Times Greater Risk Research Articles

Relationship Between Age Of Menarche With Primary Dismenorea In Adolescents

Background: The first period is also known as menarche. The age of early menarche is one of the factors causing menstrual disorders. one of the menstrual disorders is dysmenorrhoea. Dysmenorrhea or also known as menstrual pain that is felt before or during menstruation in the lower abdomen. In Indonesia, 54.89% were found experienced primary dysmenorrhea.Objective: to determine the relationship between the age of menarche and the incidence of primary dysmenorrhoea in adolescents.Materials and Methods: This research is an observational analytic study with a cross sectional approach. Sampling was carried out by multistage random sampling on 133 female adolescents at Senior High School Number 9 and Senior High School Number 15 in Padang. Data of dysmenorrhoea and age of menarche was obtained by filling out a questionnaire that had been provided, it was analysis by chi square statistical test at the significant level α = 0.05.Results: 93.8% of respondents who have early menarche age experience primary dysmenorrhea. Relationship between the age of menarche and the incidence of primary dysmenorrhea in adolescents (p= 0.004, OR=4.933).Conclusion: Adolescents with early menarche have a 4.933 times greater risk of experiencing primary dysmenorrhea.International Journal of Human and Health Sciences Vol. 06 No. 01 January’22 Page: 123-126

Retrospective Study Analyzing Risk Factors of Foot and Ankle Amputation in Patients with Diabetes Diagnosed with Osteomyelitis

Category:Ankle; Diabetes; Midfoot/ForefootIntroduction/Purpose:Osteomyelitis is an invasive infection of the bone that commonly afflicts patients with diabetes mellitus. This bacterial infection can lead to the need for amputation of portions of the foot or ankle. While the association between Osteomyelitis and amputation has been studied, little is known about additional underlying health conditions that can predispose diabetic patients to an increased risk of amputation. Understanding these relationships will be useful in early screening to prevent severe effects associated with the loss of the foot or ankle. Thus, a retrospective analysis was performed using EMR data to evaluate the effect of prior Peripheral Vascular Disease (PVD) or Neuropathy on amputations in Type 2 DM patients with Osteomyelitis.Methods:Patients with Type 2 Diabetes Mellitus and Osteomyelitis who had a foot or ankle amputation within 12 weeks of diagnosis, compared to those who also had PVD or neuropathy were identified. This was done in the EMR database using ICD 10 codes for Osteomyelitis (M86), Type 2 Diabetes Mellitus diagnosis (E11), Foot or Ankle amputations (1005524, 1005529, 28810, 1005525, 28805, 1800300006, 371186005, 180040009, 726651003, 723726002, 723731000, 180038004, 78785006, 28800, 180157006, 723312009, 773821000, 773819005, 397218006), Peripheral Vascular Diseases (I73), and Neuropathy (G62). We then stratified these patients by age (18-29, 30-39, 40-49, 50-59, 60-69,70-79, 80-89), gender (male, female), and year by decade (2001, 2010, and 2020).Results:Our search identified 125,741 patients with T2DM and Osteomyelitis, of whom 10,850 had a foot or ankle amputation within 3 months of diagnosis. 28,242 patients with T2DM, Osteomyelitis, and prior PVD were identified. These patients were found to be 2.6 times more likely to receive a foot or ankle amputation. 12,860 patients with prior Neuropathy were identified.. These patients were found to have 1.36 times more likely to receive a foot or ankle amputation. When stratified by gender, Women were found to be at greater risk of Amputation than Men, for both prior PVD and Neuropathy (2.9 vs 2.47 times greater risk, respectively). Age stratification revealed patients aged 50-59 have the highest risk for a foot or ankle amputation (10% higher risk). This was more than triple the risk seen in patients aged 18-29. The above differences were found to be statistically significant at a p-value of <.0001.Conclusion:This analysis provides insight into the pre-disposing risk factors of Foot and Ankle amputations in patients who have Type 2 Diabetes Mellitus and Osteomyelitis. Of the two risk factors analyzed, Peripheral Vascular Disease was associated with the highest risk of amputation. Overall, females and patients aged 50-59 are at the highest risk of amputation with underlying PVD. As comorbidities become more frequent and the number of foot or ankle amputations continues to rise since 2001, more research on associated risk factors will be necessary to more effectively screen these patients.

