Total Number Of Cases Research Articles

Mitigating the Risk of Dengue Fever in Nagpur City, India: Insights from a Five-year Retrospective Study

Objectives: Dengue is a significant global threat, with millions of infections yearly, primarily transmitted by Aedes mosquitoes. Vector control is crucial as no specific treatment is available, and urbanisation has led to increased susceptibility to the disease. We aimed to study dengue fever’s incidence, mortality, and various determinants in Nagpur, India. Material and Methods: This was a retrospective record-based study conducted for the period between January 2018 and December 2022 in Nagpur, India. Results: During 2018–2022, 17,306 blood samples were tested for dengue immunoglobulin M antibodies by enzyme-linked immunosorbent assay method with 2470 positive results indicating an overall test positivity of 14.27%. A median of 27 samples was tested monthly (interquartile range [IQR]: 5–178.5) with seven dengue cases (IQR: 1–15) diagnosed per month, yielding a monthly median dengue test positivity rate of 15.3 % (IQR: 6.41–24.28). Median annual dengue incidence rate (per 1,00,000 population) was 20.12 (IQR: 21.46). The median dengue-attributable death yearly was 2 (IQR: 2.25), remaining stable over the study period. The mean annual case fatality rate (CFR) was 0.43% (standard deviation [SD]: 0.34%). During the same period, India’s mean annual dengue incidence rate (per 1,00,000 population) was 1.74 (SD: 0.81), and the mean annual CFR was 0.134 % (SD: 0.042). During the five years, action was taken on 194,698 containers. The median values of environmental factors and public health interventions, as calculated on a monthly basis, were as follows: Container index: 1.15 % (IQR: 0.7–1.98); action taken on containers: 3108.5 (IQR: 2436–4282); house index: 3.02 % (IQR: 2–4.07); guppy fishes introduced: 1736.5 (1005.5–1794.5) and rainfall (mm): 26.05 (1–69.11). The total number of dengue cases, incidence rate, and CFR showed an overall decline in year-wise evaluation. The important determinants identified were as follows: Higher container index, house index, and total blood samples tested for dengue were significant determinants of the total number of dengue cases, and environmental factors such as Aedes density, container index, and house index were significant determinants of dengue-related mortality. Introducing guppy fishes and taking action on containers successfully arrested the absolute number of dengue deaths. The container index, house index, and rainfall were significant determinants of Aedes’ density. Conclusion: Our study emphasises the effectiveness of public health interventions in reducing the incidence and fatality rate of dengue fever in Nagpur City over the past five years, particularly through introducing guppy fish and container management. Stagnant water around households has been identified as a significant risk factor for dengue transmission. Prevention strategies must prioritise tackling this issue, with enhanced monitoring during the wet season, and encourage community members to take personal responsibility for eliminating stagnant water sources in their households.

Effectiveness of Using Candlestick Charts to Forecast Ethereum Price Direction: A Machine Learning Approach

Cryptocurrency is a form of decentralized digital currency. Ethereum is the second-largest cryptocurrency by market capitalization and the largest altcoin. Cryptocurrencies including Ethereum are highly volatile. Hence, shortterm directional forecasts in the cryptocurrency market have become a widely discussing topic. Candlestick charts are useful visualizations of the open, high, low and close prices which can identify patterns and gauge the near-term direction of prices. This research explores the effectiveness of forecasting hourly Ethereum closing price direction based on candlestick charts within a short time horizon. The proposed forecasting algorithm incorporates clustering methods such as fuzzy K-means, K-means and partition around medoids clustering to cluster candlestick chart properties namely upper shadow length, body length and lower shadow length. Classification methods such as random forest, support vector machine and K-nearest neighbour were used to forecast closing price direction using 16 different predictor variable sets including open, high, low and close prices, candlestick chart price direction, USL, BL and LSL. The accuracy for all considered cases was around 50%. Clustering improved the accuracy slightly and including the CPD with the predictor variable sets under consideration can increase the accuracy slightly. However, this approach is performing better in predicting the Down cases to the total number of actual Down cases because there is a higher sensitivity of 81.20% based on the SVM with Open, High, Low and Close at t in the clustering ignored method.

