Skewed Variables Research Articles

Improvement of Hypoalbuminemia and Hepatic Reserve after Stent Placement for Post-Surgical Portal Vein Stenosis.

To investigate the change in serum albumin levels and hepatic reserve scores before and after portal vein stent placement (PVS) for post-surgical portal vein stenosis. A retrospective cohort of patients undergoing PVS after abdominal surgery between 2007 and 2021 was analyzed. Patients' age, sex, and PVS technical success (defined by portal vein patency at final portography) were evaluated. Serum albumin (Alb), prothrombin international ratio (PT-INR), total bilirubin (Tbili), platelet counts (Plt), Child-Pugh scores (CPS), and albumin-bilirubin (ALBI) scores/grades before and one month after PVS were compared. Normally distributed variables were summarized as mean ± standard deviation and compared with paired t-tests. Skewed variables were summarized as median [interquartile range] and compared with signed-rank tests. Twenty-five patients (age 61±10 years; 44% female) were included. Technical success of PVS was achieved in all. Comparison was conducted for 28 PVS sessions: Alb elevated from 3.1±0.6 to 3.5±0.5 g/dL (P=0.006), with greatest change in patients with pre-PVS Alb ≤2.9 g/dL (2.6±0.3 to 3.3±0.4 g/dL, P<0.001). Improvements in CPS (P=0.026), ALBI score (P=0.002), and ALBI grades (P=0.026) were observed. PT-INR elongated (1.2 [1.1-1.3] to 1.3 [1.2-1.6]; P=0.002), mainly because of patients receiving post-PVS warfarin (P=0.005 and P=0.20 for with and without warfarin). No significant changes were observed for Tbili (P=0.40) and Plt (P=0.25). Improvement of liver synthetic function represented by serum albumin levels and in hepatic reserve scores were observed after PVS, particularly in patients with pre-PVS hypoalbuminemia.

Do clinical outcomes in individuals with malignant gliomas differ between sexes?

Sex-related differences in the epidemiology of malignant gliomas are acknowledged; however, information regarding their clinical characteristics and outcomes after surgery is limited. To identify sex-specific differences of all patients with high-grade glioma at our institution and assessed clinical outcomes and prognostic factors. This single-center study included those who underwent surgery for malignant gliomas between 2010 and 2020. Categorical, normally distributed, and skewed continuous variables were compared between men and women using the chi-square test, independent samples t-test, and Mann-Whitney U test, respectively. Survival was calculated using the log-rank and Kaplan-Meier methods. In total, 621 patients with WHO grade IV gliomas were identified (370 (59.58%) male). Men were significantly younger, underwent surgery faster after imaging diagnosis, and had a slightly higher surgical complications incidence than women. Women reported a worse preoperative performance status. Multivariate analysis showed that sex did not affect survival, surgical complications, nicotine or alcohol abuse, or preoperative tumor volume. Age, Karnofsky performance status, neurosurgical resection, and adjuvant radiotherapy with temozolomide showed a survival advantage. Men are diagnosed with malignant glioma at a younger age than women; however, no advantage in clinical outcomes was observed. No sex-related differences were observed.

Calibration Weights Estimation in Stratified Random Sampling for Multiple Skewed Variables

Calibration Weights Estimation in Stratified Random Sampling for Multiple Skewed Variables

Assessment of anxiety in parents of children undergoing tonsillectomy under general anaesthesia: A cross-sectional study.

Surgery in the pediatric age group entails a significant amount of anxiety for parents. Due to anxiety, parents are unable to take care of their children, which could affect the child's well-being and contributes to poor outcomes. The primary objective of this study is to determine the frequency of preoperative anxiety in parents before the surgery of their children. It is a cross-sectional descriptive study that included either parent of 147 children of American Society of Anaesthesiology (ASA) I & II, aged 1-12 years undergoing tonsillectomy over the period of 1 year. Each parent's demographic data were recorded and requested to answer a proforma containing the Amsterdam Preoperative Anxiety Information Scale (APAIS) for assessing anxiety on a 5-point Likert scale. Median interquartile range (IQR), and frequency (%) were used to report the normal, skewed, and categorical variables. APAIS anxiety and information scores were compared by using either the Mann-Whitney U-test or the Kruskal-Wallis test. Furthermore, anxiety scores were grouped (present/absent) with a cut-off score of 11 for the presence of anxiety, and multivariate logistic regression was performed to explore the relationship between potential risk factors and the parent's anxiety. Overall, anxiety was present in 59 (40.1%) respondents with 20 (33.9%) being fathers and 39 (66.1%) mothers. The median (IQR) for APAIS anxiety and information score were 9 ± 5 and 5 ± 2, respectively. Higher median anxiety scores were observed statistically significant in children under 5 years old, mother respondents, mothers aged 35 or younger, fathers under 40, and mothers with graduate or higher education (p < 0.05). Father respondents (AOR = 0.3, 95% CI = 0.1-0.8, p = 0.01), and mother's education less than graduation (AOR = 0.2, 95% CI = 0.1-0.6, p = 0.006) were also found to be statistically significant predictors. There is a significant prevalence of anxiety in parents of children who underwent surgery under general anaesthesia, and mothers have showed significantly higher anxiety levels than fathers.

