Routine Check-up Research Articles

Next-visit prediction and prevention of hypertension using large-scale routine health checkup data.

This paper proposes the use of machine learning models to predict one's risk of having hypertension in the future using their routine health checkup data of their current and past visits to a health checkup center. The large-scale and high-dimensional dataset used in this study comes from MJ Health Research Foundation in Taiwan. The training data for models is separated into 5 folds and used to train 5 models in a 5-fold cross validation manner. While predicting the results for the test set, the voted result of 5 models is used as the final prediction. Experimental results show that our models achieve 69.59% of precision, 77.90% of recall, and 73.51% of F1-score, which outperforms a baseline using only the blood pressure of visitors' last visits. Experiments also show that a visitor who performs a health checkup more often can be predicted better, and models trained with selected important factors achieve better results than those trained with Framingham risk score. We also demonstrate the possibility of using our models to suggest visitors for weight control by adding virtual visits that assume their body weight can be reduced in the near future to model input. Experimental results show that around 5.48% of the people who are with high Body Mass Index of the true positive cases are rejudged as negative, and a rising trend appears when adding more virtual visits, which may be used to suggest visitors that controlling their body weight for a longer time lead to lower probability of having hypertension in the future.

The Association between Paediatric Obesity, Anthropometric Parameters and Physiological Traits among Rural Schoolchildren in Alice Location, Eastern Cape, South Africa

Background: Obesity is an epidemic non-communicable disease in South Africa (SA). Few data exist on rural schoolchildren. This study presented the association between paediatric obesity, anthropometric parameters and physiological traits in schoolchildren in the Alice Location of Raymond Mhlaba Municipality, South Africa. Methods: The sum of 305 schoolchildren including girls 146; boys 159 between 5 – 7 years old were enrolled. Body mass index (BMI) specific for gender and age was used to describe overweight and obesity. Systolic/Diastolic blood pressure (SBP and DBP) was ≥ 90th percentile for gender and age. An aneroid sphygmomanometer was used to measure blood pressure (BP). Results: 15.75% of girls were overweight compared to 10.69% of boys while 16.35% of boys were obese compared to 10.27% of girls. Pre-hypertension was detected in both girls (2.0%) and boys (0.3%). SBP and DBP were significantly (P<0.05) associated with body mass, stature, BMI, hip and waist circumference (HC & WC), the sum of skinfolds, fat-mass (FM), fat-free mass (FFM), and fat-free mass index (FFMI). Conclusion: Overweight, obesity and pre-hypertension are predominant amongst rural SA schoolchildren living in Alice location. Routine check-up and control of excessive weight gain in schoolchildren is crucial for early prevention of potential cardiovascular diseases in the future.

Prediction of high-grade cervical precancerous abnormalities: The role of personal factors, vaginal microflora, sexually transmitted infections, and high-risk human papillomavirus.

High-risk human papillomavirus infection (HR-HPV) is necessary but not the only factor needed to develop cervical cancer. It is essential to estimate cervical cancer development risk in the population of high-risk HPV-positive women and to avoid unnecessary examinations and treatment in low-risk individuals. The study aimed to identify associations between different personal factors, vaginal microflora, sexually transmitted, high-risk HPV infection, and various degrees of cervical precancerous lesions. A study was performed in 2016-2020. The study group consisted of 112 patients with abnormal cervical cytology results referred for colposcopic examination. 120 women who came for a routine gynecological check-up were included in the control group. Material from the cervix and upper vaginal fornix was taken for pH measurement, wet mount microscopy, testing the six most common high-risk HPV DNA types (16/18, 31, 33, 45, 58), HPV E6/E7 mRNA, and 7 genital infections-C. trachomatis, N. gonorrhea, T. vaginalis, M. hominis, M. genitalium, U. urealyticum, U. parvum. Results showed that women with all grades of cervical intraepithelial neoplasia (CIN) more often were smokers, had increased vaginal pH levels, and had positive HR-HPV DNA and HR HPV E6/E7 mRNA expression. Abnormal vaginal microflora, especially types associated with aerobic vaginitis, and M. hominis were significantly more often found in women with CIN2+. The presence of C.trachomatis, U. parvum, and U.urealyticum did not differ between the groups. The most important factors independently associated with CIN2+ were positive high-risk HPV E6/E7 mRNA expression (OR 59.4, 95% CI 14.84-237.51), and positive high-risk HPV DNA (OR 3.9, 95% CI 1.16-13.23). Higher education level was associated with reduced risk of CIN2+ (OR 0.2, 95% CI 0.07-0.71). In conclusion, this study reports HR-HPV DNA of the most common six types and E6/E7 mRNA positivity as the most significant factors associated with CIN2+ lesions and higher education related to lower risk of high-grade cervical lesions.

