Unfavorable Consequences Research Articles

Thresholds of visceral fat area and percent of body fat to define sarcopenic obesity and its clinical consequences in Chinese cancer patients

The current criteria for defining sarcopenic obesity (SOB) combines the threshold criteria for sarcopenia and obesity, but no consensus has been reached on the criteria. Given the variations among ethnic groups and in the prevalence of sarcopenia, the study aim was to establish sex-specific cutoff points for Chinese cancer patients and investigate the effect of SOB on clinical consequences. A prospective study of 2480 cancer patients was conducted. Clinical materials, bioelectrical impedance analysis measurements, and follow-up data were analyzed. The survival receiver operating characteristic curve was used to determine threshold values. The odds ratios for nutrition risk, severe malnutrition, and quality of life were calculated. The global and sex-specific survival statistics were extracted from the Kaplan-Meier curve and Cox proportional hazard regression models. The cutoff points of visceral fat area to best classify patients regarding time to death were >75.6cm2 for males and >61.2cm2 for females. And the cutoff points of percent of body fat were 15% in males and 25% in females. Among all participants, the prevalence of SOB was 3.03% in males and 4.46% in females. SOB significantly increased the nutrition risk and severe malnutrition probability and worsened quality of life. Finally, SOB was significantly associated with overall cancer mortality [hazard ratio 2.772, 95% confidence interval 2.080-3.694, P<0.001]. On the basis of sex-specific cutoff values, SOB was strongly associated with unfavorable clinical consequences and mortality in cancer patients. These results indicate the importance of SOB detection in routine clinical practice for improving patient assessments, cancer prognosis, and intervention.

Atrial fibrillation and stroke: importance of left atrium as assessed by echocardiography.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, which has been increasing dramatically. AF has unfavorable consequences, such as stroke, heart failure, and cardiovascular death. Of these, stroke has been considered to be the serious complication. Recently, direct oral anticoagulation or new technologies, such as the WATCHMAN left atrium (LA) appendage closure device, have emerged to prevent stroke. Therefore, the accurate estimation of thromboembolic risk and appropriate prevention are essential for high-risk patients with AF. Although CHADS2 and CHA2DS2-VASc scores has been widely used to predict the risk of stroke in patients with AF, some researchers showed that there was no relationship between CHADS2 and CHA2DS2-VASc scores and LA appendage thrombus formation. Recent studies have reported that combination of echocardiographic parameters to CHADS2 or CHA2DS2-VASc scores can stratify high risk groups for LA appendage thrombus formation and onset of stroke. In this review, we focus on the epidemiological, pathophysiological, and prognostic associations between AF and stroke, and review the clinical and echocardiographic predictors for stroke in patients with AF.

In Vitro Analysis of the Fatigue Resistance of Four Single File Canal Preparation Instruments.

Instrument separation during root canal therapy is inevitable in endodontics with several unfavorable clinical consequences. Therefore, examining the cyclic flexural fatigue resistance of commonly used rotary endodontic files is crucial. This study aimed to determine the cyclic flexural fatigue resistance of four nickel–titanium (NiTi) rotary files used as a single canal preparation technique: WaveOne, Reciproc, Protaper F2, and Unicone medium instruments. According to the manufacturer’s instructions, each file was rotated freely within a 1.3 mm deep and 1.3 mm wide V-shaped groove in a stainless-steel block with a 40° and 5 mm radius of curvature. Cyclic fatigue resistance was compared between the NiTi files by verifying the time needed to crack. The data were analyzed using one-way analysis of variance (ANOVA) followed by Scheffé post hoc with a significant level set at p < 0.05. Our results demonstrated that the WaveOne instrument had the highest cyclic flexural fatigue resistance among the tested groups (p ≤ 0.05), while Unicone had the lowest cyclic flexural fatigue resistance. This study concluded that WaveOne size 25/0.08 could illustrate a superior cyclic flexural fatigue resistance when instrumenting root canals with the lowest possibility to cause instrument separation.