Reliability, validity and minimal detectable change of the Chinese Version of the Assessment of Physical Activity in Frail Older People (APAFOP-C)

BackgroundPhysical activity (PA) is essential in mitigating frailty syndrome, and it is necessary to measure PA in older adults with frailty. Assessment of Physical Activity in Frail Older People (APAFOP) is a suitable patient-reported outcome measure (PROM) for assessing PA among older adults with frailty. This study aimed to determine the reliability, validity and minimal detectable change of the Chinese version of the APAFOP (APAFOP-C).MethodsThis cross-sectional validation study was designed to measure the reliability and criterion validity of the APAFOP-C with 124 frail community-residing older adults. APAFOP-C was completed twice within an interval of 7–17 days to determine test-retest reliability. The investigator triangulation method was used to investigate inter-rater reliability, and a pedometer was used as the reference measurement to assess the criterion validity. Reliability and criterion validity were assessed using the intraclass correlation coefficient (ICC2,1), Pearson correlation coefficient for normally distributed variables, Spearman correlation coefficient, Wilcoxon signed-rank test for skewed variables, and the minimal detectable change at 95% level of confidence (MDC95). Agreement assessment was conducted using Bland-Altman plots for inter-rater reliability and criterion validity. Kendall’s W test assessed absolute agreement among three raters in inter-rater reliability. The Mann-Whitney U test was used to evaluate whether any particular day was more representative of certain daily activities.ResultsTotal PA on any arbitrarily chosen day illustrates daily activity (Z= -0.84, p = 0.40). The APAFOP-C exhibited strong-to-very strong test-retest reliability (ICC2,1=0.73–0.97; Spearman ρ = 0.67–0.89), and the total PA score demonstrated MDC95 < 10%. Inter-rater reliability was also strong-to-very strong (ICC2,1=0.96–0.98; Spearman ρ = 0.88–1.00), and moderate criterion validity when compared with total PA score on pedometer readings (Spearman ρ = 0.61). Limits of agreement among different raters regarding the APAFOP-C and the pedometer were narrow.ConclusionThe APAFOP-C was found to have limited but acceptable psychometric properties for measuring PA among community-dwelling older adults with frailty in China. It was a feasible comparative PROM for assessing PA worldwide. Practitioners can develop individualized exercise programs for frail older adults and efficiently track changes in PA utilizing the APAFOP-C.

Role of PON1 L55M Gene Polymorphism in Parkinson's Disease among North Indian Population.

The role of various genetic markers including alpha synuclein, Parkin, etc., is known in the pathogenesis of Parkinson's disease (PD). Novel genetic markers including paraoxonase 1 (PON1) have also been linked to PD pathogenesis in recent studies. The PON1 L55M allele carriers may have defective clearance of environmental toxins and may result in increased susceptibility to PD. Hence, we studied the role of PON1 L55M polymorphism in PD among a North Indian population. Seventy-four PD patients and 74 age- and sex-matched controls were recruited in this hospital-based case-control study. Baseline characteristics were recorded using structured questionnaire. DNA was extracted from 3-4 ml of venous blood, followed by PCR and restriction digestion. PON1 L55M genotypes were visualized as bands: LL (177 bp), LM (177, 140 bp) and MM (140,44 bp) on 3% agarose gel. Mann-Whitney U test and Chi-squared test were used for comparing two groups of skewed and categorical variables, respectively. Measures of strength of association were calculated by binary regression analysis. P value < 0.05 was considered as significant. Parkinson's disease patients had significantly higher exposure to pesticides (12.2%; P (organophosphate exposure) < 0.001) and well water drinking (28.4%; P = 0.006) compared to controls. Frequency distribution of LL, LM, MM genotypes was 67.5% (50/74), 28.4% (21/74), and 4.1% (3/74), respectively, for cases and 72.6% (54/74), 26% (19/74) and 1.4% (1/74), respectively, for controls. PON1 L55M genotype distribution between Parkinson's disease cases and controls was not significant (P = 0.53). PON1 L55M polymorphism was not associated with PD after adjusting for confounders by binary regression analysis. There was no significant association between PON1 L55M polymorphism and PD. Larger population-based studies would be required from India before drawing any definite conclusions.