Evaluation of Standard Wire Loop Method in Determination of Significant Bacteriuria among Pregnant Women in Ekpoma

Standard wire loop method is a time-tested method for UTI diagnosis. The term "bacteriuria" means the presence of bacteria in urine. It may result from contamination during or after collection of urine or it may indicate the presence of bacteria in the bladder urine. There are several cultural quantitative techniques for determining bacteriuria but standard wire loop method is the most popular method though relatively simple and cheap. This study was carried out to evaluate the standard wire loop method for determination of significant bacteriuria among pregnant women in Ekpoma. A total of one hundred (100) early morning mid-stream urine samples from pregnant women attending antenatal clinics in Ekpoma and environs were collected aseptically using sterile, wide-mouthed, leak-proof universal bottles. Microscopic examination was carried out to detect the presence of pus cells, epithelial cells, red blood cells, yeast cells, crystals, parasites, bacteria and casts. Undiluted urine, 1:10and 1:1000 diluted urine samples were aseptically inoculated into blood agar and MacConkey agar using the Standard Loop method and compared with Miles and Mirsa method, it was incubated at 370C aerobically for 24 hours. After incubation colonies were counted and isolates identified by standard biochemical methods. Colony count of ≥105 CFU per ml were considered as significant growth. In vitro antibiotics susceptibility of bacterial isolates was determined using disc diffusion technique. The data generated was analyzed statistically using the chi-squared statistics to ascertain the significance of the results. Out of 100 urine samples collected 39(39%) samples yielded significant bacterial growth, while 61(61%) of the samples had no significant bacterial growth or no growth with higher prevalence in age group <25 years which is a sexually active group than in other age group ≤35 years which had incidence rate of 12 (25%). Standard loop method gave false positive rates of 4/35 (11.4%) and false negative rates of 4/36 (11.1%). The standard loop was found to have a sensitivity of 100%, specificity of 88.9% and identical results in 76.3% of the samples. To reduce bacteriuria and consequently prevent UTIs, it is necessary to take the precautions by doing regular routine check-ups and appropriate treatment. For large scale urine surveys the method chosen should be reasonably accurate, fast and simple to use. The materials required should be minimal, stable and easily transported. It is recommended that the method of choice for most laboratories is the standard loop method.

Acceptance of Human Papillomavirus (HPV) vaccine among the parents of eligible daughters (9-15 years) in Bangladesh: A nationwide study using Health Belief Model.

To align with the 2030 vision of the World Health Organization (WHO) to ensure 90% of girls receive the HPV vaccine before turning 15, Bangladesh has recently started the (HPV) vaccine campaign nationwide. Therefore, our study aimed to assess the level of its acceptance among parents of eligible daughters in Bangladesh. This nationwide cross-sectional study was conducted among the self-identified parents of daughters in the age group of 9-15 years between June 28 and August 2, 2023. A total of 2,151 parents were conveniently selected from all eight divisions of Bangladesh. Data was collected through face-to-face interviews using a semi-structured questionnaire. The Health Belief Model was used to appraise respondents' beliefs concerning HPV and its vaccination. Adjusted odds ratios (AOR) with a corresponding 95% confidence interval (CI), and a p-value of <0.05 was considered statistically significant. R Studio (Version 2023.09.0+463) was used as an interface for data analysis, while R (the programming language) was used for statistical computations. The mean age of the study participants was 38.18 (±5.86) years. The overall acceptance rate of the HPV vaccine was 86.61% (95%CI: 85.09-88.02). The vaccine acceptance level was positively associated with all the domains of the HBM (p<0.001), except in the perceived barrier domain (p = 0.489). After adjustment for other factors, it was found that higher age was associated with a decreased acceptance (AOR: 0.92; 95% CI: 0.89-0.95). The urban residents exhibited 42% lower odds of vaccine acceptance than rural (AOR: 0.58; 95% CI: 0.36-0.92). Similarly, participants of the middle-income group had 44% lower odds than the lower-income group (AOR: 0.56; 95% CI: 0.32-0.97). Our study found a reasonably good level of acceptance of the HPV vaccine among the parents of eligible daughters. Multiple factors such as younger age, urban residence, belonging to the middle income group, history of regular routine health check-ups, knowledge of cervical cancer, positive perception about benefits of the vaccine, and positive cues to actions were associated with HPV vaccine acceptance.