A Comparison of the Performance of Out-of-hospital Cardiac Arrest Score and Standard Severity Scores in Predicting Hospital Mortality and Neurological Consequence in Out-of-hospital Cardiac Arrest Patients

Objective: There is limited data to determine the performance of general and specific severity score in out-of-hospital cardiac arrest (OHCA) patients. Hence, we compared the performance of the OHCA score with Acute Physiology and Chronic Health Evaluation (APACHE) and Simplified Acute Physiology Score (SAPS) to predict outcome in OHCA patients.Material and Methods: A retrospective study was conducted in a mixed intensive care unit of a tertiary hospital. The primary outcome was in-hospital mortality. The secondary outcome was poor neurological outcome.Results: A total of 190 OHCA patients were enrolled. The OHCA score had moderate discrimination with an area under the receiver operating characteristic curve (AUC) 0.77 (95% CI 0.7-0.837) whereas discrimination of APACHE II-IV, SAPS II, and SAPS 3 were good with an AUC more than 0.8. The actual hospital mortality rate was 64.7%. The OHCA score predicted hospital mortality of 95.3±8.4, which significantly overestimated the mortality with standardized mortality ratio 0.68 (95% CI 0.56-0.81). However, all severity scores revealed poor calibration. Additionally, overall performance of APACHE II-IV, SAPS II and SAPS 3 were better than the OHCA score. For secondary outcome, discrimination of the OHCA score was moderate with an AUC 0.790 (95% CI 0.700-0.878) whereas other severity scores demonstrated good discrimination with AUC more than 0.8.Conclusion: APACHE II-IV, SAPS II, and SAPS 3 indicated superior overall performance and demonstrated good discrimination for predicting hospital mortality and unfavorable neurological consequence better than the OHCA score. However, all severity scores attested poor calibration, therefore, specific scores for OHCA patients should be modified.

Nutritional Complications After Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: A Comparative Systematic Review and Meta-Analysis.

A systematic review and meta-analysis were carried out involving studies that compared the nutritional complications of Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB); these included the incidence of malnutrition as well as deficiencies of other nutritional elements, such as total protein, albumin, calcium and iron. A comprehensive search strategy was implemented in PubMed, Embase, and the Cochrane Library. Effect sizes included the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs), as well as mean differences (MDs) and 95% CIs of the percentage total weight loss (%TWL) and excess weight loss percentage (%EWL).Thirteen studies were included (12,964 patients, 66.27% females, 53.82% underwent OAGB). At the longest follow-up period (≥3 years), OAGB was associated with significantly higher %TWL (MD=5.41%, 95%CI, 1.52 to 9.29) and %EWL (MD=13.81%, 95%CI, 9.60 to 18.02) compared to RYGB. However, OAGB procedures were associated with malnutrition (OR=3.00, 95%CI, 1.68 to 5.36, p<0.0001), hypoalbuminemia (OR=2.38, 95%CI, 1.65 to 3.43, p<0.0001), hypoproteinemia (OR=1.85, 95%CI, 1.09 to 3.14, p=0.022), anemia (OR=1.38, 95%CI, 1.08 to 1.77, p=0.011), and hypocalcemia (OR=1.78, 95%CI, 1.01 to 3.12, p=0.046). On subgroup analyses, the proportions of anemia and hypoalbuminemia remained significantly higher at longer follow-up periods and in studies published in Asia.Despite the favorable weight loss profile, the unfavorable nutritional consequences of OAGB merits further investigations to explore the malabsorptive element, ethnic variation, and the role of biliopancreatic limb length.

Update about "minimally verbal" children with autism spectrum disorder.

ABSTRACTObjective:To review clinical and neurobiological features of minimally verbal children with autism spectrum disorder.Data source:We carried out a narrative review using the PubMed database. We considered the following search terms combined through the Boolean operator “AND”: “autism spectrum disorder”; “minimally verbal.”Data synthesis:To date, there is no shared definition of minimally verbal children with autism spectrum disorder. The heterogeneity in intellectual functioning and in linguistic abilities among these individuals suggests there is no single mechanism underlying their difficulties in learning to speak. However, the reasons why these children do not speak and the biological markers that can identify them are still unknown. Language impairment in these children can lead to several unfavorable consequences, including behavior problems (such as self-aggression, hetero-aggression, and property destruction), poorer daily living and social skills. Psychiatric comorbidities (including attention deficit/hyperactivity disorder, specific phobias, and compulsions) consist in a serious problem related to the lack of verbal language in individuals with autism spectrum disorder. Although in the literature there are very few evidence-based results, several findings suggest that an alternative and augmentative communication intervention, creating an extra-verbal communication channel, may be effective in these individuals.Conclusions:The exact definition, clinical characteristics, associated disorders, etiology, and treatment of minimally verbal subjects with autism spectrum disorder must still be further studied and understood.

