Significant Difference In Prevalence Research Articles

Significant stenosis without thrombus may be the third most common etiology of acute coronary syndrome

Abstract Background Plaque rupture (PR), plaque erosion (PE) and calcified nodule (CN) are known as major etiologies of acute coronary syndrome (ACS). On the other hand, significant stenosis without thrombus (SSWT) can be sometimes observed in culprit plaque of ACS. However, incidence and clinical feature of SSWT in ACS patients are not well known in Japanese. Method This is a sub study of TACTICS registry which include ACS patients (n=702) undergoing primary percutaneous coronary intervention (PCI) under optical coherence tomography (OCT) in Japan. Using this registry data, we compared the clinical features and OCT findings of SSWT in ACS patients in comparison with PR, PE and CN. Major adverse cardiac event (MACE) was defined as death, non-fatal myocardial infarction, heart failure, or ischemia-driven revascularization at 1-year. Results Plaque rupture (PR: n=411, 61%) and plaque erosion (PE: n=178, 26%) were 2 major etiologies, which was followed by SSWT (n=59, 9%) and calcified nodule (CN: n=28, 4%). Clinical characteristics are shown in table 1. Patients with SSWT was slightly older than PR and PE but younger than CN. Proportion of male was fewer than PR and PE but greater than CN. In terms of traditional coronary risk factors, there were significant differences in prevalences of diabetes, active smoking, and hemodialysis among different etiologies. In SSWT, non-ST elevation myocardial infarction was the main type of ACS followed by unstable angina and ST elevation myocardial infarction (51%, 39% and 10%, respectively), which may be associated with the least CK level and greater TIMI flow. Lesion was less complex with lower proportion of type B2 or C, shorter procedure time, lower proportion of multivessel disease and lower syntax score. OCT findings are shown in table 2. Regarding lipid component and calcification, SSWT showed similar finding as PE. Cholesterol crystal was relatively less as compared to PR and PE. Kaplan-Meier survival curve showing MACE and ischemia driven-TLR are shown in figure 1 and 2. MACE and TLR was the least in SSWT. Conclusion SSWT was the third most common etiology of ACS with different feature from PR, PE and CN.

Physical activity habits among members of the Athens Medical Society in Greece

Abstract Introduction Benefits of regular physical activity and exercise are well documented. Healthcare workers play a crucial role in counseling and appropriately referring their patients to adopt physical activity. However, doctors’ exercise habits range between different medical specialties and health service infrastructure. Purpose In this study, we assess physicians’ exercise performance according to the recommendations of 2020 ESC Guidelines. Methods The population of this cross-sectional study comprised 742 physicians of the Athens Medical Society (AMS), Greece. The study instrument was a self-administered questionnaire mailed in October 2023 to investigate physicians’ exercise habits, baseline characteristics of population, specialty, and health service infrastructure [Greek National Healthcare System (GNHS) or Private Practice (PP)]. European Society of Cardiology (ESC) Guidelines recommend at least 150 min/week of moderate-intensity exercise in all healthy adults. Subjects were divided in two groups according to their compliance to ESC Guidelines: 1. Moderate-intensity endurance exercise training per week ≥ 150 min (Group A); 2. Moderate-intensity endurance exercise training per week <150 min (Group B). Results The recommended exercise training per week goal is achieved by the majority of AMS members (53.4%) with an estimated mean exercise endurance training time of 240 ± 285 minutes. Between Group A and Group B there was no difference in age (50±12years vs. 50±13years, p=0.73), whereas there was significant difference in male sex prevalence (58% vs. 43%, p <0.001), in Body Mass Index (24.7 ± 3.8 kg/m2 vs. 26.2 ± 4.7 kg/m2, p <0.001), in Smoking habits (17.4% vs. 23.5%, p=0.04), in diabetes mellitus incidence (6.6% vs. 11.8%, p= 0.01) and in the use of activity monitoring wearables (45.2% vs. 29.8%, p<0.001). Interestingly, there was significant difference between GNHS and PP doctors representation in Group A and B with more doctors in the PP categorized in the Group A (p=0.008) (Figure 1). Importantly, logistic regression analysis revealed that even after adjustment for the aforementioned confounders there was significant under-representation of the GNHS in the Group A or otherwise doctors in the GNHS have 33% decrease odds of achieving the recommended exercise training per week (Odds Ratio: 0.676, 95%CI 0.484, 0.943, p=0.02) (Table 1). Conclusion A significant proportion of the AMS members follows the recommended ESC guidelines for minimum exercise training per week. Several factors affect their adherence to exercise time recommendation. Interestingly, AMS doctors working on the GNHS independently of other factors are less adherent to exercise recommendations. These findings emphasize the need to strengthen prevention strategies to AMS.