Guillain Barre Syndrome in Children : Case Report

Background: The incidence of GBS at the age of <15 years is 1.5 cases per 100,000 population and peaks at the age of 70-79 years, reaching 8.6 cases per 100,000 population. The peak of this disease at the age of 15-35 years and 50-75 years. Infants are said to have the lowest risk of developing GBS. Male have 1.5 times greater risk than female Case: a 7 years old male children was presented with main complaint of weakness at extrimites on both side since March 27th, 2019. Patient felt weakness at lower extremities first and then followed by upper extremities two days later. patient cannot use his hand and leg at all. patient was unable to transfer from lying to sitting independently and unable to slide his buttocks. patient felt numbness on his both arms and leg. patient got dyspepsia one week before weakness. Based on physical and diagnostic examination patient diagnosed with Tetraparesis LMN type due to Guillan Barre Syndrome (GBS). Patient got rehabilitation program consist of NMES, ROM, active breathing, endurance, strengthening, transfer and mobilization exercise, and occupational therapy. Patient got improvement in muscle power of upper and lower extremities after five (5) month rehabilitation medicines. Barthel index improved from 25 to 95 and activity daily living independently. Conclusion: NMES, ROM, active breathing, endurance, strengthening, transfer and mobilization exercise, and occupational therapy can improve muscle power of upper and lower extremities for GBS of male children in five month rehabilitation program.

The Role of US in Depicting Axillary Metastasis in High-Risk Breast Cancer Patients.

Purpose: The aim of this study is to evaluate the role of US in depicting axillary nodal disease in high-risk patients with and without pathogenic mutations. Methods: The retrospective study included consecutive high-risk breast cancer (BC) patients who underwent a multigene testing panel for hereditary cancers, pre-operative axillary US and breast/axillary surgery. The group was divided into patients with pathogenic mutations (PM group) and patients without PM. Statistical analyses were performed using GraphPad Prism by applying Chi-square and Fisher exact tests, with a reference p-value < 0.05 and a CI of 95%. Results: Out of 190 patients with BC, 96 (51%) were negative and 94 (49%) were positive for PM as follows: 28 (25.5%) BRCA1, 16 (17%) BRCA2, 15 (16%) CHECK2, 14 (14%) RAD Group, 7 (7%) PALB, 6 (6%) NBN, 3 (3%) TP53 and ATM and 2 (2%) BARD1. US was positive in 88 of the patients, 36 with PM and 52 without PM. US and surgery (≥N1 stage) were both positive in 31 (62%) of PM patients and 44 (88%) of patients without genetic changes. There were 19 (61%) false negative US examinations in the PM group and 6 (13%) in the group without genetic changes, respectively. If the US is positive, there is a 2.6 times greater risk of positive nodes in PM patients (p-value < 0.000, 95% CI = 4.2–37.9), and a 6.2 times greater risk of positive nodes in patients without genetic changes (p-value < 0.000, 95%CI = 8.4–37.4). In the PM group, US compared to surgery reached a sensitivity = 62, with PPV = 86 and NPV = 67. In the BRCA1/2 subgroup, there is 2.5 greater times risk of nodal disease if the US is positive (p-value = 0.001, 95%CI = 2.6–76). In patients without PM, US compared to surgery reached a sensitivity = 88, PPV = 84 and NPV = 86. Conclusion: US is more sensitive in depicting axillary nodal disease in high-risk patients without PM compared to PM patients. Furthermore, there are more false negative US examinations in PM patients, compared to surgery patients.

Relationship between rotating shift work and white blood cell count, white blood cell differential count, obesity, and metabolic syndrome of nurses

ABSTRACT This study investigated the relationship between working rotating shifts and white blood cell (WBC) count, WBC differential count (DC), obesity, and metabolic syndrome of nurses. Samples were obtained from a total of 720 nurses who had received health checkups at a large teaching hospital in Taiwan. Among these nurses, 500 worked rotating shifts, and the remaining 220 nurses worked fixed daytime shifts. We used binary logistic regression to identify the risk factors of obesity or metabolic syndrome. The results indicate that nurses working rotating shifts had a significantly higher WBC count than those working fixed daytime shifts. WBC count was an independent factor relating to an overly large waist circumference or overly high body mass index (BMI) of nurses. For every 103/μL increase in WBC count, the risk of waist circumference exceeding 90 cm and 80 cm respectively in male and female nurses increased by 46%, and for every 103/μL increase in WBC count, the risk of a BMI 24 kg/m2 in nurses increased by 50%. Similarly, WBC count and work type were independent factors influencing the metabolic syndrome of nurses. For every 103/μL increase in WBC count, the risk of metabolic syndrome occurring in nurses increased by 65%. Nurses working rotating shifts were at a 3.34 times greater risk of having metabolic syndrome than those working fixed daytime shifts. The mean age of our participants was 29.54 years old, and only approximately 4% of the participants had metabolic syndrome. Among these nurses, we found that high WBC was correlated with an overly large waist circumference and overly high BMI. Furthermore, the nurses working rotating shifts may have been at greater risk of metabolic syndrome than those working fixed daytime shifts, and increases in WBC were also associated with the occurrence of metabolic syndrome.