Determinants of hyperparathyroidism in children after kidney transplantation.

Hyperparathyroidism (HPT) can contribute to metabolic bone disease following kidney transplantation. We evaluated post-transplant trends in intact parathyroid hormone (iPTH) and determined predictors of HPT in pediatric kidney transplant (KTx) recipients. In this single-center study, retrospective data were collected on 88 children from 2013 to 2019. Data collected included dialysis vintage, biochemical parameters, post-transplant trends in iPTH, 25(OH)Vitamin D levels and estimated glomerular filtration rate (eGFR ml/min/1.73 m2 ). Pre-transplant treatment for HPT was quantified with a Treatment Burden score (TB, score range: 0-100). After log-transforming skewed variables (iPTH and eGFR), multivariable linear regression was performed to determine predictors of log {iPTH} at 6 and 36 months (mo) post-transplant. Median age was 12.8 (range: 1.9-20.5) years, and dialysis vintage was 11.2 (range:0.0-112.9) months. The majority were of Hispanic and African Ancestry (77.3%). Median post-transplant iPTH was 69.5 (range: 1.8-306.8) pg/ml at 6mo with a gradual downward trend to 59.0 (range: 28.0-445.0) pg/ml at 36mo. Significant multivariable predictors of higher log {iPTH} post-transplant included longer dialysis vintage, higher TB, and lower log{eGFR} at 6mo, and higher TB, lower log{eGFR}, and deceased donor transplant at 36mo. Recognition of risk factors for HPT and monitoring iPTH post-transplant may facilitate timely interventions to mitigate cardiovascular and bone disease in pediatric KTx recipients. Describe serial trends in intact PTH after kidney transplantation. Pre- and post-transplant factors that contribute to persistence or re-occurrence of hyperparathyroidism after kidney transplantation in children include longer dialysis vintage, high pre-transplant treatment burden and decreased post-transplant GFR. Recognition of these factors, and monitoring intact PTH after kidney transplantation, could facilitate timely interventions to mitigate cardiovascular and bone disease in children.

Puerperal Sepsis and its Associated Factors: Review of Cases in a Tertiary Hospital in Jigawa, North-West Nigeria

Background: Puerperal sepsis is the 3rd leading cause of direct maternal death in developing countries. The case fatality rate of puerperal sepsis was reported to be as high as 8%, and it complicates 1-8% of all deliveries. It is an infection of the genital tract occurring anytime between the rupture of membranes and 42nd day postpartum. &#x0D; Objective: The aim of the study was to determine the prevalence of puerperal sepsis and associated factors.&#x0D; Materials and Methods: This was a retrospective cross-sectional study carried out in the Department of Obstetrics and Gynecology of Rasheed Shekoni Federal University Teaching Hospital. The study participants were all the patients managed for puerperal sepsis during the period under review. The patients” data were collected using a structured proforma from their case files. Data obtained was analyzed with IBM SPSS version 21.0. Measured variables were expressed in descriptive statistics; mean ± SD for normally distributed quantitative variables, median and interquartile range for skewed quantitative variables. Qualitative variables were expressed in percentage and proportions.&#x0D; Results: The prevalence of puerperal sepsis was of 10.7%. The mean age of the patients was 25.85 + 7.5. The mean parity was 3.89 + 4.5. Most (74.71%) of the women were unbooked and had home delivery (69.3%). Fever (90.7%) was the most frequent presenting complaints. The commonest (75.0%) organism cultured was staphylococcus aureus. Anemia was the commonest (63.6%) complication.&#x0D; Conclusion: The prevalence of Puerperal sepsis in this study is high. Low literacy level, unemployment, un-booked status and home delivery were found to be predisposing factors.

Profile of hospitalised maltreated children aged 0 to 3 years and their families.