Prevalence of domestic chicken ectoparasites in the east Goejam, Amhara, Ethiopia

Ectoparasites significantly impact the health and productivity of chickens, both directly and indirectly. From October 2022 to September 2023, a cross-sectional study was conducted in the East Gojam Zone of the Amhara region, North West Ethiopia to identifying the ectoparasite species infesting free-ranged chicken. Additionally, a questionnaire survey was used to assess farmers knowledge and attitudes towards control practices. The purposeful sampling method was utilized to select study districts and peasant associations (PAs), while the simple random sampling method was employed to select interviewed respondents (n = 90) and sampled chickens. Samples were collected from 384 chickens through visual examination of their entire bodies, including skin scraps, to expose any ectoparasites present. The ectoparasites were then identified according to diagnostic guidelines. Out of the 384 local chickens examined, 184 (47.9 %) were found to harbor one or more of ectoparasites. Four genera of ectoparasites were identified, with louse (Menacanthus stramineus) most prevalent species (N = 133/184) 72.3 % and fleas (Ceratophyllidae) being the least prevalent N = 3 (1.6 %). Lice species included Menacanthus stramineus (N = 98) 53.3 %, Lipeurus caponis (N = 15) 8.2 %, Goniocotes gallinae 7 (3.8 %), Menopon gallinae (N = 7) 3.8 %, and Cuclotogaster heterographus (N = 6) 3.3 %. Additionally, one species of ticks (Argas persicus, (N = 9) 4.9 %, mites (Knemidocoptes mutans, (N = 5) 2.7 %, and fleas (Echidnophaga gallinacean, (N = 3) 1.6 % were found. Statistically significant differences (p = 0.040) in prevalence were observed between age groups, breeds, management systems, and study areas. However, the prevalence was not statistically significant (p > 0.05) between sex categories. Results from the questionnaire survey revealed that most poultry farmers were female (N = 74) 82.2 % and illiterate (N = 52) 57.8 %. A majority of respondents (N = 55) 61.1 % lacked information regarding ectoparasite infestations in chickens, while (N = 36)36.7 % of respondents fed their chickens supplementary feed once a day. This study highlights the prevalence of ectoparasite infestations among chickens in the studied areas. Therefore, it is recommended to raise awareness among the community about control practices and conduct further studies focusing on the impacts of ectoparasites.

The hidden burden of atopic dermatitis in central and Eastern European countries

ABSTRACT Background Atopic dermatitis (AD) imposes a hidden burden through its negative effects on quality of life and productivity. We aim to estimate this hidden burden in adults and adolescents in Central and Eastern European (CEE) countries. Methods We created a burden of disease model to quantify AD’s hidden burden. Humanistic burden was calculated by estimating the monetary value of quality-adjusted life years (QALYs) lost, using prevalence data from the Global Burden of Disease study and gross domestic product (GDP) per capita for each country. Indirect economic burden was estimated based on productivity loss from absenteeism and presenteeism, adjusted for labor force participation and unemployment rates. Total hidden burden was determined by combining productivity losses and QALYs lost. Results QALY loss due to AD ranged from 1,832 to 58,596 annually in CEE countries, equating to 38 million to approximately 1 billion Euros per country. Productivity losses ranged from 3.6 to 148.9 million Euros annually. The total hidden burden of AD represents 0.11% to 0.43% of the GDP. Conclusions Our estimates reflect significant differences in population size, prevalence, and economic strength among CEE countries. Adjusting findings to country-specific GDP provided insights into AD’s true hidden burden, offering valuable information for decision-making.

Dynamics of Amphibian Pathogen Detection Using Extended Museum Specimens.

Natural history collections have long served as the foundation for understanding our planet's biodiversity, yet they remain a largely untapped resource for wildlife disease studies. Extended specimens include multiple data types and specimen preparations that capture the phenotype and genotype of an organism and its symbionts-but preserved tissues may not always be optimized for downstream detection of various pathogens. Frogs are infected by an array of pathogens including Batrachochytrium dendrobatidis (Bd), Ranavirus (Rv), and Amphibian Perkinsea (Pr), which provides the opportunity to study differences in detection dynamics across tissue types. We used quantitative PCR protocols to screen two tissue types commonly deposited in museum collections, toe clips and liver, from two closely related host species, Rana catesbeiana and Rana clamitans. We compared Bd, Rv, and Pr infection prevalence and intensity between species and tissue types and found no significant difference in prevalence between species, but Bd intensity was higher in R. clamitans than R. catesbeiana. Toe tissue exhibited significantly higher Bd infection loads and was more useful than liver for detecting Bd infections. In contrast, Rv was detected from more liver than toe tissues, but the difference was not statistically significant. Our results support the use of extended specimen collections in amphibian disease studies and demonstrate that broader tissue sampling at the time of specimen preparation can maximize their utility for downstream multipathogen detection.