Unintentionally Retained Elevator Blade Left for 8 Years Causes Mild Chronic Pain.

Fracture of surgical instruments in dental practice is not usually reported in the literature. Management involves searching for and retrieving the fragment to avoid issues such as infection, swallowing, or aspiration. Although foreign bodies may not cause symptoms for years, some can cause chronic pain. The authors describe herein the unusual case of an unintentionally retained broken elevator blade left for 8 years before being found during an orthodontic evaluation. Panoramic radiography revealed a foreign body in the alveolar bone of the right mandibular third molar that was causing mild chronic pain. The patient was unaware whether routine radiographic examination had revealed its presence. Cone-beam computer tomography was performed to identify the position of the blade fragment, and surgery was performed to retrieve it. The mild chronic pain disappeared after removal. It is advisable to use high-quality surgical instruments and to perform routine checkups before and after surgery.

“Exploring The Nexus”: Chronic musculoskeletal pain in diabetic vs non-diabetic population

IntroductionDiabetes-mellitus (DM) has transcended the boundaries and affected populations across globe, it predisposes individual to stiffness and musculoskeletal-pain due to accumulation of glycation-end-products. Musculoskeletal-pain is a common yet frequently neglected complication. Pain mechanisms have been categorized as nociceptive, neuropathic, nociplastic, and idiopathic. Four criteria were put by Kosek-et-al to identify nociplastic pain that affects the musculoskeletal-system. Study aimed to evaluate prevalence of chronic musculoskeletal (cMSK) pain and its association with diabetes and glycaemic control and to evaluate comorbid conditions of cMSK pain. Methods and materialsA prospective case-control study was conducted at a level-1-tertiary-care-facility. Patients with type-2 DM above 30-years-age who visited outpatient department participated in the study (study group). Age-matched equal number of healthy individuals (control-cohort) were recruited in the study. We collected data from 300 participants in each group. Analysis was done based-on HbA1c-levels, random-blood-sugar (RBS),clinical-history, and comorbidities. Information regarding cMSK-pain was gathered using modified version of Nordic standard questionnaire. ResultsOverall prevalence of cMSK pain was 23.3 % (140 out of 600). Among Group-1/Diabetic group, it was 27.7 % and among group-2/Healthy Cohort it was 19 % and the odds ratio was 1.6. Most commonly reported region with cMSK among group-1 and group-2 was shoulder (32.5 %) and knee (36.8 %) respectively. We found a significant association between cMSK-pain and HbA1c levels (p < 0.005). and individuals with HbA1c levels of more than 12 reported involvements in multiple regions. We didn't find significant association between cMSK and DM, HTN, dyslipidemia, or hypothyroidism (P > 0.05). ConclusionStudy highlights higher-prevalence and significant impact of cMSK pain in diabetic patients compared to non-diabetic individuals. Addressing musculoskeletal-pain is crucial for improving overall quality-of-life in diabetic patients. Clinicians should adopt a proactive and comprehensive approach to pain management in diabetics. Using a simple Nordic questionnaire during routine check-ups helps with screening of joint and surrounding soft tissue pathology, preventing future complications that could lead to disability.