Maltreatment adversely affects children's health and development. Knowledge of child maltreatment in early childhood is limited. We studied the demographic factors and health issues in children aged 0-3 years who were hospitalised for maltreatment. In this retrospective cohort study, health and demographic information was extracted from the electronic medical records of children hospitalised in KK Women's and Children's Hospital between January 2018 and June 2019. High-risk groups were children with developmental delay (DD), missed vaccination (MV), low outpatient attendance, high dependency unit (HDU) or intensive care unit (ICU) admission and Child Protection Service (CPS) referral. Chi-square or Fisher's exact test was used for categorical variables. Mann-Whitney U test was used for skewed quantitative variables. Among the 101 children included in the study, the most common type of abuse and alleged perpetrator were physical abuse and parents, respectively. In addition, 35.6% of the children had pre-existing health conditions before hospitalisation, 58.4% had new health conditions diagnosed during hospitalisation requiring follow-up and 26.7% had maltreatment-related injuries. One-fifth of the children had DDs and another one-fifth had MVs. About 20% of them had defaulted all outpatient appointments. High-risk children mostly lived in rented housing. Their mothers mostly had primary education or lower. Most children admitted to ICU or HDU were <6 months old (8/12 [66.7%] vs. 6-24 months 3/12 [25%] vs. 24-47 months 1/12 [8.3%], P = 0.001). A higher number of children with DD were referred to CPS (63.2%, P = 0.049) than to other agencies. Maltreated children have significant health needs that are not fully met through routine surveillance practices. They are at risk of defaulting their hospital appointment. It is imperative that families at risk of child maltreatment are identified early and their needs holistically evaluated, with care coordinated within the hospital-community support system.

Selenium deficiency is associated with anemia in heart failure patients - The HARVEST Study

Abstract Background Heart failure (HF) patients with anemia have worse clinical outcomes with increased hospitalization rates, decreased exercise tolerance, and higher mortality compared to those without anemia. Previous studies have indicated a correlation between selenium deficiency and anemia in healthy elderly individuals and in pregnant women. The BIOSTAT-CHF study reported that HF patients with higher selenium levels were less likely to have anemia or iron deficiency. These studies suggest that selenium deficiency can lead to the development of anemia. However, studies regarding this association in HF patients are limited. Purpose The purpose of this study was to examine the relationship between selenium deficiency, measured by selenoprotein P (SELENOP) levels, and anemia, hemoglobin levels, and iron state in subjects with acute HF. Methods SELENOP, a well-validated plasma marker of selenium status, was measured in 320 subjects hospitalized for HF in the Swedish HeArt and bRain failure inVESTigation trial (the HARVEST study). Of these subjects, 310 had complete data on all covariates. Prior to analyses, skewed variables were ln-transformed. The relationships between continuous SELENOP levels and 1) Hb levels, 2) anemia (Hb &amp;lt; 115 g/L (women), &amp;lt; 130 g/L (men)), and 3) iron status (as measured by transferrin receptor 1 (TfR1) which increase in iron deficiency) were evaluated using multivariable logistic and linear regression models adjusting for age, sex and renal function (cystatin C). Additionally, selenium deficiency was defined as SELENOP levels in the lowest quartile and its association with anemia, hemoglobin, and iron state was explored in multivariable logistic and linear models. Results Anemia was present in 133 subjects (42.9%). SELENOP levels were positively correlated with hemoglobin levels (0.238; p = 2.3x10-5) and negatively associated with TfR1 levels (-0.238, p = 2.0x10-6). In multivariable linear regression models, each 1 standard deviation increase in SELENOP was linked to higher Hb levels and lower TfR1 levels (Table 1). Furthermore, selenium deficiency was associated with lower Hb levels, higher TfR1 levels, and higher odds of anemia in HF patients (Table 1). Conclusions In acute heart failure patients, lower levels of selenoprotein P were associated with lower hemoglobin levels, higher transferrin receptor 1 levels, and a higher prevalence of anemia.