Electrocardiographic predictors of ventricular fibrillation in ST-segment elevation acute myocardial infarction

Abstract Introduction Ventricular fibrillation (VF) during ST-segment elevation myocardial infarction (STEMI) is a critical emergency that requires immediate action to recover sinus rhythm and prevent sudden death. The surface electrocardiogram (ECG) is an essential diagnostic tool performed during STEMI. Our objective was to identify markers on the ECG that might be useful as potential predictors of peri-infarct VF. Methods Data was obtained prospectively from consecutive patients with a STEMI diagnosis admitted to the Cardiology Acute Care Unit at a tertiary hospital from July-2019 to May-2020. In all cases, primary angioplasty was performed. Clinical and laboratory data and in-hospital complications were collected. Surface ECG parameters were evaluated at the time of diagnosis. Results Of a total of 93 patients included, 11 patients had peri-infarct VF (11.8%). No differences in age, sex or cardiovascular risk factors between groups were found. The ECG at admission showed notable differences: the degree of maximum elevation of the ST segment in mm (STmax) and the sum of such elevation (STsum) in all leads were significantly higher in the VF group (Table). A receiver operating characteristics analysis was performed in order to evaluate the diagnostic capacity of STmax for VF (Figure). A cut off of 4 mm (4mV) in STmax demonstrated the highest sensitivity and specificity for predicting VF. Patients with ST elevation &amp;gt;4mm in any lead had a 16 times greater probability of developing peri-infarct VF (OR 16.4, 95% CI 1.98–136.4; p=0.01). After adjusting for age, STsum also showed a significant association with peri-infarct VF. An STsum of &amp;gt;12mm resulted in a 4 times greater risk of VF. Conclusions The surface ECG remains an essential tool in the evaluation of patients with STEMI. The maximum ST elevation and the sum of the ST elevation demonstrates a strong association with the development of peri-infarct VF. A ST elevation &amp;gt;4mm in any lead is associated with a 16 times higher risk of developing VF. Funding Acknowledgement Type of funding sources: None. Table 1. Baseline demographics, electrocardiographic (ECG) and laboratory data in patients with and without ventricular fibrillation. CKD: chronic kidney disease. STmax: maximum elevation of the ST segment in the ECG measured in millivolts (mV). STsum: sum of all ST elevation on the 12 lead ECG. LVEF: left ventricular ejection fraction.Figure 1. Receiver operating characteristics (ROC) curve analysis to evaluate the diagnostic capacity of maximum ST elevation for the development of ventricular fibrillation in patients with infarction.

Evolution of oral status in adults with intellectual and developmental disabilities: a longitudinal study

This longitudinal retrospective study aimed to assess oral status of people with intellectual and developmental disabilities and analyse the influence of attendance to oral hygiene appointments on oral status over a 10-year period. Clinical oral assessment at first and last visit used the Decayed, Missing and Filled Permanent Teeth Index, the Simplified Debris Index, and the Gingival Index. The sample included 58 participants that visited for at least 10-year period a dental school clinic in Lisbon, with intellectual disability (55.2%), cerebral palsy (31.0%) and trisomy 21 (13.8%). During the study period the Decayed Teeth Index increased from 5.72 (±5.63) to 8.91 (±6.72) (p < 0.001), 59.3% of the participants lost at least one tooth, with a mean tooth loss of 1.78 (±2.15), which was not different between disabilities. The number of annual visits had a positive impact on Gingival Index (p = 0.002). Coming less than one annual visit resulted in 1.21 (CI = 0.52–2.44; p = 0.802) times greater risk of losing at least one tooth. Regular oral hygiene visits had a positive impact on improving and maintaining oral health.