Clinical Value of Urinary Wilms' Tumour-1 and Mu-Glutathione S-Transferase Gene Expression in Kidney Injury in Type 2 Diabetes Mellitus.

To investigate the diagnostic value of urinary Wilms' tumour-1 (WT-1) and mu-glutathione S-transferase (Mu-GST) gene expression for detecting kidney injury in type 2 diabetes mellitus (T2DM). Patients treated between October 2022 and June 2023 were divided into two groups: a diabetic nephropathy (DN) group (105 patients) and a diabetes mellitus (DM) group (100 patients). Additionally, 100healthy individuals undergoing routine medical check-ups were selected as the control group. The urinary albumin/creatinine ratio (ACR), as well as urinary WT-1 and Mu-GST expression levels, were measured. The sensitivity and specificity of these markers for predicting renal injury were evaluated. The levels of ACR, WT-1 and Mu-GST in the DN group were significantly higher than those in the DM and control groups. The ACR in the DM group was also significantly higher than that in the control group (P < 0.05), and WT-1 and Mu-GST gene expression levels demonstrated a positive correlation with ACR (r = 0.391 and 0.342, respectively). The sensitivity and specificity of WT-1 were 74% and 95%, respectively, whereas those of Mu-GST were 70% and 96%, respectively. The combined detection of WT-1 and Mu-GST yielded a sensitivity of 82% and a specificity of 97%. The levels of WT-1 and Mu-GST gene expression are closely related to T2DM kidney injury, helping to identify the location of kidney injury to some extent, which provides valuable information for the clinical diagnosis and treatment of kidney injury.

Development and Validation of Machine Learning Models for Identifying Prediabetes and Diabetes in Normoglycemia.

Prediabetes and diabetes are both abnormal states of glucose metabolism (AGM) that can lead to severe complications. Early detection of AGM is crucial for timely intervention and treatment. However, fasting blood glucose (FBG) as a mass population screening method may fail to identify some individuals who are actually AGM but with normoglycemia. This study aimed to develop and validate machine learning (ML) models to identify AGM among individuals with normoglycemia using routine health check-up indicators. According to the American Diabetes Association (ADA) criteria, participants with normoglycemia (FBG≤5.6mmol/L) were collected from 2019 to 2023, and then divided into AGM and Normalgroups using glycosylated haemoglobin (HbA1c) 5.7% as the threshold. Data from 2019 to 2022 were divided into training and internal validation sets at a 7:3 ratio, while data from 2023 were used as the external validation set. Seven ML algorithms-including logistic regression (LR), random forest (RF), support vector machine (SVM), extreme gradient boosting machine, multilayer perceptron (MLP), light gradient boosting machine (LightGBM), and categorical boosting (CatBoost)-were used to build models for identifying AGM in normoglycemia population. Model performance was evaluated using the area under the receiver operating characteristic curve (auROC) and the precision-recall curve (auPR). The feature contributions to the optimal model was visualised using the SHapley Additive exPlanations (SHAP). Finally, an intuitive and user-friendly interactive interface was developed. A total of 59,259 participants were finally enroled in this study, and then divided into the training set of 32,810, the internal validation set of 14,060, and the external validation set of 12,389. The Catboost model outperformed the others with auROC of 0.806 and 0.794 for the internal and external validation set, respectively. Age was the most important feature influencing the performance of the CatBoost model, followed by fasting blood glucose, red blood cells, haemoglobin, body mass index, and triglyceride-glucose. A well-performed ML model to identify AGM in the normoglycemia population was built, offering significant potential for early intervention and treatment of AGM that would otherwise have been missed.