Prevalence of acute kidney injury and outcome in cats treated as inpatients versus outpatients following lily exposure.

To investigate the prevalence of acute kidney injury (AKI) and outcome in cats treated for lily exposure as inpatients (IPs) or outpatients (OPs). Medical records of cats with lily exposure were retrospectively evaluated; 112 cats were included. Signalment, type of exposure, time from exposure to presentation, decontamination procedures, treatment group (IPs vs OPs), creatinine and International Renal Interest Society AKI grade at specific time points (initial presentation, 0 to 24 hours, 24 to 48 hours, and 48 hours to 2 weeks), whether an AKI developed at any point, whether AKI grade was static or improved when comparing baseline to last documented AKI grade, and outcome (alive or dead/euthanized) were recorded. There were no significant differences in prevalence of AKI between the IP cats (45 of 96 [46.9%]) and OP cats (7 of 16 [43.8%]). Of the AKI cats, 27 IP cats (60%) and 4 OP cats (57.1%) had a static or improved AKI grade. Inpatient cats had a significantly higher survival compared to OP cats (100% vs 86.5%). Cats exposed to lilies in both groups had a higher prevalence of AKI than previously reported; however, many cats with AKIs had a static or improved AKI grade by the last documented AKI grade. Although the survival was lower in OP cats compared to IP cats, overall survival was excellent. Results of our study suggested that IP cats have a superior outcome than OP cats; however, cats treated as OPs may still have favorable outcomes.

Nutritional Assessment Based on Mid-upper Arm Circumference Among Tribal Preschool Children of Three Distinct Ecological Zones of India

Undernutrition among infants and children retards the physical and cognitive growth and increases susceptibility to infections and diseases. Educational attainment and productivity of children get adversely affected by undernutrition, NFHS (2019–2020) and IIPS (2021) found the prevalence of undernutrition indicators to be high among the under-five children of the nation and tribal children to be in a more vulnerable condition. Mean mid-upper arm circumference (MUAC) is a quick, simple and precise screening tool to use in large-scale community-based nutritional programme. The present study aimed to assess the prevalence of undernutrition based on MUAC among three tribes of three distinct ecological zones of India, namely Bhil Tribe (Desert ecology), Dhodia tribe (Coastal ecology) and Kinnaura tribe (Himalayan ecology). The present cross-sectional study consists of 985 tribal children (509 boys and 476 girls) belonging to the age group 0–1 through 5+ years (below six years). Z-score was computed using WHO (2006) recommended age and sex-specific cutoff points for MUAC and the prevalence of undernutrition was assessed for children of below five years of age. MUAC has been found to have significant age difference among all communities ( p < .001). Prevalence of undernutrition was found to be the highest among the Bhil tribe, the one residing in the desert ecology (41.03%) followed by Dhodia (18.06%) and Kinnaura tribe (12.16%). Among Bhil and Kinnaura children, prevalence of undernutrition was higher among the girls, while the Kinnaura boys manifested higher prevalence of undernutrition in comparison to their counterpart. Significant ( p < .01) sex difference in undernutrition prevalence was found only in case of Bhil tribe (boys: 33.33%, girls: 48.02%). The prevalence of undernutrition significantly differs among the tribes of three distinct ecological zones ( p < .001). The nutritional status of the tribal children, particularly that of the Bhil children, was unsatisfactory. To improve the nutritional wellbeing of the tribal population of the nation, studies at regular intervals focusing on the causes responsible for nutritional status are needed.

Prevalence of Vibrio Species Isolated from Water Bodies in Buguma Community in Rivers State, Nigeria