Dynamics of Dental Care for the Population of the Ryazan Region in COVID-19 Pandemic

INTRODUCTION: Identification of morbidity (based on requests) and the population’s need for dental care optimizes the planning and distribution of compulsory health insurance (CHI) funds between medical organizations at the regional level. However, due to a decrease in the population’s demand for medical care in the context of the new coronavirus infection (Corona Virus Disease 2019, COVID-19), the dynamics of the provision of dental care and the structure of dental morbidity taken into account in the compulsory medical insurance system, have changed. AIM: To study the structure and dynamics of the provision of dental care in the period 2018–2021 (pre-pandemic and COVID-19 pandemic period) based on the volume of dental care paid for in the compulsory medical insurance system provided to citizens of the Ryazan region (RR). MATERIALS AND METHODS: The analysis was carried out on the basis of registers of bills accepted for payment submitted by medical organizations, taking into account the results of control and expert measures. All completed cases of treatment of insured persons with dental diseases in medical organizations of the Ryazan Region for 2018–2021 were selected for study according to territorial compulsory medical insurance programs. RESULTS: In the structure of outpatient primary health care in 2021, cases of its provision in the ‘Dentistry’ profile amounted to 7.40 ± 0.10%, taking 3rd place; the total number of cases of providing medical care to patients with this pathology decreased by 5.60% compared to 2018. Despite the reduction in the volume of primary dental care, the volume of dental examinations of the population of the RR increased by 30.46%. There was also a 34.08% reduction in completed cases of treatment of chronic periodontitis (p 0.02). For the 2018–2021 period 73,049 medical and economic examinations (MEE) and 1,626 examinations of medical care quality (EMCQ) were carried out, and 1,966 violations were identified (1,316 based on the results of the MEE and 650 based on the results of the EMСQ). The vast majority of these concerned non-compliance with standards of care and clinical guidelines. CONCLUSION: The results of the study indicate a reduction in the number of cases of insured persons seeking medical care for dental diseases during the COVID-19 pandemic. Owing to the approval of Order No. 231n of the Ministry of Health of Russia of March 19, 2021, obliging medical insurance organizations to carry out control and expert measures in each medical organization in a certain amount of dental care cases accepted for payment, the number of examinations has increased, and, as a result, the identification of violations in the provision of dental care.

Global, regional, and national burden of gout, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

Gout is an inflammatory arthritis manifesting as acute episodes of severe joint pain and swelling, which can progress to chronic tophaceous or chronic erosive gout, or both. Here, we present the most up-to-date global, regional, and national estimates for prevalence and years lived with disability (YLDs) due to gout by sex, age, and location from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, as well as forecasted prevalence to 2050. Gout prevalence and YLDs from 1990 to 2020 were estimated by drawing on population-based data from 35 countries and claims data from the USA and Taiwan (province of China). Nested Bayesian meta-regression models were used to estimate prevalence and YLDs due to gout by age, sex, and location. Prevalence was forecast to 2050 with a mixed-effects model. In 2020, 55·8 million (95% uncertainty interval 44·4-69·8) people globally had gout, with an age-standardised prevalence of 659·3 (525·4-822·3) per 100 000, an increase of 22·5% (20·9-24·2) since 1990. Globally, the prevalence of gout in 2020 was 3·26 (3·11-3·39) times higher in males than in females and increased with age. The total number of prevalent cases of gout is estimated to reach 95·8 million (81·1-116) in 2050, with population growth being the largest contributor to this increase and only a very small contribution from the forecasted change in gout prevalence. Age-standardised gout prevalence in 2050 is forecast to be 667 (531-830) per 100 000 population. The global age-standardised YLD rate of gout was 20·5 (14·4-28·2) per 100 000 population in 2020. High BMI accounted for 34·3% (27·7-40·6) of YLDs due to gout and kidney dysfunction accounted for 11·8% (9·3-14·2). Our forecasting model estimates that the number of individuals with gout will increase by more than 70% from 2020 to 2050, primarily due to population growth and ageing. With the association between gout disability and high BMI, dietary and lifestyle modifications focusing on bodyweight reduction are needed at the population level to reduce the burden of gout along with access to interventions to prevent and control flares. Despite the rigour of the standardised GBD methodology and modelling, in many countries, particularly low-income and middle-income countries, estimates are based on modelled rather than primary data and are also lacking severity and disability estimates. We strongly encourage the collection of these data to be included in future GBD iterations. Bill & Melinda Gates Foundation and the Global Alliance for Musculoskeletal Health.

Prevalence of Cutaneous Adverse Drug Reactions According to Iraqi Pharmacovigilance Center; A retrospective study for 11 years (2010-2021)

Background: Cutaneous Adverse Drug Reactions (CADRs) are among the leading causes of morbidity and mortality. Insufficient data exists on cutaneous adverse reactions, as many of these reactions are not reported due to their constantly changing patterns and the interaction of multiple risk factors. Aim: This study aims to evaluate the prevalence of cutaneous reactions in Iraq and find the most commonly involved active ingredients with the commonest skin manifestations. Method: A retrospective study based on the safety reports of patients having cutaneous reactions that were collected and submitted to VigiBase by the Iraqi Pharmacovigilance Center between 2010 and 2021. The study involved the analysis of gender, age, medicines, type of CADR, and seriousness of more than 4,300 reports. Results: Skin rash was the most commonly reported CADR, and antibiotics were the leading drug class; ceftriaxone and vancomycin were responsible for 40.3% and 16.2% of the cases caused by antibiotics only, respectively. The mean age of the patients was 28 years, and the male-to-female ratio was 0.78:1. Out of the total number of cases, more than 1300 were deemed serious, and 15 patients have passed away. Conclusion: Iraq comes in the 51st place among other countries in the number of skin and skin-related ADR cases. Older adults are at higher risk of developing serious CADRs. Ceftriaxone and rash were the leading drug and cutaneous manifestations, respectively.