Improving health awareness with real-time monitoring through a three-dimensional visualized digital health avatar

IntroductionThe use of modern technologies has become crucial for enhancing people's awareness of health problems. By early health risk detection, there will be better treatment outcomes, the severity of illness will decrease, and costs for treatment will also reduce. Performing routine checkups could help patients feel less anxious about their health in the future. In this study, the innovation of "Digital Health Avatar" enables users to monitor physical changes, raise awareness of medical conditions, and encourage healthy behaviors by visualizing health status as a 3D figure. MethodsHealth data were collected using medical devices like blood test strips, body composition meters, and automatic blood pressure monitors. Advanced algorithms, such as computer vision and natural language processing (NLP), were used to process these collected data and produced a three-dimensional avatar that indicated the user's health status. User satisfaction survey on using the health avatar system was assessed through a survey of 61 participants. ResultsHealth avatar system successfully generate the data and display the measurement results on the health report page of the system. Users can easily check and record their physiological conditions through the avatar. Moreover, users showed satisfaction on the use of the health avatar system and its effectiveness in health check-ups in the survey. ConclusionsThe 'Digital Health Avatar' has the potential to significantly promote individual well-being and health awareness. Its development will be improved by user feedback and continued study, ensuring it becomes an efficient tool for promoting healthier lifestyles.

058. A Rare Case: Anterior Wall Rectum Perforation Due to Intrauterine Device Migration

Background: Intrauterine devices (IUDs) are widely used for contraception due to their long-acting, safe, and effective nature in preventing pregnancy. However, common side effects and complications, such as vaginal bleeding, expulsion, displacement, translocation, and perforation necessitate attention, with translocation and perforation being rare but potentially severe, warranting prompt removal according to WHO recommendations. This study aims to document and analyze a rare case of rectal perforation resulting from the migration of an IUD. Case: A report was made from 31-year-old pregnant woman with a history of two cesarean sections presented with 10-day abdominal pain and an IUD inserted 42 days post-surgery, which MRI revealed had translocated into the left anterolateral rectal wall, prompting retroscopy for extraction. Uterine perforation and IUD migration into adjacent organs can result in various complications, including uterine, bladder, and intestinal perforation, with initial symptoms potentially being asymptomatic, emphasizing the need for routine check-ups. Retrieval of migrated IUDs can be achieved through methods such as endoscopy, laparoscopy, or laparotomy, as illustrated in a case involving a patient with abdominal pain and imaging evidence of IUD translocation to the rectum's anterior wall, managed through less invasive rectoscopy. Conclusion: Translocated IUDs may exhibit varying symptoms or none at all, necessitating removal regardless of type or location, with management guided by radiological and endoscopic findings alongside understanding abdominal organ anatomy

“…considered ‘essential workers’, so we report to work and serve the community”: experiences of community health workers during COVID-19 pandemic in the Eastern Cape, South Africa

BackgroundCommunity health workers (CHWs) played an essential part in providing health services to the communities they served prior to and during the COVID-19 pandemic, and they had some positive impact on community/household health service promotion and delivery. Nonetheless, restricted movement and social isolation made it challenging for community members to access CHW services, which are normally provided in person. We explore community health workers’ opinions on the impact of COVID-19 on their responsibilities, clients, and communities in South Africa’s Eastern Cape.MethodsUsing a semi-structured interview guide, we conducted individual (n = 10) and focus group discussions (n = 13) with 23 community health workers. Participants were community health workers servicing three Black township communities in Buffalo Municipality District, Eastern Cape, South Africa. Transcripts from audiotaped and transcribed verbatim interviews were analysed thematically using Atlas.ti.ResultsThe COVID-19 had an impact on the CHWs’ job-related activities, the clients’ health, and caused disruptions in community social and economic activities, all of these had a negative impact on population health. COVID-19 had detrimental effects on the clients’ health in various ways, including restricted movement and fear of contracting the virus, isolation and deaths created anxiety and terror, or refusal to attend clinics for routine medical check-ups and treatment. Furthermore, CHWs claimed that COVID-19 affected community livelihoods, exacerbating food insecurity and job insecurity. The vast majority of CHWs, who were predominantly women, had to balance their employment workload tasks with domestic responsibilities, which added extra pressure and burden. In addition, many individuals experienced personal loss and bereavement. However, the clients and the community exhibited remarkable resilience and perseverance despite the multifaceted obstacles faced by the COVID-19 pandemic.ConclusionFinancial hardships, unemployment, and work disruptions or changes created by the COVID-19 pandemic triggered stress, sadness, worry, and terror among the CHWs. The client’s health conditions were adversely affected, as some clients refrained from visiting clinics for their medications and treatment because of restricted movements, concerns about contracting the virus, and isolation, all of which contributed to their anxiety and fear. The social isolation and quarantine, as well as food and job insecurity, all had an impact on the community’s social and economic life. Despite the COVID-19 risks and stressors, CHWs demonstrated resilience during the COVID-19 pandemic burden and emphasising their importance as “essential workers” in community health care which further underscores the need to provide CHWs with adequate resources and training in preparation for future pandemics.