Data validation techniques used in admission discharge and transfer systems: Necessity of use and effect on data quality

BackgroundOne of the most important functions of the admission unit is the speed of staff in receiving the information correctly and recording them on the computer, and providing suitable conditions for continuing the patient's treatment. The occurrence of errors in data recording affects the quality of care and may have unfavorable consequences. The application of data validation techniques can help users to record information correctly. ObjectivesHence, the present study aims to identify the techniques and determine the level of compliance with them, their necessity in Admission Discharge Transfer (ADT) systems, and their effect on data quality. MethodsThis observational study investigating data quality in the ADT systems was carried out in two stages. In the first stage, a checklist of data control techniques was developed by reviewing the literature. The admission unit of hospital information systems in different units of the teaching hospitals of Kerman (in terms of application of data validation techniques) was evaluated. In the next stage, a researcher-made questionnaire was designed, and users' views on the necessity of using these techniques in HIS and their effect on data quality were evaluated. Data analysis was done using frequency, standard deviation, and mean and Friedman ranking test. ResultsIn this study, six data techniques were investigated in the studied systems. Users gave the highest mean for the necessity of applying data control techniques for the first name, surname, and national code data items and the lowest mean for the data items related to vital signs. In the ranking of data validation techniques in terms of the importance of their application, the highest rank was obtained in the components of pattern control (17.29), and the lowest rank was obtained in delta control (2.91). In the general ranking of the effect of techniques on data quality, pattern control (5.95) and interval control (4.95), respectively, obtained the highest mean (out of 6). ConclusionsThe results revealed that the existing HISs had fewer benefits of using data control. However, users not only consider it necessary to use these controls in the systems but also believe that their application will improve their performance in recording information. Thus, for accurate documentation, HIS designers must implement these techniques in these systems, and their application should become a mandatory standard for system development.

СОЦІАЛЬНО-ЕКОНОМІЧНА ОЦІНКА ДІЯЛЬНОСТІ ЗАХИСТУ НАСЕЛЕННЯ В НАПРЯМКУ РЕГУЛЮВАННЯ ЗАЙНЯТОСТІ НАСЕЛЕННЯ

The article reveals a theoretical overview of the system of interrelationships between population employment and population protection activities in accordance with the current stage of the country's economic development. It has been investigated that among modern youth there is a noticeable inequality in the availability of general education, spiritual and cultural development, professional training, and the choice of a place of work. It has been analyzed that under the current realities in different regions of Ukraine, negative changes are occurring in the structure of employment of the population and this has a devastating effect on the development of the national economy and consists in an imbalance between the demand and supply of labor force. The study of structural changes in the employment of the population under the modern realities of the socio-economic development of Ukraine is substantiated, which shows that employment is the basis of reproduction of the potential labor force, and the active measures of the state regulation mechanism are the introduction and increase of employment, in turn, contributes to the reduction of the level of unfavorable social-economic consequences, such as unemployment and poverty. It is noted that each region has its own characteristics and the need for a comprehensive approach to these issues, in particular the process of European integration, innovative activity. It is noted that the transition from the planned and intensive movement of labor resources to free movement will change the system of interests, motivations and incentives of the economically active population, and therefore, the sources, segmentation and will affect the directions of state regulation of employment of the population. The components of the system of labor relations and the group of prerequisites determining the socio-economic environment of the normal functioning of the regional labor market are considered. The employment of the population is defined as the socio-economic development of the region, which is one of its most important factors in the formation of the innovative employment structure of the labor market, especially the activity of population protection. The impact on the employment of foreign scientists and the need for labor force is considered. The model of youth policy implementation in the context of decentralization in the priorities of the State Strategy for the Development of Regions until 2027 is presented. A comprehensive analysis and forecast of certain regularities for the future is provided with the help of the latest theoretical and methodological approaches, which can be used by competent state bodies to develop effective management solutions in the field of development of social and labor relations in the national/regional labor market.