Analysis of the Causes and Conditions for the Formation of a High Incidence of Acute Respiratory Infections in the Population of the Altai Krai (Part 2. Environmental factors, diagnosis of coxiellosis and tick­borne rickettsiosis)

Relevance. Altai Krai (AK) is one of the least prosperous subjects of the Russian Federation in terms of the incidence of acute respiratory infections (ARI). Results of studying long-term and intra-annual dynamics of the incidence of ARI and community-acquired pneumonia (CAP) in various population groups of the AK in 2011–2021 led to a conclusion about possible connection between the characteristics of the epidemic process of ARI and environmental factors, primarily air pollution, as well as the widespread distribution of natural and atropurgic foci of tick-borne transmissible and zoonotic infections in the territory of the AK, along with the problems of diagnostics. Aim. Assessment of the possible influence of environmental factors on the formation of a high level of registered incidence of ARI in the Altai Territory, as well as diagnostics of some natural focal and zoonotic infections with fever and respiratory symptoms. Materials and methods. A retrospective epidemiological study was conducted based on annual and monthly official statistical reporting during 2011–2021 about the morbidity of the population, demographic and environmental features of the territory of the AK for each of the municipalities (MU), the average long-term incidence rates of ARI, VBP, tuberculosis, Siberian tick typhus (STT), ixodid tick-borne borreliosis, tick-borne viral encephalitis were calculated; appeals of the population regarding tick bites; population density and annual average sulfur dioxide (SO2) emissions. Pearson correlation coefficient was used to assess the strength of the relationship between the analyzed indicators; and seasonality coefficients and the method of trend-seasonal decomposition were used to assess the intra-annual dynamics of the incidence of ARI and CAP (for the period 2011-2019). To study seroprevalence of antibodies to C. burnetii, R. sibirica and SARS-CoV-2 in febrile patients with symptoms of ARI blood samples were collected in October 2022 from ten rural districts of the AK. Results and discussion. It was established that there was a significant direct correlation between the incidence of ARI and the amount of SO2 emissions into the atmosphere (r = 0.61, p < 0.001), as well as between the incidence of ARI and population density (r = 0.53, p < 0.001). The largest share (69%) of the total number of ARI cases in the Altai Territory in 2011–2021 was attributed to the cities of Barnaul, Biysk, Rubtsovsk, Zarinsk and Novoaltaisk, which are characterized by maximum SO2 emissions and population density. An additional contribution (8% total) to the incidence of ARI in the Altai Territory was attributed to 7 rural areas with the highest levels of SO2 emissions. Regardless of the ranking for the incidence of ARI and CAP, in 9 out of 10 areas selected for the study, patients had both anamnestic and diagnostic titers of antibodies to C. burnetii and/or R. sibirica. At the same time, coxiellosis cases in these areas were not registered for 12 years, and the number of cases of STT was much less than the probable number based on the proportion of patients which were seropositive to R. sibirica and had symptoms of ARI. IgM to SARS-CoV-2 were detected in 5 out of 203 examined samples, IgG – in 188 out of 203 examined samples, moreover 13.8% of samples had 118 to 499 BAU/ml, 40.9% of samples had 500 to 5000 BAU/ml, and the rest of samples had more than 5000 BAU/ml. Conclusion. Among all the variables analyzed in the study, the greatest role in the formation of the high level of registered incidence of ARI in the AK for many years belong to the high level of air pollution with SO2 emissions, high population density and, especially, their combination. Underdiagnosis of tick-borne rickettsioses and coxiellosis is of particular importance due to the unavailability of test kits for laboratory verification. Starting from 2020, a new coronavirus infection made some contribution to the registered incidence of ARI.

Clinico-Laboratory Profile and Outcome of Kawasaki Disease in Children in a Tertiary Care Hospital in Kathmandu