Interethnic validation of an artificial intelligence algorithm for prediction of atrial fibrillation using sinus rhythm electrocardiogram

Abstract Background Previous research has demonstrated acceptable diagnostic accuracy of artificial intelligence (AI)-enabled sinus rhythm (SR) electrocardiogram (ECG) interpretation for identifying paroxysmal atrial fibrillation (AF). However, interethnic validations of the AI algorithms have not been widely conducted. Purpose We aimed to develop our own AI model for the identification of paroxysmal AF based on SR ECGs in the Korean population and to validate its diagnostic performance in Brazilian citizens. Methods We trained a Transformer-based vision network on 90% of a dataset comprising 808,194 ECGs from 121,282 patients at Seoul National University Bundang Hospital (2003-2020). The remaining 10% of the dataset was used for internal validation. The model was trained to compute a risk score for paroxysmal AF or new-onset AF within 2 years. External validation was conducted using non-AF ECGs from the CODE 15% dataset provided by the Telehealth Network of Minas Gerais, Brazil. Results In internal validation, our AI model achieved an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.911 (95% CI: 0.902 - 0.921), with a sensitivity of 78.1% and a specificity of 89.0%. Subgroup analyses showed an AUROC of 0.893 (95% CI: 0.876 - 0.909) for patients in routine health checkups or outpatient settings, and 0.854 for patients with "Normal ECG" interpretations. In external validation with the CODE 15% dataset, the AI model exhibited an AUROC of 0.884 (95% CI: 0.869-0.900), which increased to 0.906 (95% CI: 0.893-0.919) when adjusted for age and sex (Figure 1). In the subset of patients with "Normal ECG" interpretations, the AUROC was 0.826 (95% CI: 0.769-0.883), increasing to 0.861 (95% CI: 0.814-0.908) after applying the same adjustments. Conclusions Our AI-powered SR ECG interpretation model demonstrated excellent diagnostic performance in predicting paroxysmal AF, with valid performance in the Brazilian population as well. This suggests that the model has potential for broad application across different ethnic groups.Figure 1

Point-of-care screening for heart failure with reduced ejection fraction using simple pulse oximetry

Abstract Background More than 64 million patients with heart failure (HF) are burdened with poor quality of life, frequent hospitalizations, and high readmission rates. While HF with reduced ejection fraction (HFrEF) accounts for approximately half of these patients, there is currently no effective tool for performing cost-effective and reliable early-stage screening. For this purpose, we derived and cross-validated a machine learning (ML) based system capable of identifying HFrEF based on analysis of the photoplethysmographic (PPG) signal recorded by a simple pulse-oximeter. Methods Patients attending a routine ambulatory check-up at an outpatient clinic were included in the study. Left ventricular ejection fraction was determined by standard transthoracic echocardiography. Diagnosis of HF was based on the latest ESC recommendations for HF. PPG was measured using a standard oximeter modified to record raw PPG signal. Before processing, the quality of the measured PPG signal was assessed by signal quality indices to determine whether the quality of signal was sufficient for further analysis. In brief, the signal processing involved noise removal, filtering for specific frequencies, automatic artifact detection and identification of individual heartbeats, on which specific parts of the signal and signal characteristics, necessary for further analysis, were identified. Four different ML processing pipelines with different approaches to feature selection and class balancing were deployed, validated using the K-fold cross-validation and compared. Results A total of 371 patients were included in the study: 54 patients with HFrEF (mean age 66.87 ± 14.35, 74.07% male) and 317 patients with HFmrEF (4), HFpEF (42) or no history of HF (271) (mean age 54.12 ± 17.79, 51.73% male). From the 4 ML pipelines, LightGBM with SMOTE + Edited Nearest Neighbors balancing had the highest cross-validated predictive performance for detection of HFrEF (c-statistics 0.8, CI 0.69 – 0.89). Conclusions Our results suggest that HFrEF can be effectively screened using a simple pulse oximeter, thanks to ML signal analysis. This solution could be adapted to a simple, non-invasive, readily available, time-saving, and inexpensive point-of-care diagnostic tool for primary care. Early disease detection and referral to a cardiologist (or HF specialist) would have a positive impact on patient morbidity and mortality.Receiver Operating Characteristics CurveModel Performance Metrics