Aim: To assess the prevalence of Vibrio species isolated from water bodies and stool samples in Buguma community in Rivers State, Nigeria. Study Design: This was a cross-sectional study with simple randomized sampling technique. Methodology: The study used a total of 80 samples comprising of 40 stool and 40 water samples from different water bodies where public toilets were collected in Buguma community in Rivers State, Nigeria. The Vibrio species were isolated from the samples using Thiosulphate Citrate Bile Salt agar (TCBS), and blood agar as a confirmatory after which biochemical tests were carried out for further identification. Data collected was analyzed with Graph pad prism version 8. The prevalence and distribution of Vibrio were presented in frequencies and percentages with all analysis done at a 95% confidence interval and P-values less than .05 were considered significant. Results: From chi-square analysis there was a 35% prevalence rate in water bodies samples in comparison to stool samples that had a 7.5% prevalence (P value = .56). A higher prevalence was also reported in the female subjects (7.6%) compared to the male subjects (7.4%). There was a statistically significant difference in consumption of shellfish which poses to be a risk factor (P value = .01). There was also a statistically significant difference in prevalence of Vibrio species in water bodies and Vibrio species isolated from human stool sample (P value = .0026). Conclusion: Higher prevalence of Vibrio species was found in water bodies compared to stool. The consumption of shellfish is potential a risk factor for Vibriosis in Buguma community in Rivers State of Nigeria.

Evaluating Predictive Factors for Lymphocele Formation Following Kidney Transplantation.

Lymphocele is a common complication post-kidney transplantation, influenced by various factors including surgical technique, graft vessel count, operator experience, body mass index, ischemia time, and immunotherapy regimens. The purpose of this study was to evaluate lymphocele risk factors, particularly focusing on the role of end-stage kidney disease. A retrospective study was conducted on renal transplant recipients from a single center (March 2020 to December 2022). Patients were categorized into those developing lymphocele and those without during the postoperative period. Data, including sociodemographic, personal history, graft-related variables, intervention, and postoperative outcomes, were collected from electronic medical records. Out of 291 renal transplant recipients, 57 (19.6%) developed postoperative lymphocele, with 15 (5.1%) being symptomatic. Patients with body mass index <24.9 kg/m2 have lower risk of developing lymphocele with an Odds Ratio of 0.538 (P=0.046). Higher lymphocele prevalence was noted in patients with chronic tubulointerstitial nephritis (46.2%; OR 3.815; P=0.024). Focal segmental glomerulosclerosis patients showed no lymphocele (0.0%; OR 0.123; P=0.048). Other factors, including autosomal dominant polycystic kidney disease, did not exhibit significant differences in lymphocele prevalence. The etiology of end-stage kidney disease can serve as a significant predictor of lymphocele development during the postoperative period following renal transplantation. Further larger prospective studies are required to comprehensively assess risk factors and explore end-stage kidney disease potential role in predicting lymphocele formation.

Prevalence and risk of occurrence of visible birth defects in mining areas in South Kivu: A hospital-based cross-sectional study.

Possible contamination related to mining activities might contribute with other risk factors in increasing the burden of birth defects (BDs) in many developing countries including the Democratic Republic of Congo. The subsequent prevalence is frequently underestimated. Implementation of focused public health interventions is hindered by the paucity of comprehensive data. We assessed the potential impact of mining on the prevalence and occurrence of visible BDs in neonates in South Kivu (SK). A hospital-based cross-sectional study was conducted among 65,474 newborns registered in 7 hospitals in SK from 2016-2021. Hospitals were categorized based on mining activities in their respective catchment areas. Living in a mining zone was the exposure, whereas the outcome was visible BDs. Prevalence was estimated per 100,000 live births, and risk of occurrence with odds ratio (OR) and their 95% confidence interval. 261 neonates with visible BDs were recorded accounting for a prevalence of 399 cases per 100,000 live births. The prevalence ranges between 217 and 1365 cases per 100,000 live births. An increased risk was found in mining zones(OR=2.07; 95%CI=1.59-2.68), Mubumbano(OR=1.72, 95%CI=1.22-2.43), and Mwenga(OR=3.89, 95%CI=2.73-5.54), whereas a reduced risk was reported in non-mining zones(OR=0.48, 95%CI=0.37-0.62) in Katana (OR=0.49, 95%CI=0.33-0.73). Musculoskeletal(28.74%) and central nervous systems(19.92%) were the most common BDs. A significant difference in prevalence for BDs involving the face, GI system and abdominal wall, musculoskeletal, central nervous and genitourinary systems between mining and non-mining zones was found(p<0.001). There is an excessive risk for visible BDs in areas with hazardous mining activities in SK region.​​ More complex studies are needed to define the possible causal relationship. Moreover, findings generated herein should be corroborated by other research design, periodically monitored by public health authorities, and used to inform initiatives promoting enhanced environmental health, access to pediatric surgical care, and public health campaigns aimed at decreasing risk of BDs.