Introduction: Kawasaki disease (KD) is one of the most common vasculitis of childhood. It contributes significantly to acquired heart disease in children and results in coronary artery abnormalities including aneurysm in 25% of untreated children. This study aims to retrospectively assess the clinical course, laboratory results, and presenting symptoms of patients with complete and incomplete KD treated at tertiary care hospital in Kathmandu.Method: This retrospective study was conducted in the Department of Pediatrics. Data from January 2020 to December 2020 were retrieved from medical records department of the hospital and analyzed using Microsoft excel.Result: The total number of cases evaluated in our study was 9. The median age at the time of the diagnosis of KD was 24 months (median age for incomplete KD-21 months, complete KD-37 months). Male to female ratio was 1.2:1. The peak season of KD occurrence was Spring (March – May). Mean duration of stay in the hospital was 7 days. All children presented with fever, with an mean fever duration of 7 days at the time of presentation. Fever was present in every case. The most common principal symptom was a polymorphous skin rash, observed in 88% of the cases. Elevated CRP levels (≥3 mg/dl) were noted in all 9 cases. Cardiovascular complications were present in 88% of the patients, with coronary artery aneurysm (CAA) detected in 11%, coronary artery dilation in 22%, and mild pericardial effusion documented in 66% of the cases. Eight patients (88%) received IVIG, all 9 patients (100%) received aspirin, and 2 patients received steroids. There were no fatalities.Conclusion: KD is a common vasculitis in children which do not have significant sex predilection in oppose to most of the studies. Majority of cases occurred in spring season. The most common symptom was polymorphous rash. A high level of suspicion for diagnosing KD is essential, and early treatment is crucial to prevent complications and reduce the future economic burden on families and the nation.

Automating the Generation of Notifiable Bacterial Disease Reports: Proof-of-Concept Study and Implementation in Six Hospitals in Thailand.

Information on notifiable bacterial diseases (NBD) in low- and middle-income countries (LMICs) is frequently incomplete. We developed the AutoMated tool for the Antimicrobial resistance Surveillance System plus (AMASSplus), which can support hospitals to analyze their microbiology and hospital data files automatically (in CSV or Excel format) and promptly generate antimicrobial resistance surveillance and NBD reports (in PDF and CSV formats). The NBD reports included the total number of cases and deaths after Brucella spp., Burkholderia pseudomallei, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Neisseria meningitidis, nontyphoidal Salmonella spp., Salmonella enterica serovar Paratyphi, Salmonella enterica serovar Typhi, Shigella spp., Streptococcus suis, and Vibrio spp. infections. We tested the tool in six hospitals in Thailand in 2022. The total number of deaths identified by the AMASSplus was higher than those reported to the national notifiable disease surveillance system (NNDSS); particularly for B. pseudomallei infection (134 versus 2 deaths). This tool could support the NNDSS in LMICs.

Advance on Chinese Medicine for Hypertensive Renal Damage: Focus on the Complex Molecular Mechanisms.

Hypertensive renal damage (HRD) is a major cause of end-stage renal disease. Among the causes of end-stage renal disease, HRD accounts for nearly 34% of the total number of cases. Antihypertensive treatment is primarily drug-based, but therapeutic efficacy is less effective and can have serious side effects. Chinese medicine (CM) has significant advantages in the treatment of HRD. CM is rich in various active ingredients and has the property of targeting multiple targets and channels. Therefore, the regulatory network of CM on disease is complex. A large number of CM have been employed to treat HRD, either as single applications or as part of compound formulations. The key possible mechanisms of CM for HRD include regulation of the renin-angiotensin-aldosterone system, antioxidation, anti-inflammation, rescue of endothelial function, regulation of vasoactive substance secretion and obesity-related factors, etc. This review summarized and discussed the recent advance in the basic research mechanisms of CM interventions for HRD and pointed out the challenges and future prospects.

Quantifying the basic reproduction number and underestimated fraction of Mpox cases worldwide at the onset of the outbreak.

In 2022, there was a global resurgence of mpox, with different clinical-epidemiological features compared with previous outbreaks. Sexual contact was hypothesized as the primary transmission route, and the community of men having sex with men (MSM) was disproportionately affected. Because of the stigma associated with sexually transmitted infections, the real burden of mpox could be masked. We quantified the basic reproduction number (R 0) and the underestimated fraction of mpox cases in 16 countries, from the onset of the outbreak until early September 2022, using Bayesian inference and a compartmentalized, risk-structured (high-/low-risk populations) and two-route (sexual/non-sexual transmission) mathematical model. Machine learning (ML) was harnessed to identify underestimation determinants. Estimated R 0 ranged between 1.37 (Canada) and 3.68 (Germany). The underestimation rates for the high- and low-risk populations varied between 25-93% and 65-85%, respectively. The estimated total number of mpox cases, relative to the reported cases, is highest in Colombia (3.60) and lowest in Canada (1.08). In the ML analysis, two clusters of countries could be identified, differing in terms of attitudes towards the 2SLGBTQIAP+ community and the importance of religion. Given the substantial mpox underestimation, surveillance should be enhanced, and country-specific campaigns against the stigmatization of MSM should be organized, leveraging community-based interventions.

Surgical Management of Achilles Tendon Ruptures in the United States 2006-2020, an ABOS Part II Oral Examination Case List Database Study.