Multicenter Study to Assess the Outcomes and Prognosis of Richter's Transformation in the Era of Novel Agents and Cell Therapy

INTRODUCTION: Richter's transformation (RT) is the transformation of chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL) into an aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL). RT occurs in 2-10% of CLL patients, usually between 2-5 years after CLL diagnosis. The prognosis of RT is poor and the historical median overall survival (OS) after diagnosis is about 8-14 months. However, with the development of novel therapeutic agents including Bruton tyrosine kinase inhibitors (BTKi) and anti-CD19 CAR T-cell therapy, the natural history and prognosis of RT have evolved. To date there is limited data on the prognosis and management of RT in the era of novel therapies. To better understand the prognosis, impact of new therapeutics, and survival for RT in the modern era we performed a multicenter retrospective study to assess the outcomes of RT. METHODS: We performed a multicenter retrospective study including 4 US centers evaluating patients who were diagnosed with RT between 2012-2022 with the current analysis limited to those patients with large B-cell lymphoma transformation. Statistical analyses include descriptive statistics, t-tests for normally distributed continuous variables, non-parametric tests for skewed variables, and chi-square for categorical variables. Overall survival (OS) was calculated using Kaplan-Meier estimates. RESULTS: We analyzed 78 patients with DLBCL transformation from underlying CLL. The median age at RT diagnosis was 66 years (43-84 years). Most patients had advanced stage III-IV disease 92% (n=72). Extranodal disease was present in 68% (n=53). Among 31 patients with 17p deletion or p53 mutational data available at the time of CLL diagnosis, one of these findings was present in 18 patients. Patients had 2 median lines (range 0-7) of treatment for CLL prior to RT diagnosis. 49% (n=38) had BTKi exposure and 28% (n=22) had Venetoclax exposure before RT diagnosis. 24% (n=19) had no prior treatment for CLL before RT. The median time from CLL to RT diagnosis was 42.5 (0-332) months. Median lines of therapy for RT were 2 (range 1-8). The most common frontline regimens for RT included R-CHOP/ R-CHOP-like backbone in 58% (n=45) or high intensity chemoimmunotherapy regimens (R-EPOCH/CVAD) in 14% (n=11). Overall response rate (ORR) to frontline treatment was 56% (complete response (CR)=32/partial response (PR)=12). Of the patients who received 1 st line treatment and achieved a CR/PR (n=44), the 1-year duration of response (DOR) was 50% and the median DOR was 14 months. Fifty-one patients either relapsed or had refractory/progressive disease after frontline treatment and 48 patients received further treatment. Among these 48 patients, 29% (n=14) received a covalent or a non-covalent BTKi in the 2 nd or higher line setting, with an ORR of 43% (CR=4, PR=2). 23% (n=11) received venetoclax with/without other agents in the 2 nd or higher line setting, with an ORR of 36% (CR=3, PR=1). In total, 17 patients received CD19 based CAR T-cell therapy as part of treatment for RT, all in a second or later line of treatment. The ORR and CR rate to this therapy was 82% (n=14). Of these 14 responding patients, the 1-year DOR was 57% and the median DOR was not reached. 12 patients underwent allogeneic transplant (alloHCT), 11/12 as a consolidative treatment option. At first disease assessment after allo-HCT, the ORR was 92% (CR=11). Of the 11 responders, the 1-year DOR was 73% and the median DOR was 42 months. For the entire cohort (n=78), the 1-year OS was 62% and the median OS was 31 months (95% CI 22-NR), which suggest improvement compared to historical reports. CONCLUSION Although RT has a poor prognosis, with the use of novel therapies such as BTKi and CAR T-cell therapy, the overall survival of these patients has improved in the current era. The overall response to chemoimmunotherapy in the first line setting remains poor. Despite this, advances in the management of RT with incorporation of targeted and cellular therapies has improved clinical outcomes of RT. Incorporating these agents either alone or in combination with chemoimmunotherapy in the earlier setting may further improve outcomes in patients with this aggressive disease.

Prehospital Transport Time and Outcomes for Pediatric Trauma: A National Study

IntroductionHistorically, emergency medical services have aimed to deliver trauma patients to definitive care within the 60 min (min) “Golden Hour” to optimize survival. There is little evidence to support or refute this for pediatric trauma. The objective of this investigation was to describe national trends in prehospital transport time, in relation to the “Golden Hour,” and pediatric trauma outcomes. MethodsRetrospective cohort study of patients (<15 y old) receiving emergency medical services trauma transport between 2017 and 2019. Transport time (less than or greater than 60 min) was the exposure variable, and analyses were adjusted for injury severity score (ISS). Continuous variables with a normal distribution were compared by t-test was and skewed variables were compared by Mann-Whitney U-test. Categorical variables were compared by Chi-Square test. Results54,489 patients met our criteria: 49,628 blunt and 4861 penetrating. Most patients (62.2%) had transport times less than 60 min: 30,389 (61.2%) blunt and 3479 (71.6%) penetrating. The overall mortality rate was 1.6%, 1.2% for blunt and 5.5% for penetrating. For blunt trauma, mortality was higher for transport times less than 60 min (1.5%). For penetrating trauma, mortality was lower for transport times less than 60 min (0.7%). Mean ISS was greater for blunt (7.9) compared to penetrating trauma (7.1), and greater for both trauma types with transport times less than 60 min. For both trauma types, mean length of stay was significantly longer for transport times greater than 60 min, when adjusting for ISS (P < 0.001). ConclusionsWe did not find evidence that prehospital transport within the “Golden Hour” had a substantial association with survival, though it may be associated with length of stay. There are many factors contributing to trauma outcomes, so efforts should continue to expand access and pediatric readiness.