Страхование как инструмент снижения финансовых рисков, связанных с поствакцинальными осложнениями

Population’s participation in vaccination for immunization against infectious diseases entails not only the risks of harm to health, but also financial risks. Unfavorable financial consequences of immunization can arise due to refusals from vaccinations and the development of postvaccinal complications. The problem of the discrepancy between the volume of state social support provided to citizens and the material consequences of vaccination actualizes the role of insurance in reducing the corresponding financial risks. The authors found that insurance companies on the Russian market offer financial coverage that is larger than that provided for by the state guarantees of social security for the vaccinated. However, the offers on the market have a number of serious limitations that impede the ability of interested parties to have the content of insurance coverage that would meet their expectations. At present, in insurance practice, formulations such as “serious complications”, “postvaccinal reactions and complications”, “complications, side effects, and other health disorders as a result of vaccination”, “complications arising after vaccination”, “conditions that have emerged since the moment of vaccination” are used in the formation of relevant programs, which significantly complicates the understanding of insurance conditions by the insurance services’ recipient and makes it difficult to compare the content of different programs in order to form optimal consumer preferences. Each insurance company fills the programs’ content with its own meaning so that quite often the amount of insurance coverage does not correlate with the list of side effects that occur after immunization accepted in medicine. Violation of industry standards in terms of the volume of disclosed information is allowed, which casts doubt on the quality of the insurance services provided. The authors propose to unify the approach to determining the basic categories for this type of insurance in order to remove the existing multivariance allowed by insurers in the development and further commercialization of insurance programs. Contribution of the authors: the authors contributed equally to this article. The authors declare no conflicts of interests.

Strategic Emphasis on Service-Based Business Models During the Corona Crisis: Are Customer Solutions a Curse or Blessing for Manufacturing Firms?

Firms increasingly rely on service-based business models, such as customer solutions, to strengthen their market position and secure robust revenues in competitive environments. While extant research has shed light on the financial implications of service-based business models in general, no empirical research has yet explored whether a strategic emphasis on customer solutions pays-off or backfires in a global crisis such as the corona pandemic. As theoretical arguments lend support for both, favorable and unfavorable consequences of a strategic emphasis on customer solutions during a pandemic crisis, this study creates a unique dataset of 565 U.S. manufacturing firms and analyzes the revenue implications of customer solutions during the crisis peak. Results demonstrate the resilient character of customer solutions. Manufacturing firms with a strategic emphasis on customer solutions experience on average $30 million less revenue decline during the pandemic. A finer-grained view distinguishes different types of customer solutions and uncovers mixed performance effects. While customer solutions generally help manufacturers to weather the crisis, resource-intensive turnkey solutions have a negative effect on firm revenues. These insights help managers to understand the financial implications of customer solutions and navigate successfully through a health-based crisis.

ВИЗНАЧЕННЯ СТРЕСОВИХ ЧИННИКІВ У РОБОТІ ПРАЦІВНИКІВ ЗА ДОПОМОГОЮ НОРМУВАННЯ ПРАЦІ

The questions related to warning of stress factors’ strengthening in the workplace by means of rationing of labor s are investigated in the article. Realization of the sociological questioning by the Ukrainian platform of Gradus Research and Advisory Board, set that over 70% polled are in permanent stress. The ponderable factor of stress are professional difficulties in the workplace. It is considered to distribute professional stress on six categories by factors: personal, physical, social, description tasks, structural, role-play. In accordance with the questioning of “Deloitte” company the most stressful factors for respondents are the amount of work (overload, overstrain) and vagueness with the pandemic of Covid-19 ‒ production reorganization, passing to remote work or change of work terms. The least stress for the workers of the enterprise is the relationship with colleagues, organization management, using of out-of-date technique and technologies of decision making indicators. The research of different generations’ answers (Y, Z) in relation to mental health in working environment in the edge of the whole world and Ukraine is analyzed. By means of application of the methods of rationing of labor of business hours’ photo and time-study it is possible to discover or warn the stress factors’ strengthening in workers at the workplace. The photo of business hours allows watching the implementation of productive operation and setting the factors that influence on the worker, worsening of his behavior and labour discipline, his emotional attitude of different types of production tasks, to watch lances of overload and tiredness during the working day. The factors of direct and indirect influence on forming and use of stress management systems was offered by M.F. Honchar are analyzed. It is considered that the stress management system of the enterprise needed to be equated to management of pessimistic variant that will take into account possible problems and threats, and how to follow them for the removal of unfavorable consequences. Events in relation to the development of stress management system and introduction of wellbeing-programs in activity of the enterprise are offered.