In correlation with a growing body of evidence regarding nonoperative management for Achilles tendon rupture (ATR), studies from Europe and Canada have displayed a decreasing incidence in surgical management, which has not been noted in the United States. The primary objective of this study is to evaluate the US trend in ATR repair volume. The American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List Database was used. All cases using Current Procedural Terminology codes for primary ATR repair were requested from the years 2006-2020. Total submitted Achilles repair volume, the number of candidates submitting an Achilles repair case, and the overall submitted case volume per examination year was analyzed. Poisson and linear regressions were used to determine statistically significant trends. The total number of Achilles repair cases submitted for the ABOS Part II Oral Examination significantly increased from 2006 to 2011 and then decreased until 2020. Taking Achilles repair cases as a proportion of total orthopaedic cases submitted, the same trend was seen. The number of candidates submitting an Achilles repair case increased from 2006 to 2009 and then decreased until 2020. Foot and Ankle fellowship-trained candidates submitted an increasing number of ATR repair cases per candidate during the time period studied. This is the first study to demonstrate a decline in the volume of ATR repair in the United States. The decline in ATR repair volume seen in the ABOS Part II Case Lists does not match previously published US surgeon practice patterns but is not necessarily generalizable to beyond this period. Although the overall ATR repair volume in the ABOS Part II Case Lists is decreasing, we found Foot and Ankle fellowship-trained surgeons are operating on an increasing number of ATRs during their board collection period. Level III, retrospective cohort study.

Edukasi Upaya Pencegahan Demam Berdarah Dengue di Wilayah Kerja Puskesmas Tanjung Karang

Dengue hemorrhagic fever (DHF) is one of the most common health problems in society which causes various health problems. This disease is caused by the bite of the Aedes Aegypti mosquito which transmits the dengue virus. In the Tanjung Karang Community Health Center working area, 96 residents in the last 2 years have been affected by dengue fever. The aim of implementing this community service is to provide education to people who have been affected by dengue fever so that they have a higher level of knowledge in efforts to prevent dengue fever. This community service program is implemented using the Asset Based Community Development method. The population in this study were all residents who had experienced dengue fever in the Tanjung Karang Community Health Center working area. The total number of dengue fever cases in the Tanjung Karang Community Health Center working area from 6 sub-districts, namely from January 2021 to August 2022, was 96 people. Then it was entered into the Slovin formula with an error rate of 0.05 and the result was 77.41, so the researchers took 77 people as respondents. Education can increase knowledge about dengue prevention efforts in the community to knowledge that was previously quite good. It is hoped that the community will play an active role in carrying out environmental cleanliness, especially in carrying out the eradication of mosquito nests in order to reduce as little as possible the opportunity for mosquitoes to nest and breed by carrying out draining, closing water reservoirs both outside the house and inside the house and burning used items. Communities who have higher knowledge can be empowered as leaders in efforts to prevent DHF.

An old unknown: 40 years of crayfish plague monitoring in Switzerland, the water tower of Europe

The oomycete Aphanomyces astaci is the causative agent of crayfish plague, a disease threatening susceptible freshwater crayfish species in Europe.To detect its spatiotemporal occurrence in Switzerland, we reviewed (1) the literature regarding occurrence of crayfish plague and North American crayfish carrier species and (2) the necropsy report archive of the Institute for Fish and Wildlife Health (FIWI) from 1968 to 2020. In the past, crayfish plague was diagnosed through several methods: conventional PCR, culture, and histology. When available, we re-evaluated archived Bouin’s or formalin-fixed, paraffin-embedded samples collected during necropsies (1991–2020) with a recently published quantitative PCR.Literature research revealed putative reports of crayfish plague in Switzerland between the 1870s and 1910s and the first occurrence of three North American crayfish species between the late 1970s and 1990s.Finally, 54 (28.1%) cases were classified as positive and 9 (4.7%) cases as suspicious. The total number of positive cases increased by 14 (14.7%) after re-evaluation of samples. The earliest diagnosis of crayfish plague was performed in 1980 and the earliest biomolecular confirmation of A. astaci DNA dated 1991. Between 1980–1990, 1991–2000 and 2001–2010 crayfish plague spread from one to two and finally three catchment basins, respectively.Similar to other European countries, crayfish plague has occurred in Switzerland in two waves: the first at the end of the 19th and the second at the end of the 20th century in association with the first occurrence of North American crayfish species. The spread from one catchment basin to another suggests a human-mediated pathogen dispersal.

Trends and Patterns of Top Ten Common Cancers in Eastern India from 2014 to 2021: A Retrospective Hospital-based Cancer Registry Data Update.

