboratory data, antimicrobial resistance, and risk factors for in-hospital mortality and sepsis in patients with IPD in intensive care units (ICUs) were analyzed systematically.ResultsA total of 178 IPD patients were included in the study. The majority of the IPD children were 2–10 years old. Antimicrobial resistance tests of S. pneumoniae isolates revealed high resistance to erythromycin, tetracycline and compound sulfamethoxazole (SMZ-Co). All the isolates were sensitive to vancomycin, linezolid, moxifloxacin, telithromycin, ofloxacin, and levofloxacin. IPD patients may experience poor outcomes, including death and sepsis. The in-hospital mortality was 3.93%, and 34.27% of patients suffered from sepsis. Temperature (OR 3.80, 95% CI 1.62–8.87; P = 0.0021), Partial Pressure of Oxygen in Arterial Blood (PaO2) (OR 0.99, 95% CI 0.98-1.00; P = 0.0266), and albumin (OR 0.89, 95% CI 0.80–0.99; P = 0.0329) were found to be independent risk factors for sepsis in children with IPD.ConclusionPediatric IPD deserves attention in China. Appropriate surveillance and antibiotic selection are crucial in managing resistant strains. Early identification of high-risk individuals with risk factors contributes to the development of appropriate treatment strategies.

Profile of Stroke Patients Admitted to the Medicine Unit of Dhaka Medical College Hospital

Background &amp; objective: Stroke is a leading cause of death and a serious disability for adults. However, it is preventable and manageable, provided a complete updated profile (incidence, prevalence, and long-term outcome) of the disease is in our hands. The present study was therefore undertaken to assess the demographic, clinical characteristics, and outcome of the stroke patients admitted to the Dhaka Medical College Hospital. Methods: This descriptive cross-sectional study was conducted in the Department of Medicine, over a period of 12 months between January 2004 and December 2004 at the Dhaka Medical College Hospital (DMCH), Dhaka. The study sample consisted of 101 stroke patients who were admitted to the Green Medicine Unit of DMCH. However, stroke patients who were too severely debilitated or in a state of stupor were not allowed to participate in the study. Through pertinent clinical laboratory and imaging tests, stroke risk variables were evaluated. The outcome was evaluated in terms of the number of patients cured, died, or remained static. Result: There was no significant difference between ischemic and haemorrhagic stroke patients in terms of age (p = 0.658), sex (p = 0.276) and diurnal variation of its occurrence (p = 0.490). While diabetes mellitus and ischaemnic heart diseases were generally associated with haemorrhagic stroke (p = 0.039 and p = 0.056 respectively), hypertension was more or less common in ischemic stroke (p = 0.176). In both groups, hemiplegia was the most frequent cause of admission, after coma. While seizures were more common in the ischemia group, vomiting was a more common manifestation in the hemorrhagic group. The majority of patients in both groups maintained a steady pulse and normal blood pressure. The total cholesterol level was relatively greater in the ischemic group than in the hemorrhagic group. The mean HDL level in the hemorrhagic group was significantly higher than in the ischemic cohort. However, there was no appreciable difference in serum LDL and Tg levels across the groups. A substantial proportion of patients in both groups had to stay in the hospital for a brief period (10 or &lt; 10 days). After receiving treatment, nearly 85% of the patients in the hemorrhagic group and 76.3% of the patients in the ischemic group were cured; some 5.5% in the ischemic group and 4.3% in the haemorrhagic group died of the disease. Conclusion: The study concluded that smoking, uncontrolled hypertension, and diabetes mellitus are the three main risk factors for stroke. After a median treatment of 7 days, most patients in both the hemorrhagic and ischemic groups recovered, leaving a few to die of the disease. The risk of stroke can significantly be reduced by lowering blood pressure, treating diabetes, and giving up smoking. Ibrahim Card Med J 2023; 13 (1&amp;2): 47-52

The incidence of stroke and contribution of risk factors for stroke in high-risk stroke population in southwestern China