Association of gut microbiota imbalance with risk of postoperative infections in patients with left ventricular assist device

Abstract Background Infections are the most common complications following left ventricular assist device (LVAD) implantation and associated with adverse events. Gut microbial imbalance may predispose to mucosal colonization with pathogens, resulting in a risk of subsequent serious infections. However, it remains unclear whether gut microbiota imbalance is associated with postoperative infections in patients with LVAD. Purpose The aim of this study was to investigate whether gut microbiota imbalance was associated with postoperative infections in patients with LVAD. Methods We prospectively examined 22 consecutive LVAD patients who were admitted to a university hospital for routine check-ups and had stool cultures taken between March 2022 and December 2023. All patients had no signs of infection. The patients were divided into two groups according to positive (normal bacterial flora and other bacteria including Streptococcus viridans, Klebsiella, or Extended-spectrum β-lactamase Escherichia coli; n = 7) and negative (normal bacterial flora only; n = 15) for stool culture. The primary outcome was serious infection requiring hospitalisation treated with intravenous antimicrobial agents. Results Patients were predominantly male (68%) and the median age was 49 (interquartile range [IQR] 29-58) years. There were no significant differences in age, sex, primary aetiology of heart failure, type of LVAD devices, time on LVAD support, the history of infection, or antibiotics use within six months between the groups. During a median follow-up period of 316 days (IQR 242-559), the primary outcome occurred in seven patients (32%), including four hospitalisation for driveline infections, two pneumoniae and bacterial bloodstream infections, and one lung abscess and bacterial bloodstream infection. Kaplan–Meier analysis showed that the adverse events more frequently occurred in LVAD patients with positive for stool culture (P = 0.010) (Figure). A multivariable Cox regression analysis showed that positive for stool culture was independently associated with an increased subsequent risk of the primary outcome (hazard ratio 6.99, 95% confidence interval 1.17-41.7, P = 0.033), even after adjustments for age, male, body mass index, diabetes, INTERMACS profile, mechanical circulatory support, serum creatinine, serum albumin, and white blood cell count, which are known to be strong determinants of worse clinical outcomes in patients with LVAD. Conclusions In patients with LVAD, gut microbial imbalance was associated with subsequent serious infections. These findings suggest that the screening of stool culture might be useful for early identification of high-risk patients for infectious complication after LVAD implantation.

Perawatan Preventive Maintenance Mobil Satlantas Model Sedan Mazda dengan Metode Reliability Centered Maintenance pada Polres Kota X

The aim of this research is to find out the preventive maintenance of Mazda Sedan Model Traffic Cars using the reliability centered maintenance method at the City functional block diagram, determining system function and functional failure, failure mode and effect analysis, logic tree analysis, and task selection. The results of this research are that the maintenance system for traffic vehicle units carries out routine check-ups every 5,000 kilometers or every 3 months and for brake and tire components every 10,000 kilometers or 6 months, the damage that appears with the current maintenance system is the break caliper (right front), hose (water pump), and ball joint, factors that arise with current maintenance problems are safety problems, proposed improvements that need to be made to resolve the problem are preventive maintenance for the break caliper (right front), hose (water pump), and ball joint every 11000 hours or 458 days.