India is a vast and diverse country with existing variations in the frequency and distribution of cancers across its various parts. In regions lacking population-based cancer registries (PBCRs) in a vast country like India, hospital-based cancer registry (HBCR) data become an important source of information on the trends and patterns of a region. To determine the numerical trends of cases of the top ten cancer sites reporting to HBCR of a tertiary care cancer center in Bihar from 2014 to 2021. The details of all histopathologically confirmed cancer cases registered in the HBCR department of radiation oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, India between January 2014 and December 2021 were included in this retrospective observational study. All these cases were grouped site-wise and listed in descending order of the total number of cases reported in each group. Cross-tabulation with age and sex distribution was done. The frequency distribution of the top ten leading cancers for every consecutive calendar year was plotted in line diagrams for time trend analysis. Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). was used for analysis. Annual percent change (APC) was determined for the number of cases of all ten cancer sites using joinpoint regression analysis (Joinpoint Regression Software, Version 4.0.4-May 2013; Statistical Methodology and Applications Branch, Surveillance Research Program of the US National Cancer Institute; Bethesda, MD, USA). Out of 32,057 total cancer cases registered between Jan 2014 and Dec 2021, 21,848 patients (68.2%) cases constituted the top ten cancers. The top ten cancers among both sexes were cancer gallbladder (n = 4204, 13.1%), head and neck (n = 3395, 10.6%), breast (n = 3392, 10.6%), lung (n = 2069, 6.5%), cervix (n = 2039, 6.4%), hematolymphoid (n = 1930, 6.0%), liver (n = 1572, 4.9%), stomach (n = 1116, 3.5%), ovary (n = 1103, 3.4%), and colon-rectum (n = 1028, 3.2%). Except for cervical and hematolymphoid cancers, the rest all showed a rising trend over consecutive years. Cancer of the gallbladder continues to be among the most common cancers in the region. Focused research in all aspects of this deadly disease is needed. Strengthening of prevention and screening programs for common cancers and upliftment of the existing infrastructure for diagnosis and treatment of cancer in the region are necessitated.

Incremental Societal Costs of Perioperative Complications Following Adult Elective Inpatient Major Therapeutic Surgery in the State of Florida: A Seven-Year Retrospective Epidemiological Analysis.

Introduction There is an expanding role for anesthesiologists in the preoperative optimization and postoperative management of patients, often in the context of a so-called perioperative surgical home. Such efforts typically include enhanced recovery after surgery (ERAS) protocols and often an anesthesiologist-led team for perioperative management. Studies of the cost-effectiveness of such approaches have generally been conducted at single institutions, with most patients cared for by small numbers of surgeons. This limitation creates generalizability issues as to whether improvement was related mostly to organizational culture or the studied surgeons' practices (non-generalizable) versusthe procedures (generalizable). We studied whether other organizations can rely on achieving similar benefits following the adoption of a studied process improvement strategy at a single institution. Methods All patients undergoing elective major therapeutic inpatient surgery discharged between October 2015 and June 2022 at non-federal hospitals in the state of Florida were included. For each discharge, the United States Medicare Severity Diagnosis-Related Group (MS-DRG) weighting factor (i.e., the multiplier for the hospital's base rate for admissions that determines reimbursement) and the Clinical Classification Software Refined (CCSR) code for the principal procedure were determined at admission and discharge from the state's inpatient healthcare database based on the diagnoses present at those time points. An increase in the weighting factor from admission to discharge represents societal costs from perioperative complications. Statewide, by hospital, and by surgeon, we calculated the total increase for each CCSR's weighting factor. Our primary hypothesis was that surgeon variability would be statistically greater than CCSR variability but that the incremental effect would be <5%. If CCSR and surgeon variability were comparable, this would be supportive of generalizability. In contrast, if there were a predominant effectrelated to the surgeon, results from one institution might not be applicable to others. Results Among the 1,482,344 discharges studied, the pooled (N=7 years) contributions to MS-DRG weighting factor increases from the upper 20% of surgeons were 2.8% more than from the upper 20% of CCSRs (95% CI 1.9%-3.9%, p=0.0006). Those CCSRs accounted for 85.5% (95% CI 79.4%-91.7%, p<0.0001) of the total increase in the MS-DRG weighting factor. The average contribution of the top two surgeons at each hospital to that hospital's increase in the weighting factor ranged among CCSRs from 68% to 97%.The median and 75th percentile of surgeons performing at least 10% of the total number of cases at each hospital was similar to those values for the contributions to the increases in the MS-DRG weighting factor, median 2.0 to 3.0, and 75th percentile 1.75 to 4.0. Conclusions Because variability among surgeons in their contributions to increases in the MS-DRG weighting factor only slightly exceeded the variability among CCSR surgical categories, perioperative surgical home and ERAS study research results involving single institutions and a small number of surgeons would likely be generalizable to other hospitals and healthcare systems. Funding agencies should not be hesitant to fund single-center perioperative surgical home studiesand ERAS interventions based on concerns related to lack of generalizability.