The Role of Implantable Loop Recorder in Patients with Cryptogenic Stroke

Objective: The objective of this study was to provide data on implantable loop recorder (ILR)-based atrial fibrillation (AF) rates, recurrent stroke rates, and predictors of AF in patients with cryptogenic stroke (CS) after 1, 6, 12, 24, and 36 months of follow-up. Methods: We searched MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and reference lists of retrieved reports, which were published by April 30, 2023, which was the date of our last search. We utilized random-effects meta-analysis for detection rates, and meta-regression analysis, t-test (for normally distributed variables), and Mann-Whitney (for skewed variables) for predictor factors. Results: Thirteen studies were analyzed, which included data from 3,377 patients with CS or embolic stroke of undetermined source. The ILR-based AF rates in patients with CS were 4.73% (95% confidence interval [CI] 3.91–5.71) at 1 month, 13.45% (95% CI 12.19–14.81) at 6 months, 17.5% (95% CI 16.25–18.82) at 12 months, 20.69% (95% CI 19–22.49) at 24 months, and 25.98% (95% CI 23.21–28.58) at 36 months. Age and CHA2DS2-VASc score were positively associated with AF detection. Specifically, the mean difference of age and CHA2DS2-VASc score in the group with AF versus the group without AF was 7.47 (95% CI 4.58–10.36, P &lt; 0.001) and 0.75 (95% CI 0.22–1.28, P = 0.01), respectively. Finally, AF detection was positively associated with recurrent strokes with an estimated risk ratio of 1.27 (95% CI 0.69–2.31). Conclusions: There is a correlation between AF detection rate and ILR monitoring duration. One out of eight patients was diagnosed with AF after 6 months of follow-up and about one quarter after 3 years. Our results demonstrate the critical use of ILRs, especially in older patients, and in patients with high CHA2DS2-VASc scores.

The role of lead and cadmium in deciduous teeth and saliva on dental caries in children residing in Tehran, Iran

BackgroundLead (Pb) and Cadmium (Cd) are important environmental contaminants. There is no biological monitoring of exposure to these heavy metals and their potential effect on dental caries in children in Tehran, Iran, a polluted megacity. Therefore, the present study investigated the potential association between Pb and Cd levels in primary teeth and saliva and dental caries. MethodsIn a cross-sectional design, 211 children aged 6–11 years referred to Tehran University of Medical Sciences, School of Dentistry and residing in Tehran were examined. Pb and Cd levels of exfoliated primary teeth and stimulated saliva were determined by atomic absorption spectrophotometry (AAS). Dental caries prevalence was evaluated according to WHO criteria. Socioeconomic status, oral hygiene behavior, snacking frequency and salivary pH data were acquired as confounding factors. Frequency and percentages were reported for categorical variables, mean and standard deviation (SD) for continuous variables, and geometric mean for skewed continuous variables. A simple linear regression and Pearson correlation tests were used for statistical analyses. P-values < 0.05 were considered as significant. ResultThe mean (95 % confidence interval) Pb and Cd levels in teeth were 213.26 ppb (164.29–274.84) and 23.75 ppb (20.86–27.05), respectively. The mean Pb and Cd levels in saliva were 11.83 ppb (10.71–13.06) and 3.18 ppb (2.69–3.75), respectively. Furthermore, Pb and Cd in primary teeth and saliva were not associated (p > 0.05) with socioeconomic status, oral hygiene behavior and snacking frequency ConclusionThis study showed no association between Pb and Cd concentrations in primary teeth and in saliva with dental caries prevalence.

U-shaped association between serum IGF2BP3 and T2DM: A cross-sectional study in Chinese population.