Prenatal Diagnosis and Management of Advanced Abdominal Pregnancy in Dr. Moewardi Hospital Surakarta: A Case Series

Background: The abdominal pregnancy is a pregnancy anywhere in the abdominal cavity other than the tube, ovary, and broad ligament. Abdominal pregnancy has 7.7 times greater risk than tubal pregnancy and 90 times greater than intrauterine pregnancy. This study aims to reveal the diagnosis and treatment of abdominal pregnancy in Dr. Moewardi Hospital Surakarta. Subjects and Method: This was a case series study conducted at Dr. Moewardi Hospital Surakarta. This study report three cases of advanced abdominal pregnancy at Dr Moewardi Hospital (2019 – 2020), that consisted of two cases of advanced abdominal pregnancy to term, and one advanced abdominal pregnancy with acute abdomen. Case presentation: Case 1 (it was found abdominal pregnancy at 30 weeks), the condition of the mother and the fetus was good, the pregnancy was continued until the gestational age was term. The patient was given corticosteroids for lung maturation and magnesium sulfate for neuro­protection. Case 2 (an abdominal pregnancy was found at term), it was decided to immediately terminate it with good preoperative preparation. Both patients in case 1 and case 2 had good result in both the mother and the fetus. The placenta was left in situ in both cases to prevent massive bleeding and injury to the gastrointestinal organs. Case 3 (advanced abdominal pregnancy with acute abdominal symptoms) decided to undergo an emergency laparotomy and removal of the placenta. Conclusion: Abdominal pregnancy must be diagnosed and managed properly to reduce maternal mortality and morbidity. In advanced abdominal pregnancy, it could be considered to continue the pregnancy until the term. The placenta management of in situ without methotrexate might be considered in cases of abdominal pregnancy.

A Comparative Study for an Assessment of Arterial Stiffness with Cardio-Ankle Vascular Index and Clinical Determinants between those Individuals with and without Diabetes

Background: Arterial stiffness and dysfunction are clinical determinants in predicting long-term cardiovascular risk in type 2 diabetes (T2DM). Cardio-ankle vascular index (CAVI) is a novel tool in detecting atherosclerosis by measuring arterial stiffness along the aorta to tibial arteries. Objective: To compare clinical parameters between diabetes and non-diabetes groups. The present study explored clinical factors associated with CAVI of 8.0 or more in diabetes patients. Moreover, the study determined the correlation between CAVI and clinical predictors for long-term cardiovascular risk. Materials and Methods: The present study was a retrospective, cross-sectional study. The controls or non-diabetes were matched with the cases or diabetes in ratio 2:1 and aged matched in two groups, 40 years and older and less than 40 years old. Results: Two hundred fifty-two subjects were enrolled, 84 were diabetes and 168 were non-diabetes. The present study found those subjects with high body mass index (BMI) of 25.0 kg/m² or more and CAVI of 8.0 or more were the factors associated with greater risk of having diabetes than non-diabetes. Subjects with T2DM aged 40 years or older had 11.95 times greater risk of having CAVI of 8.0 or more than those younger than 40 years in T2DM (p=0.002). Known essential hypertension was another independent factor associated with 4.28 times greater risk of having CAVI of 8.0 or more than those without hypertension in T2DM (p=0.010). The present study found significant positive correlation between CAVI and the previously reported clinical markers, RAMA-EGAT score and the mean common carotid artery intima-media thickness, that predict long-term cardiovascular events in T2DM (Pearson’s correlation coefficient; r=0.6738 and 0.4207, respectively, p&lt;0.05). Conclusion: Those subjects with CAVI of 8.0 or more and BMI of 25 kg/m² or more had significantly greater association with diabetes than nondiabetes. Age of 40 years or older and history of hypertension were independent risk of high CAVI of 8.0 or more in T2DM. CAVI also correlated with the previously reported clinical marker to predict long-term cardiovascular risk such as RAMA-EGAT score, the mean common carotid artery intima-media thickness in T2DM. Keywords: Type 2 diabetes; Cardio-ankle vascular index (CAVI); Arterial stiffness

Ethnic disparity in mental health legislation at the point of inpatient entry: pilot review in detained adolescents with developmental disorders