EPH101 Estimating Total Number of Influenza Cases From Reported Hospitalizations: A Multi-Country Comparison of the Multiplier Method

EPH101 Estimating Total Number of Influenza Cases From Reported Hospitalizations: A Multi-Country Comparison of the Multiplier Method

Global, regional, and national burden and trends of migraine among women of childbearing age from 1990 to 2021: insights from the Global Burden of Disease Study 2021

BackgroundMigraine, a neurological disorder with a significant female predilection, is the leading cause of disability-adjusted life years (DALYs) in women of childbearing age (WCBA). There is currently a lack of comprehensive literature analysis on the overall global burden and changing trends of migraines in WCBA.MethodsThis study extracted three main indicators, including prevalence, incidence, and DALYs, related to migraine in WCBA from the Global Burden of Disease(GBD) database from 1990 to 2021. Our study presented point estimates with 95% uncertainty intervals (UIs). It evaluated the changing trends in the burden of migraine in WCBA using the estimated annual percentage change (EAPC) and percentage change.ResultsIn 2021, the global prevalence, incidence, and DALYs cases of migraine among WCBA were 493.94 million, 33.33 million, and 18.25 million, respectively, with percentage changes of 48%, 43%, and 47% compared to 1990. Over the past 32 years, global prevalence rates and DALYs rates globally have increased, with an EAPC of 0.03 (95% UI: 0.02 to 0.05) and 0.04 (95% UI: 0.03 to 0.05), while incidence rates have decreased with an EAPC of -0.07 (95% UI: -0.08 to -0.05). Among the 5 Socio-Demographic Index (SDI) regions, in 2021, the middle SDI region recorded the highest cases of prevalence, incidence, and DALYs of migraine among WCBA, estimated at 157.1 million, 10.56 million, and 5.81 million, respectively, approximately one-third of the global total. In terms of age, in 2021, the global incidence cases for the age group 15–19 years were 5942.5 thousand, with an incidence rate per 100,000 population of 1957.02, the highest among all age groups. The total number of migraine cases and incidence rate among WCBA show an increasing trend with age, particularly in the 45–49 age group.ConclusionsOverall, the burden of migraine among WCBA has significantly increased globally over the past 32 years, particularly within the middle SDI and the 45–49 age group. Research findings emphasize the importance of customized interventions aimed at addressing the issue of migraines in WCBA, thus contributing to the attainment of Sustainable Development Goal 3 set by the World Health Organization.

Prevalence and Associated Factors of Nonunion in Open Tibial Shaft Fracture among Patients Treated with External Fixation in Tibebe Ghion Specialized Hospital

Background: The definitive treatment of open tibial shaft fractures remains challenging and nonunion after treatment of open tibial shaft fractures with external fixation complicates a significant proportion of cases. There are varying rates of occurrence of nonunion and the prevalence is not well known in Ethiopia. The objective of the study is to assess the prevalence and associated factors of nonunion in open tibial shaft fractures treated with EX FIX in TGSH. Methods: The study was conducted using a cross-sectional study in patients with open tibial shaft fractures who were admitted and treated with external fixation in the Tibebe Ghion Specialized Hospital orthopedics department from January 1, 2019, to January 29, 2021. The study involved 75 patients, which was the total number of cases in the study period and fulfilled the inclusion criteria. Bivariate and multiple variable logistic regression analyses were used to analyze the association between variables. The degree of association between variables was determined at the p-value of &lt;0.05. Results: The overall prevalence of nonunion in open tibial shaft fractures treated with external fixation in TGSH was 21.3%. The severity of the injury, presence of wound infection, and treatment factors affect the occurrence of nonunion. It occurs in 9 of 19 (47.4%) Gustilo-Anderson grade IIIB fractures and 6 of 48 (12.5%) Gustilo-Anderson grade IIIA fractures. A delay in soft tissue covering of Gustilo-Anderson grade IIIB fracture of 15 days or more increases the nonunion rate to 72.7%. Nonunion occurred in 41.7% of cases with SSI and 11.8% of cases without SSI. Gustilo-Anderson grade (AOR=4.85, CI 95%: 1.31-18.01), surgical site infection (AOR=4.12, CI 95%: 1.11-15.26), and time until coverage of bone of Gustilo-Anderson grade IIIB fracture (AOR=18.23, CI 95%: 1.17-284.8) have statistically significant association with nonunion. Conclusion and Recommendation: External fixation use for definitive treatment of open tibial fractures should be disfavored as the prevalence of nonunion in open tibial shaft fractures treated with EX FIX is higher than other previous studies done in European and Asian countries. Gustilo-Anderson grade of injury, surgical site infection, and time from injury to bone coverage of Gustilo-Anderson grade IIIB fractures were found to be statistically significantly associated with the occurrence of nonunion. Therefore, attention should be given to early soft tissue reconstruction of exposed bones to establish a favorable environment for bone healing and to make treatment with internal fixations possible. Better management of wounds to minimize surgical site infections is required for better healing of open tibial shaft fractures. Prospective studies are also recommended on the issue.