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Background and objectivesPregnancy the most challenging period of women’s lives were greatly hit by the Coronavirus pandemic and lockdown implemented to curtail the spread of infection in the community has also affected antenatal care. The present study was aimed to find out the effectiveness of mental health education programmes in pandemic related pregnancy stress among women pregnant during COVID-19.Material and methodsA combination of descriptive and experimental research design was used. The stress related to COVID 19 was measured using the Pandemic-Related Pregnancy Stress Scale (PREPS) in 123 pregnant females. The compact mental health education intervention programme specially designed for COVID-19 was administered in the experimental group of 61 pregnant females. The stress levels were compared with 61 pregnant females of the control group who were not exposed to the mental health education programme. The results were compared and evaluated for the effectiveness of mental health education programmes in combating the stress during this pandemic. The programme was reintroduced during the second COVID-19 wave and results were accordingly analysed.ResultsFrom the study, we found there exists a significant difference in the COVID 19 pandemic related pregnancy stress between control and experimental groups. The mean scores of PREPS preparedness of the experimental group before and after the intervention was 3.36±0.89 and 1.25±0.81 respectively. A t-value of 12.38 was found which is statistically significant at a CI of 95% (1.77 to 2.44). Similarly, the mean score of PREPS infection of experimental group before and after the intervention was 3.36±0.91 and 1.28±0.71 and for PREPS positive appraisal of the experimental group before and after the intervention was 1.27±0.90 and 3.34±11.58 respectively The t-value of 11.58 was found which is statistically significant at CI of 95% (-2,42 to -1.71). However, in control the mean scores for PREPS subscales before and after were almost the same (3.34±0.71 and 3.34±0.71, 4.04±0.91 and 3.94±0.80, 2.27±0.90 and 2.01±0.80). The t-values were statistically insignificant. Therefore from the results, we conclude that in both the experimental and control group the PREPS subscale scores were higher before intervention and reduced to significant levels after intervention in the experimental group however, there was no significant change in stress levels in the control group who were not exposed to the intervention programme. There was also a significant improvement in positive appraisal in pregnant females who received mental health education. Similar results were found during the second COVID-19 wave.ConclusionPandemic related pregnancy stress had increased and can be of unfavourable consequences regarding mother and infants health. Therefore, early intervention to improve self-care and motivate women to approach the self in a way that entails inculcating and exercising things that inevitably enhance physical and mental health. At the same time refraining from the contrary thereby dispensing with professional medical help will eventually improve the overall mental health of pregnant females.

FROM MIGRATION TO INTEGRATION: THE JOURNEY OF MIGRANT WORKERS IN KERALA

Culture continues to be a constantly evolving and dynamic. With the continuous interactions between people at all levels and between different cultures, the notions of culture of a particular target group keeps changing. The development of a cultural notion is dynamic and will continue to be so, and it can only be comprehended over a longer period of time.Migration is a social fact that cannot be attributed specifically to one point in time. For a variety of reasons, people have crossed boundaries. Some individuals relocate in quest of better career prospects. Others relocate to avoid violent conflict, hardship, hunger, fear, persecution, or abuses of human rights. Others do it in reaction to the unfavourable consequences of environmental issues like natural catastrophes, climate change, or other environmental problems. Many people relocate for a mix of these causes. However, there is an unavoidable relationship between a number of social, economic, political, cultural, and ecological elements that forms the foundation of migration with each journey that is performed by a person or a group of people. It is hard to generalise a consistent theory or a cause due to the very dynamic character it exhibits. Migration, which is sometimes thought of in terms of uniformity, is a phenomenon that differs from person to person. The effects of migration impact the economy, society, and state, however minimal they may be.Migration to a place with a different culture generally involves a difficult journey. Blending into the host society is often a practical choice for migrants. An individual or group habituates to the customs and values of another culture while keeping its own unique culture via the process of acculturation.In the background of the Indian society, the variety of languages, dialects, beliefs, traditions, and festivals continues to play a crucial role in the acculturation of immigrants. Migrants have a choice: they may either adapt to the dominant group's culture, reject it in order to preserve their own, or merge into a hybrid group (Berry, 1980). According to Üstüner (2017), three key factors shape the consumer lives of poor migrants, including (1) migration strips migrants of their naturalised cultural moorings from their previous local identities and forces them to deal with a mass-produced alien culture; (2) their minority ideology clashes with the dominant culture and is actively marginalized by it; and (3) they are forced to cope with the dominant consumer ideology.India, which is rich in several diverse forms of culture, continues to serve as a social hub for people from different socioeconomic and cultural backgrounds. The paper attempts in reviewing the migration to Kerala, in the background of the factors that pull the workers from other parts of the country and their responses and ability to negotiate – both at workplace and in the society, which are crucial for their social inclusion.