Oral health status and factors associated with oral health of primary school children in Gulu district, northern Uganda

BackgroundGlobally, oral diseases remain a major public health problem. However, there is limited information about the oral health status and factors associated with oral disease among children in Uganda. The aim of this study was to examine the oral health status and factors associated with oral health of primary school children in urban and rural areas of the Gulu district of northern Uganda.MethodsA comparative cross-sectional study was conducted among 356 school children aged 11–13 years attending six schools located in urban and rural areas. The children received a clinical oral examination and participated in a questionnaire survey that collected information on sociodemographic and oral health knowledge, attitude, and practices. All data were entered and analysed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp statistical software. Logistic regression analyses examined factors associated with dental caries and gingival bleeding.ResultsOf the 356 children (11–13 years) included, the mean age was 12.2 years, 140 (39.3%) were male and 176 (49.4%) were from urban areas. The proportion of school children with dental caries was 33.6% (n = 119), with the mean decayed, missing due to caries, and filled teeth (DMFT) index of 0.81 (25th percentile = 0; 75th percentile = 1.00). There was no significant difference in caries prevalence between rural and urban children (31.6% versus 35.6%, p = 0.33). Of the children involved in the study, 141(39.8%) had gum bleeding. The mean oral knowledge score was 2.85 ± 1.53 (range, 0–7), while the mean attitude, hygiene practice, frequency of sweets consumption, and oral health related impact scores were 4.25 ± 1.23 (range, 1–6), 5.40 ± 1.81 (range, 0–9), 25.66 ± 4.29 (range 9–54) and 2.1 ± 1.65 (range, 0–6), respectively. Using logistic regression analyses, as oral health knowledge score increased the odds of not having dental caries increased (aOR = 1.19, 95% CI 1.02–1.39).ConclusionThe prevalence of dental caries and gum bleeding of primary school children in Gulu district is high. Children lacked knowledge on causes of oral disease, and behaviour towards oral disease prevention. In addition, oral health knowledge scores were significantly associated with dental caries. Oral health education programs in schools should emphasise providing skills-based education.

Prevalence and risk factors of low back pain in military personnel: a systematic review.

Low back pain (LBP) has a significant impact on the general population, especially on military personnel. This study aimed to systematically review the relevant literature to determine the prevalence and risk factors of low back pain among military personnel from different military occupational categories. For this systematic review, we searched Embase, PubMed, and Cochrane. We performed study selection, data extraction, and assessed the quality of the evidence using the adapted risk of bias assessment tool by Hoy et al. This review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study is registered on the Center for Open Science, registration DOI: 10.17605/OSF.IO/HRGE8. Out of 860 papers, 19 studies met the inclusion criteria. More than 360 000 military people with lumbar pain situation were considered for inclusion in this systematic review. The 1-year prevalence of LBP could be up to 81.7% in the Army, 5.2% in the Marines, and 48.1% in the Air Force. Age (OR = 0.494-2.89), history of LBP (OR = 2.2-8.91), and sedentary position (OR = 0.55-3.63) were the most common physical, sociodemographic, and occupational risk factors, respectively. Low back pain was prevalent among military personnel. There was heterogeneity in studies and a significant difference in prevalence and incidence across various occupational categories. Physical, sociodemographic, and occupational risk factors were researched more than psychological risk factors in the military.

Association between postoperative pain and analgesic use in minimally invasive cardiac surgery.

This study aimed to investigate the effects of surgical methods on pain duration and oral analgesic administration in patients who underwent cardiac surgery using various minimally invasive methods. We included 90 patients who underwent an anterior incision with costal cartilage transection, lateral incision without costal cartilage transection, or total endoscopic cardiac surgery using a lateral incision and no retractor. Oral analgesics were postoperatively administered upon patient request. All the patients were instructed to rate their pain during the daytime 3 and 7 days postoperatively. Between-group differences included surgical method, wound size, operation/cardiopulmonary bypass time/cardiac arrest time, and intraoperative fentanyl dose. No differences were found in sex, age, diabetes status, paravertebral block use, or blood loss. The number of postoperative days, postoperative analgesic use, and pain 3 days postoperatively demonstrated no difference. Pain ratings were most severe for the costal cartilage resection group and least severe for the total endoscopic cardiac surgery group 7 days postoperatively. Similarly, patients who underwent costal cartilage research exhibited the highest rate of analgesic use for 30 days postoperatively, whereas patients who underwent total endoscopic cardiac surgery demonstrated the lowest. We revealed significant between-group differences in pain prevalence and postoperative oral analgesic administration in patients who underwent cardiac surgery relative to the minimally invasive surgical method used.