To clarify the expression of N6-methyladenosine (m6 A) modulators involved in the pathogenesis of type 2 diabetes mellitus (T2DM). We further explored the association of serum insulin-like growth factor 2 mRNA-binding proteins 3 (IGF2BP3) levels and odds of T2DM in a high-risk population. The gene expression data set GSE25724 was obtained from the Gene Expression Omnibus, and a cluster heatmap was generated by using the R package ComplexHeatmap. Differential expression analysis for 13 m6 A RNA methylation regulators between nondiabetic controls and T2DM subjects was performed using an unpaired t test. A cross-sectional design, including 393 subjects (131 patients with newly diagnosed T2DM, 131 age- and sex-matched subjects with prediabetes, and 131 healthy controls), was carried out. The associations between serum IGF2BP3 concentrations and T2DM were modeled by restricted cubic spline and logistic regression models. Two upregulated (IGF2BP2 and IGF2BP3) and 5 downregulated (methyltransferase-like 3 [METTL3], alkylation repair homolog protein 1 [ALKBH1], YTH domain family 2 [YTHDF2], YTHDF3, and heterogeneous nuclear ribonucleoprotein [HNRNPC]) m6 A-related genes were found in islet samples of T2DM patients. A U-shaped association existed between serum IGF2BP3 levels and odds of T2DM according to cubic natural spline analysis models, after adjustment for body mass index, waist circumference, diastolic blood pressure, total cholesterol, and triglyeride. Multivariate logistic regression showed that progressively higher odds of T2DM were observed when serum IGF2BP3 levels were below 0.62 ng/mL (odds ratio 3.03 [95% confidence interval 1.23-7.47]) in model 4. Seven significantly altered m6 A RNA methylation genes were identified in T2DM. There was a U-shaped association between serum IGF2BP3 levels and odds of T2DM in the general Chinese adult population. This study provides important evidence for further examination of the role of m6 A RNA methylation, especially serum IGF2BP3 in T2DM risk assessment.

Gender disparity in stoke: Women have higher ICH scores than men at initial ED presentation for intracerebral hemorrhage

ObjectiveTo determine what if any differences in presentation exist between men and women who present with acute intracerebral hemorrhage (ICH) to the emergency department (ED). MethodsThis was an IRB approved prospective cohort study of ED patients presenting with acute intracerebral hemorrhage. Statistical analyses were performed in JMP 14.1. Non parametric methods were used for skewed variables. The study was conducted in a comprehensive stroke center. The independent variable was the ICH score, and the dependent variable of interest was ultimate disposition (death or hospice vs. home or skilled nursing facility). ResultsThe cohort consisted of 129 patients (54 women and 75 men). The median age was 71 years (IQR 58-81). The baseline co-morbidities were similar between both men and women and whether or not they were independent in their activities of daily living prior to experiencing their ICH. The overall median ICH score for women was 2, IQR 1-4, and 1 for men, IQR 1-2 (P = 0.0369) . A higher ICH score was significantly associated with in-hospital death and or hospice status (P = .0095, 95% CI 0.6340 – 0.4825). Conversely, a lower ICH score was significantly associated with being discharged home (P< 0.001, 95% CI -0.1694 to -0.0759). ConclusionWomen have higher ICH scores than men at initial ED presentation for intracerebral hemorrhage. A higher ICH score is significantly associated with the worse outcomes of death and/or hospice.

A three-year audit of pregnancy outcomes in women with pulmonary hypertension admitted to the high-risk obstetric unit at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa.

The aim of this study was to describe the profile and outcomes of pregnancies in women with pulmonary hypertension in South Africa. A retrospective study was undertaken at a state-subsidised hospital. Data were analysed using SPSS. Descriptive statistics were used to summarise categorical variables. Central tendency and dispersion of data were measured using means and standard deviations for normally distributed variables and medians and interquartile ranges for skewed variables. A p-value less than 0.05 was considered statistically significant. Of a cohort of 185 women, 86.3% had pulmonary hypertension secondary to left heart disease. The median age of the cohort was 28 years (interquartile range 23-33) with 37.8% being HIV infected and 59% having mild pulmonary hypertension. Frequencies of deaths, intensive care unit admissions and cardiac failure events increased with increasing severity of pulmonary hypertension (p < 0.001). Women with more severe pulmonary hypertension had higher rates of preterm births (p < 0.001). Adverse pregnancy outcomes were concentrated in women with moderate-to-severe pulmonary hypertension.