Hyperaldosteronism: types, clinical characteristics, and treatment

Cases with hyperaldosteronism might be asymptomatic in many events. Therefore, the diagnosis can be missed. However, the usual presentation for many patients has been reported to be a refractory elevation in the blood pressure which might be mild to severe. Based on the type of hyperaldosteronism and the diagnosis, the treatment of these conditions should be established. Therefore, it can be concluded that the treatment is specific to the management of the underlying etiology, and managing the clinical characteristics and associated complications. This present literature review aims to provide evidence regarding the types, clinical characteristics, and treatment of aldosterone based on data from the current investigations in the literature. Different clinical phenotypes have been reported for the condition. Nevertheless, the disease can be broadly classified into primary and secondary hyperaldosteronism based on the pathophysiology and etiology of the condition. Clinical characteristics might not be diagnostic since they are very non-specific, despite being common in these patients, as hypokalemia and hypertension. Therefore, clinicians should be aware of conducting the necessary diagnostic approaches before establishing the diagnosis. Management of these patients requires the integration of different approaches, including surgical and medical treatment. Perioperative care is important because it may lead to unfavorable consequences if neglected.

Predictive significance of pro-inflammatory interleukins at newborns with hypoxic-ischemic encephalopathy

Relevance. Hypoxic-ischemic damage to the central nervous system is accompanied by overproduction of pro-inflammatory interleukins in newborns. Perinatal inflammatory responses contribute to unfavorable outcomes.&#x0D; Methods of investigation. The analysis of the cytokine profile in the blood serum was performed in 45 full-term newborns by the method of enzyme-linked immunosorbent assay within 4–96 hours after birth. 32 children had the signs of HIE stage 2, 13 children — HIE stage 3. Unfavorable neurological consequences were formed in 47,4% of children.&#x0D; Research results. Revealed an increase in the levels of IL1β — 17,7 [13,6; 25,4] and IL6 35,2 [24,9; 45,0] in newborns with HIE. A significant increase in pro-inflammatory cytokines was found in patients with unfavorable outcomes compared with favorable ones. When predicting the disabling consequences of DIE, a high predictive value was established for IL1β and IL6.&#x0D; Conclusion. In newborns with hypoxic-ischemic encephalopathy, an increase in serum IL1β and IL6 is observed. It is advisable to use an increase in IL1β &gt;19,4 pg/ml (OR=12,80; 95% CI: 2,90–56,58) and IL6 &gt;40,1 pg/ml (OR=11,33; 95% CI: 2,46–52,15).

1382. A Prospective Epidemiological Study BK Polyomavirus DNAuria and DNAemia within the First Year after Kidney Transplantation

Abstract Background Screening and early detection for the preceding BK polyomavirus (BKV) DNAuria and DNAemia to prevent the occurrence of BK polyomavirus BKV-associated nephropathy (BKPyVAN) among kidney transplant (KT) recipients has not been universally utilized and never assessed in a setting where the resource is limited. Therefore, we aimed to investigate this entity’s incidence, risk factors, and outcome with this intervention at our institution. Methods A prospective study of KT recipients at a tertiary care transplant center in Bangkok, Thailand, was conducted between January 2019 and March 2020. All patients underwent preemptive monitoring of urine and plasma BKV DNA load, measured by quantitative real-time PCR at 1, 2, 3, 6, 9, and 12 months post-KT. Low- and high-level BKV DNAuria was defined as urine BKV DNA load of &amp;lt; and &amp;gt; 7log10 copies/mL, respectively. Low- and high-level BKV DNAemia was defined as plasma BKV DNA load of &amp;lt; and &amp;gt; 4log10 copies/mL, respectively. The incidences were calculated by Kaplan-Meier analysis. The chi-square or student’s T-test compared clinical characteristics between those with and without high-level BKV DNAuria as appropriate. Risk factors of high-level BKV DNAuria were analyzed using Cox proportional hazard model. Results Among 99 evaluable KT recipients, a mean (SD) age was 42 (11) years, 64.6% were male, and 69.6% received an induction immunosuppressive therapy. Within 12 months post-KT, the incidences of low-level BKV DNAuria, high-level BKV DNAuria, low-level BKV DNAemia, and high-level BKV DNAemia were 22.63%, 13.14%, 9.49%, and 5.11%, respectively. High panel reactive antibody (PRA) was associated with high-level BKV DNAuria at 6 and 12 months, (HR 1.02 [95% CI (1.00-1.04)], P=0.019) and (HR 1.02 [95% CI (1.00-1.04)], P=0.023), respectively. Underlying diabetes mellitus was associated with high-level BKV DNAuria (HR 3.49 [95% CI (1.28-9.51)], P=0.015) at six months; however, not at 12 months. There was no allograft rejection directly related to a reduction of immunosuppression for BKV infection observed. Conclusion BKPyV infection is also prevalent among KT recipients in a resource-limited setting, however, without unfavorable consequence. Those with high-level PRA and underlying diabetes could be at risk of high-level BKV DNAuria after KT. Disclosures All Authors: No reported disclosures