FREQUENCY OF ARDS IN ICU AND CAUSE-RELATED FACTORS

Acute Respiratory Distress Syndrome (ARDS) is a severe condition frequently seen in ICU patients, leading to increased morbidity and mortality. Understanding its prevalence and associated risk factors can enhance early detection and improve patient outcomes. Objective: To determine the frequency of ARDS in ICU patients and identify factors contributing to its development. Methods: This cross-sectional study was conducted in the Department of Critical Care from July 2023 to June 2024 after obtaining ethical approval. A total of 76 patients admitted to the ICU were enrolled based on pre-defined criteria. Detailed histories, physical examinations, and diagnostic evaluations, including chest X-rays, CT scans, and laboratory tests, were collected from electronic health records (EHRs). Demographic data and relevant clinical variables were analyzed using SPSS version 26. Statistical tests were applied to assess associations between ARDS development and patient characteristics. Results: Out of 76 ICU patients, 39 met the study inclusion criteria. The mean age was 51.00 ± 15.50 years, with an average hospital stay of 9.38 ± 9.49 days. Males comprised 66.7% (n=26) and females 33.3% (n=13) of the sample. ARDS was diagnosed in 33.3% (n=13) of patients. Stratification of patients by age showed 28.2% aged 20-40 years, 46.2% aged 41-60 years, and 25.6% over 60 years. The duration of ICU stay was 53.8% for 1-5 days, 15.4% for 6-10 days, and 30.8% for more than 10 days. No statistically significant differences in ARDS prevalence were found when stratified by age, hospital stay, or gender. Conclusion: ARDS was identified in 33.3% of ICU patients, highlighting the critical need for early diagnosis and prompt management. The study underscores the importance of addressing predisposing factors to improve patient outcomes. Further research is needed to explore potential therapeutic interventions.

Pooled analysis of the MANTICO2 and MONET randomized controlled trials comparing drug efficacy for early treatment of COVID-19 during Omicron waves

BackgroundThe clinical effectiveness of early therapies for mild-to-moderate COVID-19, comparing antivirals and monoclonal antibodies (mAbs) during the Omicron era, has not been conclusively assessed through a post-approval comparative trial. We present a pooled analysis of two randomized clinical trials conducted during Omicron waves. Methods The MANTICO2/MONET trial is a pooled analysis of two multicentric, independent, phase-4, three-arm, superiority, randomized, open-label trials. Nonhospitalized patients with early mild-to-moderate COVID-19 (≤5 days after symptoms’ onset) and at least one risk factor for disease progression were randomized 1:1:1 to receive 500mg of intravenous sotrovimab (SOT) or 600mg of intramuscular tixagevimab/cilgavimab (TGM/CGM) or oral 5-days course of nirmatrelvir/ritonavir (NMV/r) 300/100mg BID. Primary outcome was COVID-19-related hospitalization or death within 29 days after randomization. Fisher’s exact test for pooled data and incidence of failure was reported as overall and by arm with respective 95% CI.Pairwise comparisons across the arms were conducted using unadjusted exact logistic regression. An analysis by means of a doubly robust marginal model using augmented inverse probability weighting (AIPW) was also conducted to estimate the potential outcomes (Pom) in each treatment group and their difference by the average treatment effect (ATE). Analysis of symptom persistence within 30 days after randomization was performed using a 2-level hierarchical mixed-effects logistic model with a random intercept at the patient’s level. Point estimates and 95% confidence intervals were adjusted for age and sex and calculated using ANOVA-like methods for the mixedeffects logistic model. These trials are registred with the European Clinical Trials Database, EudraCT2021-002612-31 (MANTICO2) and EudraCT2021-004188-28 (MONET) and ClinicalTrials.gov, NCT05321394 (MANTICO2) Findings Between March 2022 and February 2023, 991 patients (SOT=332, TGM/CGM =327, NMV/r=332) were enrolled in 15 Italian centersThe overall mean age was 66 years; 482 participants (48.80%) were male and 856 vaccinated with at least a primary course ( 86%). Among the 8/991 hospitalizations observed, one resulted in death. The overall estimate of failure was 0.81% (95%CI; 0.35-1.58%). The odds ratio (OR) for the primary outcome in the NMV/r arm compared to the TGM/CGM and SOT arms was 8.41 (95% CI 1.21 to infinity; p=0.015) and 2.42 (95% CI 0.19 to infinity; p=0.499), respectively. No significant difference was observed between SOT and TGM/CGM (OR 0.32; 95% CI 0.032-1.83; p=0.174). Results were similar when we applied the marginal weighted model accounting for potential residual confounding bias. There was no evidence for a difference in the prevalence of symptoms between treatment groups, except for cough, which was higher in the SOT group compared to the other two groups at the 21-day follow-up (P=0.039) and a higher prevalence of nausea at the 7-day follow-up in the NMV/r group compared to the mAbs group (p=0.036). Interpretation NMV/r was superior to TGM/CGM in reducing hospital admission or death in clinical vulnerable patients with SARS-CoV-2 infection treated within 5 days of symptoms’ onset. No significant difference in symptom prevalence over time across the arms was found. Funding: The trials were funded by the Italian Agency of Drugs (AIFA) in 2021.