Purpose Ethical concerns about the use of the Mental Health Act (MHA) have led to calls for developmental disorders to be removed from the list of mental disorders for which individuals can be detained. In parallel, there are long-standing concerns of ethnic disparity in the application of the MHA. Nonetheless, the impact of the intersections of developmental disorder diagnosis, adolescence and ethnicity on the application of the MHA is unknown. This study aims to explore ethnic differences in MHA sections and the factors accounting for this, in an adolescent inpatient developmental disorder service. Design/methodology/approach File reviews were conducted to explore differences in MHA status, as well as demographic, clinical and risk factors that may account for this, between 39 white British and ethnic minority adolescents detained to a specialist inpatient developmental disorder service. Findings Consistent with adult literature, adolescents of an ethnic minority were overrepresented in the sample and were significantly more likely to be detained on Part III or “forensic” sections of the MHA than White British counterparts, with five times greater risk. Analyses revealed no significant differences between ethnic minority and white British participants on demographic variables, clinical needs, risk behaviours, risk measures nor application of restrictive practices and safeguarding procedures. Practical implications National audits exploring patterns of detention under the MHA across adolescent developmental disorder populations need to include analysis of intersections to ensure that the MHA is used as a means of last resort and in an equitable manner. Originality/value To the best of the authors’ knowledge, this paper is the first comprehensive exploration of the impact of ethnicity on detention patterns in ethnic minority and White British populations.

The ratio of the posterior atlanto-occipital interval (PAOI): a novel radiographic ratio method evaluating the risk of cervical spondylotic myelopathy-a case-control study.

Our study aims to introduce a dynamic interval ratio method calculated using cervical hyperextension-flexion X-ray films. Secondarily, we aim to evaluate the relationship between the posterior atlanto-occipital interval ratio and cervical spondylotic myelopathy and explain the rationale. We reviewed 83 cases with visible cervical dynamic X-ray films in our hospital from February 2015 to December 2018. Cases were divided into 2 groups according to their diagnosis (with or without spondylotic myelopathy). Radiographic measurements included the shortest distance between the posterior arch of the atlas and the occipital bone and cervical range of motion, and demographic data such as gender, age, and body mass index were also extracted. The posterior atlanto-occipital interval ratio (distance at hyperextension position/distance at hyperflexion position) was determined using logistic regression analysis models between the 2 groups. We included 40 cases in the disease group and 43 cases in the control group. The mean posterior atlanto-occipital interval ratio was 0.65±0.30 (mean ± standard deviation) in the disease group and 0.30±0.28 in the control group, with a significant difference (P<0.01). There was no correlation between the posterior atlanto-occipital interval ratio and gender or body mass index. However, the interval ratio had strong correlations with age, cervical spondylotic myelopathy, and Japanese Orthopaedic Association scores. Age, posterior atlanto-occipital interval ratio, and interval distance at hyperextension in the disease group were higher than those of the control group. Contrastingly, range of motion, Japanese Orthopaedic Association scores, and interval distance at the disease group's hyperflexion position were lower than in the control group. In all cases, the risk of cervical spondylotic myelopathy in the T2 group (cases with middle posterior atlanto-occipital interval ratio, according to the tertiles) was 6 times more than the T1 group (cases with lower ratio), and the T3 group (cases with higher ratio) had a 26.4 times greater risk than the T1 group. Our results suggest that the posterior atlanto-occipital interval ratio is a simple and meaningful parameter that could provide prognostic value for the risk of cervical spondylotic myelopathy through the imaging examinations of the selected cases. Higher posterior atlanto-occipital interval ratios indicate a greater risk for cervical spondylotic myelopathy and cervical musculoskeletal dysfunction. A higher posterior atlanto-occipital interval ratio may manifest undetected posterior atlanto-occipital stiffness, which needs more pathological evidence in future studies.

What causes AIS? Ask the genome!