ObjectiveTo estimate the incidence of stroke and determine the role that risk factors play in the high-risk stroke populace in southwest China. MethodsThis research employed a prospective cohort design that focused on the community. Eight communities in southwest China were selected randomly for this study. The residents aged 40 years and older who volunteered to participate were surveyed through face-to-face interviews. Those with a history of stroke or at least three of the eight stroke-related risk factors were categorized as the high-risk stroke population. A total of 2698 high-risk individuals were included in the study after a 4.7-year follow-up period. The incidence of stroke and the association between risk variables and stroke occurrence were estimated. ResultsDuring 4.7-year follow-up, the incidence of total stroke, ischemic stroke, and hemorrhagic stroke in high-risk stroke population were 5.0 %, 4.4 % and 0.9 % respectively. It should be noted that some participants experienced both cerebral infarction and cerebral hemorrhage during the follow-up period. The multivariate analytic model revealed that a personal history of stroke (OR=3.397, 95 % CI 2.365–4.878, p<.001) was substantially linked with an elevated risk of overall stroke. This correlation remained consistent for both ischemic and hemorrhagic stroke. ConclusionsThis study revealed a high prevalence and incidence of stroke among a high-risk group in southwestern China. Furthermore, it demonstrated that individuals with a personal history of stroke are at an elevated risk of future stroke, suggesting the need for additional precautions in this population.

Does timely reporting of preoperative CT scans influence outcomes for patients following emergency laparotomy?

Timely preoperative computed tomography (CT) scans are important for patients requiring emergency laparotomy. United Kingdom guidelines state that a CT scan should be reported within 1h for 'critical' patients (will alter management at the time) and within 12h for 'urgent' patients (will alter management but not necessarily that day). An observational study included patients who were added to the National Emergency Laparotomy Audit (NELA) at a National Health Service trust from 2014 to 2021. The association of compliance with timings guidance and mortality was investigated. Multivariable logistic regression was used to determine the odds ratio of adherence to guidelines according to age, gender, night time admission, American Society of Anesthesiology (ASA) score, NELA mortality risk and category of scan. Further models determined the influence of adherence to guidelines on mortality, also adjusted for these variables. There were 1,299 patients (48% 'critical' and 52% 'urgent' CT scans). Only 360/1,299 (28%) of scans were undertaken with adherence to the timing guidelines. Critical scans were less likely to adhere to guidelines. Although univariable analysis suggested that adherence to guidelines was associated with reduced mortality, this was not the case in the multivariable model: only age, ASA and NELA mortality risk remained significantly associated with mortality. A minority of patients met the recommended preoperative CT report timings, and this was less likely for scans designated 'critical'. This did not appear to affect mortality when adjusted for key variables of risk. This illustrates the phenomenon of guideline adherence appearing to affect patient outcomes as a product of selection bias rather than causality.

Plasma 25-hydroxyvitamin D deficiency in the peri-operative period is associated with survival outcome in colorectal cancer patients: a meta-analysis

AimSurgery had a significant impact on 25-hydroxyvitamin D (25-(OH)D) levels. Uncertainty still existed regarding the effects of peri-operative 25(OH)D deficiency on colorectal cancer (CRC) patients’ prognosis. The purpose of the present study was to explore the potential association between the peri-operative 25(OH)D deficiency and the survival outcome of CRC.MethodsSeven electronic databases [including PubMed, EMBASE, Web of Science, The Cochrane Library, OvidMEDLINE(R), China National Knowledge Infrastructure (CNKI) and Wangfang data] were searched without language limitations. The primary outcomes were overall survival and all-cause mortality. Secondary outcomes were the incidence of 25(OH)D deficiency and risk variables for low 25(OH)D level in the peri-operative period.Results14 eligible studies were obtained with 9324 patients for meta-analysis. In the peri-operative period, the pooled incidence of blood 25(OH)D deficiency was 59.61% (95% CI: 45.74–73.48). The incidence of blood 25(OH)D deficiency post-operatively (66.60%) was higher than that pre-operatively (52.65%, 95% CI: 32.94–72.36). Male (RR = 1.09, 95% CI: 1.03–1.16), rectum tumor (RR = 1.23, 95% CI: 1.03–1.47), spring and winter sampling (RR = 1.24, 95% CI: 1.02–1.49) were the risk factors for the 25(OH)D deficiency. The association between the low 25(OH)D post-operatively and short-term overall survival (HR = 0.43, 95% CI: 0.24–0.77) was most prominent, while a low 25(OH)D pre-operatively (HR = 0.47, 95% CI: 0.31–0.70) was more significantly associated with long-term all-cause mortality than that after surgery.ConclusionPeri-operative 25(OH)D impacted the CRC patients’ prognosis. Due to possible confounding effects of systemic inflammatory response (SIR), simultaneous measurement of vitamin D and SIR is essential for colorectal survival.