Musculoskeletal Injury in Australian Infantry Personnel: A Cross-sectional Study to Understand Prevention Priorities.

Musculoskeletal injury patterns are under-investigated in the Royal Australian Infantry Corps. Subsequently, more evidence is needed to support injury prevention processes in this population. One difficulty in collecting injury information to monitor injury patterns within combat populations accurately is known injury concealment behaviors in such populations. This study aims to examine musculoskeletal injury epidemiology within Australian infantry battalions using a tailored approach to mitigate reporting avoidance. A cross-sectional study using an anonymous online survey captured musculoskeletal injury information directly from personnel serving within 2 Australian infantry battalions. The survey requested information on participants' injury frequency in the previous 12 months and the context of participants' most severe injury. Injury context was restricted to the most severe during the period to limit recall bias. The applied injury case definition encompassed all injuries that affected an individual's ability to perform in their role. A descriptive analysis of all data recorded across the 2 battalions was conducted. Subgroup statistical difference was assessed by examining the 95% CI overlap between groups. The Department of Defence and Veterans' Affairs Human Research Ethics Committee granted ethical approval for this study. Overall, 166 individuals self-reported at least 1 injury in the past 12 months, representing a period prevalence of 55.5% (95% CI, 49.8-61.0%). No statistically significant prevalence differences existed between employment type, age, or sex. Approximately a quarter of injured participants were medically reclassified because of their injury, impacting their deployment fitness (n = 40, 24.4%). The following results relate to the most severe injury personnel experienced. Most injuries were service-related (n = 152, 91.6%). Field activities (n = 64, 39.3%) and physical training (n = 59, 36.2%) were the most common injury-related activities. Running was the most reported injury mechanism (n = 35, 21.7%), followed by pack marching (n = 29, 18.9%) and fall, slip, or trip (n = 18, 11.2%). Musculoskeletal injuries are common in the Australian infantry and significantly burden the workforce. Physical training and field exercises are most associated with injury and represent opportunities for injury risk-mitigation strategies to support the overall deployability of personnel and the combat effectiveness of their battalions. Future research should more formally explore the injury risk factors related to these activities using more robust study designs to collect injury and exposure information more accurately and reliably. One study strength includes using military-specific international injury surveillance guidelines to inform the survey design, to collect the recommended injury information for effective surveillance, and to enable future research comparison. A second study strength was tailoring the survey to promote participatory engagement, providing a high completion rate. A challenge in conducting this research was coordinating participant recruitment and data collection during domestic operations. Such challenges reflect the reality of conducting research in the military.

Asthma and Obstructive Sleep Apnea Overlap in a Sample of Older American Indian Adults: The Strong Heart Study.

Study Objectives: Our study aimed to investigate the association between asthma and obstructive sleep apnea (OSA) in American Indian communities, a historically underrepresented population in clinical research with a high prevalence of asthma and OSA risk factors like smoking and obesity. Methods: This cross-sectional study used data retrieved from the Strong Heart Study cohort. Participants who attended both the Asthma Sub-study and the Sleep Heart Health Study around the same time were compared for active asthma diagnosis, OSA diagnosis, and potential risk factors for asthma and OSA. The association between asthma and OSA was then evaluated. Results: Among the 2480 participants who attended the Strong Heart Study Phase III exam, 123 participated in both the Asthma Sub-study and the Sleep Heart Health Study. Of these, 13 were diagnosed with OSA, with 4 having moderate to severe OSA. There was no statistically significant difference in OSA prevalence between the active asthma group and the non-active asthma group (former asthma or no asthma) (9.6% vs. 12.5%, p = 0.63). Additionally, body mass index did not differ significantly between participants with both active asthma and OSA and those without active asthma, OSA, or both. OSA diagnosis was significantly associated with male sex (Odds Ratio [OR] 9.2 [1.85-45.87], p = 0.007) and body mass index (OR 1.1 [1.02-1.26], p = 0.016) but not with age or a diagnosis of active asthma. Conclusions: In this American Indian cohort, no significant difference in OSA prevalence was observed between participants with and without active asthma, contradicting previous studies. Further research is needed to explore the underlying reasons for this discrepancy.