The most common developmental disorder of the spine is scoliosis, a rotated, lateral deformity in the shape of the spinal column. Scoliosis may be part of the clinical spectrum that is observed in many developmental disorders, but typically presents as an isolated symptom in otherwise healthy adolescent children. Adolescent idiopathic scoliosis (AIS) has defied pathogenic understanding in part due to its genetic complexity, and to the lack of well-defined animal models. The disease is also remarkable in its sexual dimorphism, where girls are at more than five times greater risk of progressive deformity than boys. Breakthroughs have come from recent genome wide association studies (GWAS) and next generation sequencing (NGS) of human AIS cohorts. Post-hoc gene set and pathway-level analyses of genetic datasets have highlighted a role for cartilage biogenesis and the development of the intervertebral disc (IVD) in disease susceptibility. Moreover, next generation sequencing in AIS families, as well as modeling in vertebrate systems, has revealed that rare deficiencies in proteins of the cartilaginous extracellular matrix (ECM) collectively contribute to AIS. Thus, as in a jigsaw puzzle, the pieces coming together from multiple biologic studies suggest that deficiencies in the structural integrity and homeostasis of spinal cartilages are culprits in AIS susceptibility. Here, we update progress in understanding the genetic, biochemical, and cellular determinants of AIS. We also suggest a molecular model in which interaction of the hormonal environment with genetic susceptibility may increase risk of this common disorder of childhood.

Prediction of 90-day mortality after surgery for colorectal cancer using standardized nationwide quality-assurance data.

BackgroundPersonalized risk assessment provides opportunities for tailoring treatment, optimizing healthcare resources and improving outcome. The aim of this study was to develop a 90-day mortality-risk prediction model for identification of high- and low-risk patients undergoing surgery for colorectal cancer.MethodsThis was a nationwide cohort study using records from the Danish Colorectal Cancer Group database that included all patients undergoing surgery for colorectal cancer between 1 January 2004 and 31 December 2015. A least absolute shrinkage and selection operator logistic regression prediction model was developed using 121 pre- and intraoperative variables and internally validated in a hold-out test data set. The accuracy of the model was assessed in terms of discrimination and calibration.ResultsIn total, 49 607 patients were registered in the database. After exclusion of 16 680 individuals, 32 927 patients were included in the analysis. Overall, 1754 (5.3 per cent) deaths were recorded. Targeting high-risk individuals, the model identified 5.5 per cent of all patients facing a risk of 90-day mortality exceeding 35 per cent, corresponding to a 6.7 times greater risk than the average population. Targeting low-risk individuals, the model identified 20.9 per cent of patients facing a risk less than 0.3 per cent, corresponding to a 17.7 times lower risk compared with the average population. The model exhibited discriminatory power with an area under the receiver operating characteristics curve of 85.3 per cent (95 per cent c.i. 83.6 to 87.0) and excellent calibration with a Brier score of 0.04 and 32 per cent average precision.ConclusionPre- and intraoperative data, as captured in national health registries, can be used to predict 90-day mortality accurately after colorectal cancer surgery.

Aerosol components associated with hospital mortality in systemic sclerosis: an analysis from a nationwide Thailand healthcare database

Occupational and environmental associations with systemic sclerosis (SSc) have been confirmed; however, the association between aerosol components and mortality is uncertain. The study aimed to define the association between aerosol components and hospital mortality among Thai SSc patients. A study was conducted using a national database of patients covered by the National Health Security Office, hospitalised between 2014 and 2018. Data included all patients over 18 having a primary diagnosis of SSc (ICD-10: M34). Spatial resources used map information based on GPS coordinates of Thailand. Aerosol components—including organic carbon, black carbon, dust particulate matter diameter < 2.5 µm (PM2.5), and sulfate—were assessed using the NASA satellite MERRA-2 Model M2TMNXFLX v5.12.4. Spatial modelling with R Package Integrated Nested Laplace Approximation (R-INLA) was used to analyse the association between the incidence of mortality and the 5-year accumulation of each aerosol component adjusted by age, sex, and comorbid diseases. The study included 2,094 SSc patients with 3,684 admissions. Most (63.8%) were female. During admission, 1,276 cases died. R-INLA analysis indicated an increase of 1 µg/m3 of dust PM2.5 was associated with a respective increase in the risk of overall mortality and death due to pneumonia of 96% and 79%. An increase of 1 µg/m3 of dust PM2.5 resulted in 1.17, 1.18, 1.64, and 2.15 times greater risk of mortality due to pulmonary fibrosis, cardiac involvement, renal involvement, and cancer, respectively. Aerosol components—particularly dust PM2.5 exposures—increased the risk of overall, cardio-pulmonary-renal, and cancer mortality among SSc patients.