Do frailty scores predict outcome after proximal femoral replacement for musculoskeletal tumours: a case series?

Frailty has a negative independent relationship with morbidity and mortality. A frail individual has low resilience and adaptive capacity to stressors with unfavourable consequences. The relationship between musculoskeletal tumour patients undergoing surgery and frailty is underrepresented in literature. This study's questions are; what is the prevalence of frailty in patients undergoing surgery for musculoskeletal tumours; what is the correlation between frailty and survival plus secondary outcome measures including length of hospital stay (LOS); can clinicians use frailty scoring to support preoperative decision-making? Patients over 60years of age undergoing proximal femoral replacement for musculoskeletal tumours were included and classified as fit, vulnerable or frail using the modified frailty index (mFI), Rockwood and American Society of Anaesthesiologist's physical status classification (ASA) grading systems. Correlation with outcomes including survival and (LOS) was determined. 85 patients were identified of mean age 72.6years. Median follow-up was 18.9months. The prevalence of frailty ranged between 55 to 76% and the overall median survival in frail groups were 19.8months with all scoring systems used. Frail patients classified by the Rockwood score had a greater LOS and a trend to reduced survival. There is a high prevalence of frailty in this cohort and frailty scores should be considered when planning surgery as part of holistic care. Moreover, a median survival greater than 18months in frail patients supports the decision to offer surgery which may positively impact quality of life. Further research to identify the relationship between frailty and outcomes in musculoskeletal tumour patients is needed. IV, Retrospective Case Series.

Presence of Affirmable Drug Affiliated Interactions in Medical Patients in Medical OPD of Pakistani Hospital

Drug-drug interactions (DDIs), are preventable medical related hazards having grave life menacing and unfavorable consequences Purpose: To find the clinical adverse effects and interaction frequency witnessed in prescriptions of a medical OPD Study Design: Comparative study Methodology: A sample of 546 patients who were being prescribed at least two drugs simultaneously was assessed using a drug interaction program Statistical analysis: SPSS v.20.0 was used to analyze the data to present results as proportions Results: The 546 patients (72.8% male having mean age of 58.3±14.7 years. Out of these 186 (4.7%), 2595 (65.6%) and 773 (19.5%) were severe, moderate and mild interactions respectively Conclusions: We concluded that large percentage of patients were detected having one or more potential drug-drug interactions Keywords: Adverse Drug Interaction, Drug-Related Problems, Drug-Drug Interaction and Pharmaco-epidemiology.

Socioeconomic disparity is associated with faster retinal neurodegeneration in multiple sclerosis.