Easing caregiver strain: The power of health check-ups

Against the backdrop of global aging and escalating pressures on family caregiving, this study delves into the impact of health check-ups for the elderly on alleviating the objective burden of family caregiving by analyzing China's Free Health Check-up Program (FHCP). Using an unbalanced panel dataset spanning 2011, 2013, 2015, 2018, and 2020, comprising approximately 35,000 observations of the elderly population aged 65 and above, the research employs the Difference-in-Differences method. The research reveals a significant 9.18% reduction in family caregiving time following the implementation of FHCP, primarily attributed to the enhancement of the elderly's self-care abilities and health awareness. This study elucidates, for the first time, the efficacy and mechanisms of health check-ups in alleviating caregiving objective burdens, providing evidence for the formulation of pertinent policies. It underscores the significance of routine health check-ups as a public health intervention in supporting family caregivers and addressing the challenges of aging.

Parental awareness and dental health behavior of children with congenital heart disease, with diabetes mellitus, or undergoing anti-cancer treatment, compared to healthy children.

Children with chronic diseases tend to experience a considerably higher burden of oral disease compared to their healthy peers. Low awareness of the impact of systemic diseases on oral health, lack of motivation, and discomfort may render the maintenance of good oral hygiene challenging. We conducted a study of four groups of parents: of children with congenital heart disease (CHD), with diabetes mellitus type 1 (DM), and undergoing anti-cancer treatment (ACT); and a control group of healthy children (C). We aimed to compare between the groups, parental attitudes and knowledge of their children's oral health, and their reports of their children's dental habits. Parents who arrived with their children for routine check-ups at three main clinics: cardiology, endocrinology, and hematology-oncology were asked to respond to a questionnaire regarding their children's oral and dental health. A total of 287 questionnaires were collected from 76 parents of children with CHD, 100 parents of children with DM, 50 parents of children undergoing ACT, and 61 parents who comprised group C. Compared to the CHD and DM groups, the ACT group demonstrated significantly more awareness of the importance of maintaining oral and dental health following diagnosis of their children's medical condition. Mothers' education was found to correlate with dental health knowledge. Most children in the DM and C groups had previous dental examinations, compared to only half in the CHD and ACT groups. A higher proportion of the children in the C than the other groups brushed teeth twice daily. The groups were similar in their consumption of sugary drinks, and of sweets and snacks. The children's specialist physicians were the main source of information on oral health, especially in the ACT group. Although most of the parents reported awareness to the oral health aspects of their children's disease, only part of them reported that their children visited dentists, and brushed their teeth twice daily. For the parents of children with CHD, DM, and ACT, their children's treating specialists were the primary source of information regarding oral health. This highlights the importance of clear and continuous communication between pediatric specialists and dentists.

Gastrointestinal stromal tumor in Carney’s triad with laparoscopic total gastrectomy: a case report

IntroductionCarney's triad is a rare syndrome characterized by the co-occurrence of gastric gastrointestinal stromal tumor (GIST), pulmonary chondroma, and extra-adrenal paraganglioma. We present a case of a young woman with GISTs associated with this triad.Case presentationA 28-year-old woman was identified with multiple gastric tumors and a right lung nodule during a routine health check-up. CT scans and upper gastrointestinal endoscopy revealed a 50 mm mass on the lesser curvature of the stomach, along with two additional gastric lesions and a 20 mm nodule in the right lung. The patient had a history of right middle lobectomy at the age of 19 for pulmonary chondroma. During surgery, enlarged lymph nodes were observed, indicating metastasis, which necessitated a total gastrectomy with radical (D2) lymph node dissection. Pathological examination confirmed seven GISTs, with immunohistochemical staining positive for KIT (+), DOG1 (+), and negative for SDHB (−). The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. Despite opting out of adjuvant imatinib therapy, she remains disease-free 2 years postoperatively.ConclusionsThis case underscores the necessity of total gastrectomy with lymph node dissection due to the high incidence of metastasis in GISTs associated with Carney's triad. Further research is required to determine the optimal extent of lymph node dissection in such cases.

Diagnostic effectiveness of the Sport Mental Health Assessment Tool 1 supplemented with a brief clinical intake interview in a cohort of Polish elite Olympic athletes

ObjectiveSeveral studies have used the Sport Mental Health Assessment Tool 1 (SMHAT-1) among athletes but none have combined SMHAT-1 with a subsequent clinical intake interview. The aim of this study...