Development and Validation of a Risk Score for Respiratory Failure After Cardiac Surgery

BackgroundPostoperative respiratory failure, defined as ventilator dependency for more than 48 hours or unplanned reintubation within 30 days, is a costly complication of cardiac surgery that increases mortality and length of stay. Stratification of patients by risk upon intensive care unit admission could identify cases requiring early measures to prevent respiratory failure. This study aimed to develop and validate a risk score for postoperative respiratory failure after cardiac surgery. MethodsThis retrospective analysis of 4262 patients admitted to the cardiovascular intensive care unit after major cardiac surgery between January 2013 and December 2017, used The Society of Thoracic Surgeons database and ventilator data from the respiratory therapy department. Patients were randomly and equally assigned to development and validation cohorts. Covariates used in the multivariable models were assigned weighted points proportional to their β regression coefficient values to create the risk score, which categorized patients into low, medium, and high risk of postoperative respiratory failure. ResultsIn both cohorts, postoperative respiratory failure risk was significantly different between risk categories. Compared with low-risk patients, moderate-risk patients had a 2 times greater risk, and high-risk patients had a 4-7 times greater risk. Body mass index, previous cardiac surgery, cardiopulmonary bypass, cardiogenic shock, pulmonary disease presence, baseline functional status, hemodynamic instability, and number of blood products used intraoperatively were significant predictors of respiratory failure. ConclusionsThis risk score can stratify patients by risk for developing postoperative respiratory failure after major cardiac surgery, which may help in the development of preventive measures.

Independent and combined associations between fast-food outlet exposure and genetic risk for obesity: a population-based, cross-sectional study in the UK

BackgroundCharacteristics of the built environment, such as neighbourhood fast-food outlet exposure, are increasingly recognised as risk factors for unhealthy diet and obesity. Obesity also has a genetic component, with common genetic variants explaining a substantial proportion of population-level obesity susceptibility. However, it is not known whether and to what extent associations between fast-food outlet exposure and body weight are modified by genetic predisposition to obesity.MethodsWe used data from the Fenland Study, a population-based sample of 12,435 UK adults (mean age 48.6 years). We derived a genetic risk score associated with BMI (BMI-GRS) from 96 BMI-associated single nucleotide polymorphisms. Neighbourhood fast-food exposure was defined as quartiles of counts of outlets around the home address. We used multivariable regression models to estimate the associations of each exposure, independently and in combination, with measured BMI, overweight and obesity, and investigated interactions.ResultsWe found independent associations between BMI-GRS and risk of overweight (RR = 1.34, 95% CI 1.23–1.47) and obesity (RR = 1.73, 95% CI 1.55–1.93), and between fast-food outlet exposure and risk of obesity (highest vs lowest quartile RR = 1.58, 95% CI 1.21–2.05). There was no evidence of an interaction of fast-food outlet exposure and genetic risk on BMI (P = 0.09), risk of overweight (P = 0.51), or risk of obesity (P = 0.27). The combination of higher BMI-GRS and highest fast-food outlet exposure was associated with 2.70 (95% CI 1.99–3.66) times greater risk of obesity.ConclusionsOur study demonstrated independent associations of both genetic obesity risk and neighbourhood fast-food outlet exposure with adiposity. These important drivers of the obesity epidemic have to date been studied in isolation. Neighbourhood fast-food outlet exposure remains a potential target of policy intervention to prevent obesity and promote the public’s health.

RISK OF OVERWEIGHT AMONG TEENAGERS WHO FOND TO CONSUME FRIED FOOD IN LOH SUMBER, KUTAI KARTANEGARA

Teenager (12-18 years old) was a period that is vulnerable to nutritional problem. This is due to two reasons, because the teenager needs more nutrition for physical growth and for psychological development. It is also susceptible to changes in lifestyle and eating patterns. The purpose of this research was to know the risk of overweight among teenagers who fond to consume fried food in Loh Sumber, Kutai Kartanegara. This research was a quantitative with cross sectional design to 80 respondents. The sampling technique used a rapid survey method ang questionnaire as research instrument.. Data was analyzed by chi square test. The result of the research showed the overweight teenagers were as many as 26 people (32,5%) and the result of statistical analysis showed that fried foods has a significant association (P-value=0,004; OR=12,5; CI=0,233 – 3,616). The teenagers who fond to consume fried food have a 12,5 times greater risk of getting overweight compared with those who did not fond consume fried food. Therefore, it is recommended to teenager to improve the eating pattern and increase the physical activity.