Cross Sectional Study of Poultry Coccidiosis in Adele Poultry Farm, Eastern Hararghe, Oromia, Ethiopia

Objective: This study was to determine the number of chickens in intensively managed poultry farms and to assess the relationship between the number of chickens and risk factors in specific poultry farm. Methods: A cross-sectional study was conducted in Adele town between December 2014 and November 2015. The presence of oocysts in the fecal samples was examine by floatation methods and post-mortem examinations looked for intestinal lesions. Results: Out of the 262 chicken sample sources examined, 29 (11.01%) were positive for coccidian oocysts, and out of the 84 total Environmental sample source examined, 12 (14.4%) were positive for coccidian parasites. There were no statistically significant differences in prevalence across the sample type and source (p greater than 0.05). There were no changes in the prevalence of coccidiosis between the sexes of birds. Pless than 0.05 indicates a statistically significant difference between the age groups. Furthermore, a strong correlation was found between the sample times. The prevalence of coccidia was considerably higher in chicks than in adults (P less than 0.05). The environment had a greater prevalence of coccidiosis than faeces did. Of the environmental samples, the majority of coccidial infections are linked to management issues, and the prevalence of water and feed is higher than that of litter material. Conclusions: This study showed that coccidiosis is a significant disease affecting poultry in the studied area and that effective control measures must be developed to reduce the illness's impact.

Fat Necrosis in Single Perforator Deep Inferior Epigastric Artery and Superficial Epigastric Artery Perforator Free Flaps: A Prospective Randomized Study.

The deep inferior epigastric perforator (DIEP) flap is the standard of care in autologous breast reconstruction. The superficial inferior epigastric artery perforator flap (SIEA) is an alternative reconstructive option, with the compromise of less donor-site morbidity but variable perfusion to subscarpal fat zones. Fat necrosis is a known complication from marginal perfusion variability. Volumetric analysis of fat necrosis has not been performed between the two reconstructive options, nor has the amount of flap necrosis following radiation. Our objective was to compare rates and volume of fat necrosis between single-perforator DIEP and SIEA flap techniques. A single-center, blinded, prospective cohort study of patients randomized between SIEA and DIEP breast reconstruction was conducted over 2 years (June 2011-July 2013). Inclusion criteria were women undergoing immediate reconstruction following mastectomy. Randomization protocols were strictly followed. Fat necrosis volumetric analysis was determined by an ultrasound-trained attending surgeon at 12 months postoperatively. Patient demographics and adjuvant/neoadjuvant cancer treatment were analyzed. Statistical analyses included Mann-Whitney U tests, chi square, and/or Fisher exact tests. P values of 0.05 or less were considered significant. Fat necrosis was detected in 11 of 46 flaps (23.9%), with a median area of 17.9 cm2. There was no significant difference in prevalence of fat necrosis between the two flap types (P = 0.19). Postoperative radiation did not increase the prevalence (P = 0.30) or extent (P = 0.92) of fat necrosis. Single-perforator DIEP and SIEA flaps have comparable rates of fat necrosis. Postoperative radiation did not result in increased prevalence or extent of fat necrosis.

Effects of Peromyscus spp. (Rodentia: Cricetidae) presence, land use, and ecotone on Ixodes scapularis (Acari: Ixodidae) ecology in an emergent area for tick-borne disease.

As the range of Ixodes scapularis Say expands, host abundance and land use can play important roles in regions where ticks and their associated pathogens are emerging. Small mammal hosts serve as reservoirs of tick-borne pathogens, with Peromyscus leucopus Rafinesque often considered a primary reservoir. A sympatric species Peromyscus maniculatus Wagner is also a competent reservoir and is notoriously difficult to differentiate from P. leucopus. Anthropogenic land use can alter host and habitat availability, potentially changing tick exposure risk. We tested the hypotheses that tick infestation and pathogen prevalence differ between the two Peromyscus spp. and that host-seeking I. scapularis density and pathogen prevalence differ across land use and ecotone gradients. We live trapped small mammals and collected ticks across 3 land-use classifications and ecotones in Maine, an emergent area for tick-borne disease. We tested each small mammal and tick sample for Borrelia burgdorferi, Anaplasma phagocytophilum, and Babesia microti. While both Peromyscus spp. serve as hosts for immature ticks, P. leucopus exhibited a higher tick infestation frequency and intensity. We did not detect any significant difference in pathogen infection prevalence between the two species. The density of I. scapularis nymphs and the density of infected nymphs did not differ significantly between land-use types, though did differ across ecotones. We also noted a significant north/south gradient, with higher tick densities and pathogen prevalence at the southern end of the study area. Our study highlights the potential variability in tick density and pathogen prevalence across fine spatial scales within an emerging region for tick-borne disease.