1196 FRAILTY AND ARTERIAL STIFFNESS - THE ROLE OF OXIDATIVE STRESS AND INFLAMMATION (FRAXI STUDY)

Abstract Introduction There is an association between frailty and arterial stiffness. However, arterial stiffness does not uniformly correlate with the spectrum of frailty states. Both oxidative stress and inflammaging contribute to vascular aging. There are no human studies exploring links between arterial stiffness, oxidative stress, inflammaging and frailty. Our objective is to investigate arterial stiffness and inflammaging as predictors of frailty states. Methods An observational longitudinal cohort study will be used to examine the association between arterial stiffness, oxidative stress, and inflammation in 50 older adults (≥70 years) with clinical frailty scores (CFS) ≤6 over six months. All study measurements will be taken at baseline. Frailty assessment will include hand-grip strength, timed-up and go test, mini-mental state examination, geriatric depression scale and sarcopenia using body composition measurements with Tanita®. Arterial stiffness measurements will include carotid-femoral pulse wave velocity (cfPWV) and carotid-radial pulse wave velocity (crPWV) using Complior (Alam Medical, France). CAVI device will measure Cardio-ankle vascular index and ankle brachial index (ABI). Oxidative stress blood markers nitrotyrosine (NT) and 8-hydroxy-2’-deoxyguanosin (8-oxo-dG) and inflammation markers high-sensitive C-reactive protein (hs-CRP) and interlukin-6(IL-6) will be measured at baseline and 6-months along with lipid profile and glycated haemoglobin. Data Analysis Descriptive statistics for continuous data using means and standard deviations for normality distributed variables or medians and inter-quartile ranges for skewed variables will be used. Participants will be categorised into CFS 1-3, and CFS 4-6. Categorical data will use frequencies and comparison between groups. Change in frailty between the groups over 6 months will be compared using paired t-test. Simple linear regression will be done between frailty measures, arterial stiffness, inflammation, and oxidative stress biomarkers. Significance will be at p&amp;lt;0.5. Conclusion This study data will inform a larger, multi-centre study exploring further the interplay between frailty, biomarkers, and arterial stiffness parameters. This study is funded by BGS.

Right ventricular cardiac resynchronization therapy in patients with right ventricular conduction delay and heart failure

Right ventricular cardiac resynchronization therapy in patients with right ventricular conduction delay and heart failure

Factors Affecting Pulmonary Artery Catheterisation in Patients Undergoing Coronary Artery Bypass Grafting: A Cross-sectional Study

Introduction: The Pulmonary Artery (PA) catheter continues to be used for monitoring haemodynamic parameters in the majority of patients undergoing Coronary Artery Bypass Grafting (CABG) surgeries, despite concerns raised regarding costeffectiveness and safety issues. Sometimes, placement takes longer or is difficult just by looking at the pressure waves. There are several factors that may influence the duration of Pulmonary Artery Catheter (PAC) insertion. Aim: To determine the factors affecting PAC in anaesthetised patients undergoing elective CABG. Materials and Methods: A single-centred, cross-sectional study was conducted in the Cardiothoracic and Vascular Surgery operation theartre at IPGME&amp;R and SSKM Hospital, Kolkata, India including 138 patients aged 35-65 years of either sex undergoing elective CABG surgery in a tertiary care hospital in Eastern India. The attempt to perform successful first-time catheterisation or failure of the PAC done by a resident cardioanaesthesiologist was noted, as well as whether catheterisation was successfully done within a specified time or not. This time was obtained as the 75th percentile of the time taken for catheter placement for the first 30 cases catheterised in the first attempt. For ease of analysis, all first attempt successful cases were considered as Group A (n=125), and all first attempt failure cases as Group B (n=13). The study data on various parameters were recorded on a proforma and summarised as the mean and standard deviation for normally distributed numerical variables, median and interquartile range for skewed numerical variables, and counts and percentages for categorical variables. A p-value &lt;0.05 was considered statistically significant. Results: A total of 138 patients were analysed during the entire study. There was a predominance of male patients (82.6%) with a male-to-female ratio of 114:24. The first attempt failure rate of successful PAC was 13 out of 138, i.e., 9.42% (95% confidence interval 4.55% to 14.29%). The cut-off time for the procedure as the 75th percentile of the first 30 successful cases is 269 seconds. The number of cases in which it was done within this time was 109 cases, i.e., 78.99%. There was a significant difference (p&lt;0.05) in terms of body weight, body surface area, and neck length between the two groups. Conclusion: Increased body weight and increased body surface area are significant factors associated with difficult PAC placement. On the other hand, short neck length is a significant factor for taking more time in the placement of the catheter.