Risk of genotoxic damage in schoolchildren exposed to organochloride pesticides

This study identified and determined organochloride pesticide (OCs) concentrations in hair samples from children at two elementary schools: one exposed to fumigations in agricultural fields, the other unexposed. Three concentrations of OCs levels in the hair were compared (high, medium, low), and total nuclear abnormalities in buccal cells were determined: micronuclei (MNi), condensed chromatin, karyorrhexis, pyknosis, binucleate cells, karyolysis, lobed nuclei, and apoptosis. No significant differences were found for the presence of MNi between the schoolchildren from the exposed and unexposed schools, but the prevalence of OCs in both schools was over 50%, as well as the frequencies of MNi in the children were over 58%. Findings show a significant difference between the frequency of MNi in the total sample of schoolchildren (exposed school + unexposed school) in relation to the concentration of OCs detected in their hair. The children from exposed school that showed the higher concentrations of OCs in hair had higher levels of genotoxic damage in the buccal cells; compared against children with lower concentrations of OCs. The most frequent nuclear abnormalities in the exposed children were lobed nuclei (79.4%), binucleate cells (66.66%), apoptosis (65.07), and MNi (58.7%). We determined the prevalence ratio (PR) and prevalence odds ratio (POR) for the presence of MNi in buccal cells in relation to the OCs concentrations in the hair samples. Both ratios were high for MNi [PR 3.93, 95% confidence interval (CI) 1.97–7.84, p = 0.0003; and POR 7.97, 95% CI 2.62–24.28, p = 0.0003], indicating a 7.97 times greater risk that the exposed children will present > 0.2% of MNi when OCs concentrations exceed 0.447 μg/g. These indicators may be useful biomarkers of genotoxic damage in children exposed to persistent, highly-toxic compounds. Results suggest the potential risk to which those schoolchildren are exposed on a daily basis due to fumigations in nearby agricultural fields.

Prevalence of Diabetes Mellitus Among Complete Denture Patients

Diabetes Mellitus is one of the most common metabolic disorders with 1.82 times greater risk in edentulous patients than dentate patients. It is associated with complications like neuropathy, nephropathy, retinopathy, cardiovascular problems and periodontitis. They complain of burning sensation of the mouth and multiple ulcerations in the mouth. All these problems contribute to the failure of retention of complete denture. The aim of the study is to find the prevalence of diabetes mellitus in complete denture patients. Case records of 89,000 patients who visited the hospital between June 2019- April 2020 were retrieved and reviewed. This university setting study involved 351 complete denture patients. Data was tabulated with parameters - name, age, gender, medical history of diabetes or with other systemic diseases. Data was imported to SPSS for statistical analysis. Descriptive statistics and chi-square tests were done. 26.5% of the complete denture patients had diabetes mellitus. Males were found to be slightly more prevalent than females. The most common age group affected was 60-75 years age group. Chi-square test showed no significance between age or gender with diagnosis of diabetes. ( p-value &amp;gt;0.05). Diabetes mellitus is associated directly with edentulism with 26.5% of prevalence with this disease. The most common age group prevalent was in the age group of 60-75 years and commonly seen in males.

Risk areas for tuberculosis among children and their inequalities in a city from Southeast Brazil

BackgroundThe objective of the study was to identify areas of risk for the appearance of tuberculosis in children and their association with social inequalities in a municipality in southeastern Brazil.MethodsEcological study conducted in Ribeirão Preto, Brazil. To identify areas of spatial risk for tuberculosis in children, we used spatial scanning statistics. To analyze the association of cases of childhood tuberculosis with social vulnerability, we used the Social Vulnerability Index of São Paulo, and four explanatory statistical models were listed.ResultsThere were 96 cases of childhood tuberculosis, of which 90 were geocoded through a process of converting addresses to geographic coordinates. A risk area was identified in the municipality, where children under 15 years old have 3.14 times greater risk of contracting tuberculosis than those living outside this area. The variables identified as risk factors were: number of private and collective households, proportion of children aged 0 to 5 years in the population, proportion of households without per capita income, and the proportion of private households with monthly nominal incomes of up to one quarter of wage minimums. The variables identified as protection factors were the proportion of women under the age of 30 years responsible for the household under and women responsible for the household with an average income over BRL 2344.ConclusionThe study showed areas of risk for the occurrence of tuberculosis in children. The study is in line with the End TB Strategy and the 2030 Agenda, which aim to support strategic actions and, therefore, save the lives of children through the systematic, intensified, and comprehensive identification of children with tuberculosis respiratory symptoms in the community.