Disease course in multiple sclerosis is notably heterogeneous, and few prognostic indicators have been consistently associated with multiple sclerosis severity. In the general population, socioeconomic disparity is associated with multimorbidity and may contribute to worse disease outcomes in multiple sclerosis. Herein, we assessed whether indicators of socioeconomic status are associated with disease progression in patients with multiple sclerosis using highly sensitive imaging tools such as optical coherence tomography, and determined whether differential multiple sclerosis management or comorbidity mediate any observed socioeconomic status-associated effects. We included 789 participants with longitudinal optical coherence tomography and low contrast letter acuity (at 1.25 and 2.5%) in whom neighbourhood- (derived via nine-digit postal codes) and participant-level socioeconomic status indicators were available ≤10 years of multiple sclerosis symptom onset. Sensitivity analyses included participants with socioeconomic status indicators available ≤3years of symptom onset (n = 552). Neighbourhood-level indicators included state and national area deprivation indices, median household income and the Agency for Healthcare Research and Quality (AHRQ) Socioeconomic Status Index. Participant-level indicators included education level. Biannual optical coherence tomography scans were segmented to quantify thickness of the composite macular ganglion cell+inner plexiform (GCIPL) layer. We assessed the association between socioeconomic status indicators and GCIPL atrophy or low contrast letter acuity loss using mixed models adjusting for demographic (including race and ethnicity) and disease-related characteristics. We also assessed socioeconomic status indicators in relation to multiple sclerosis therapy changes and comorbidity risk using survival analysis. More disadvantaged neighbourhood-level and patient-level socioeconomic status indicators were associated with faster retinal atrophy. Differences in rate of GCIPL atrophy for individuals in the top quartile (most disadvantaged) relative to the bottom quartile (least) for state area deprivation indices were -0.12 µm/year faster [95% confidence interval (CI): -0.19, -0.04; P = 0.003], for national area deprivation indices were -0.08 µm/year faster (95% CI: -0.15, -0.005; P = 0.02), for household income were -0.11 µm/year faster (95% CI: -0.19, -0.03; P = 0.008), for AHRQ Socioeconomic Status Index were -0.12 µm/year faster (95% CI: -0.19, -0.04) and for education level were -0.17 µm/year faster (95% CI: -0.26, -0.08; P = 0.0002). Similar associations were observed for socioeconomic status indicators and low contrast letter acuity loss. Lower socioeconomic status was associated with higher risk of incident comorbidity during follow-up. Low socioeconomic status individuals had faster rates of therapy escalation, suggesting the association between socioeconomic status and GCIPL atrophy may not be explained by differential contemporaneous multiple sclerosis therapy management. In conclusion, socioeconomic disparity is associated with faster retinal neurodegeneration in multiple sclerosis. As low socioeconomic status was associated with a higher risk of incident comorbidities that may adversely affect multiple sclerosis outcomes, comorbidity prevention may mitigate some of the unfavourable socioeconomic status-associated consequences.

Вплив кадмію на здоров'я дітей в пренатальний та постнатальний періоди розвитку

The purpose of the study was to analyze on the basis of foreign literature the effects of the toxic action of cadmium on the process of embryonic and postnatal development of the child, which remain insufficiently studied. The consequences of cadmium effect on children remain insufficiently studied, although cadmium is a documented developmental toxicant. The studies show that the placenta is an important target tissue for cadmium toxic effects during pregnancy. The result of the accumulation of cadmium in the placenta is as follows: a decrease in the utero-placental circulation, changes in the integrity of cells of trophoblast and cell migration, a decrease in the synthesis and metabolism of placental hormones, disorder of the placental epigenetic regulation of cell growth, as well as immune and inflammatory signal transmission. The high level of cadmium in the placenta and umbilical cord blood can be a risk factor for deterioration of infants’ state and impact on the development of a child in the future. So far, only some aspects of the toxicokinetics of the placental cadmium and its adverse effect on intrauterine growth and development are known. The level of cadmium in the mother's serum during pregnancy is associated with the risk of premature birth. There are increasing evidence on connection between the effect of cadmium and unfavorable consequences of childbirth, as well as disorders of anthropometric indicators that differ in children of different gender. In the fetus of the female gender body weight at birth tends to decrease, the chest circumference had a tendency to decrease and these indicators corresponded to an increase in the level of cadmium in the mother’s blood. Cadmium acts as an immunotoxic agent from the very early age, even very low levels of cadmium exposure during pregnancy can lead to long-term detrimental consequences for the immune system of offspring and these effects, as well as others depend on the gender. Models to study the effect of cadmium at an early age on the development of diseases in more mature age are developed. The models in mice show that the effect of cadmium on the body leads to an increase in heart mass at birth and programs hypertension development in females in adulthood. Poisoning, which occurs at an early age (in utero and in early childhood), may have a strong influence on the risk of obesity and metabolic syndrome throughout life. The chronic prenatal effect of cadmium is associated with the late development of IQ in children, while prenatal influence of passive smoking has an increased risk of delaying cognitive development of infants aged 6 months. Early mortality from various diseases, including cancer, cardiovascular, respiratory, renal and neurological problems, correlated with intrauterine or early post-natal impact of metal. Conclusion. Cadmium is classified as a potential neurotoxicant, it reaches the brain in the early stages of the development of the fetus and is associated with behavioral and cognitive dysfunction, including bad learning memory in children of early and late childhood. The adverse consequences of the prenatal effect of cadmium for the development of the fetus and subsequent health of children have discovered a number of non-solved problems, the gender should be considered as a risk factor, since cadmium causes specific results that are veiled in mixed on gender investigations