Exploring the Association between Benign Anorectal Conditions and Colorectal Cancer from the Analysis of Lower Gastrointestinal Endoscopies

Abstract Objective Patients experiencing hemorrhoids or fissures may overlook other gastrointestinal (GI) symptoms, assuming that they are linked solely to their existing condition. However, colon cancer, often asymptomatic, can coincide with benign pathologies detected during colonoscopy. This study investigates the prevalence of colorectal cancer (CRC) in patients undergoing lower GI endoscopy for hemorrhoids and elucidates the correlation between cancer and benign pathologies identified during colonoscopy. Highlighting its potential to reveal hidden cancers emphasizes the critical role of colonoscopy in comprehensive health care. Methods The primary objective was to thoroughly investigate the prevalence of CRC in patients who underwent lower GI endoscopy for hemorrhoids. A comprehensive analysis was conducted using a dataset spanning 7 years of lower GI endoscopy. The main focus of this investigation was to determine the incidence of cancer. Additionally, a meticulous examination of accompanying benign diagnoses was performed to provide a comprehensive evaluation. Results The study cohort, comprising 6,268 patients, revealed a noteworthy coexistence of malignancies with common conditions. The revelation was of paramount significance that the total number of malignant cases within this cohort was 440. Polyps emerged as the most frequently observed condition, constituting 55.2% (n = 243) of the cases. Diverticulosis was present in 6.6% (n: 29) of cases, while ulcerative colitis was detected in 8% (n: 2) of cases. Hemorrhoids were identified in 20.7% (n: 91) of cases. The findings indicated a substantial association between these common conditions and malignancy. Specifically, it was discovered that approximately 1 in 22 individuals with hemorrhoids, 1 in 52 individuals with fissures, and 1 in 5.7 individuals with polyps were diagnosed with malignancy. Conclusion This study highlights the pivotal role of colonoscopy in uncovering hidden cancers, especially in patients with hemorrhoids. The findings emphasize the significance of doctors and patients prioritizing colonoscopy, as it allows for early detection and intervention for potential malignancies, even in the presence of hemorrhoids.

USING CLUSTER ANALYSIS TO CLASSIFY SOME ARAB COUNTRIES INTO HOMOGENEOUS GROUPS ACCORDING TO INSTITUTIONAL QUALITY CRITERIA

Objective: The objective of this study is to explore the application of cluster analysis in categorizing select Arab countries into cohesive groups based on institutional quality criteria, which consist of six indicators measuring good governance in country. These indicators cover various dimensions and allow describing the quality of services provided by the state in a specific area comprehensively. These dimensions include the scope of state intervention, these dimensions are The Political Dimension, The Economic Dimension and The Legal Dimension. Method: This study adopts a research methodology that combines both descriptive and quantitative approaches. The descriptive approach is based on presenting concepts and describing relationships among institutional quality criteria. The quantitative approach involves using cluster analysis methods: K-Means clustering and Hierarchical Clustering to classify 11 Arab countries: UAE, Bahrain, Algeria, Egypt, Jordan, Morocco, Qatar, Saudi Arabia, Sudan, Tunisia, and Yemen. This was done to conduct cluster analysis to test the homogeneity of these countries regarding institutional quality determinants, represented by the following variables: Participation and Accountability, Political Stability and Absence of Violence, Government Effectiveness, Legislative Quality, Rule of Law, Control of Corruption. Results and Discussion: The study reached the following results: - the K-Means Cluster Analysis Method is evident that The total number of cases classified in each cluster: Eleven countries were classified into seven countries: United Arab Emirates, Bahrain, Jordan, Morocco, Qatar, Saudi Arabia, and Tunisia in the first cluster and four countries in the second cluster: Algeria, Egypt, Sudan, and Yemen; -the variable Participation and Accountability does not significantly affect the classification of the Arab countries under study into homogeneous groups according to institutional quality indicators. However, variables such as Political Stability and Absence of Violence, Government Effectiveness, Regulatory Quality, Legislative Quality, Rule of Law, and Control of Corruption play a significant role in this classification; - the Hierarchical Clustering Analysis Method is evident that the Arab countries under study are distributed into two homogeneous groups. The first group forms Cluster 1, consisting of Jordan, Morocco, Tunisia, Bahrain, Saudi Arabia, Algeria, Egypt, the UAE, and Qatar. The second group belongs to Cluster 2, comprising Sudan and Yemen. This classification is based on institutional quality criteria. Originality/Value: This study sheds light on the importance of cluster analysis methods: the K-Means Cluster Analysis Method and the hierarchical cluster analysis method in classifying Arab countries according to the determinants of institutional quality, which are considered a determining factor for the economic growth of countries, and its consequent impact on various indicators reflecting economic, social, and political conditions. Consequently, institutional quality has emerged as a pivotal measure in highlighting developmental disparities among different countries. Many governments are endeavoring to create or adopt models to enhance the quality of their institutions, notwithstanding the similarities among Arab countries.