Unknown Risk Factors Research Articles

Waterpipe and cigarette smoking and drug and alcohol consumption, and the risk of primary progressive multiple sclerosis: A population-based case-control study.

Background: Multiple sclerosis (MS) is a chronic central nervous system disease, and primary progressive multiple sclerosis (PPMS) is one the main types of MS, which has unknown environmental risk factors. The present study was conducted with the aim to identify the association of waterpipe and cigarette smoking, substance abuse, and alcohol consumption with the risk of PPMS development. Methods: A population-based, case-control study was conducted in Tehran, Iran, on 146 PPMS cases and 294 controls. PPMS cases were diagnosed and confirmed by neurologists. Standard random digit dialing was used to select sex-matched healthy control participants from the same source population as the cases. Logistic regression analysis was used to estimate unadjusted and adjusted odds ratios (OR). Results: In total, 440 subjects participated in the study. PPMS was associated with ever smoking cigarettes [OR = 2.48; confidence interval (CI) = 1.44-4.27], and passive smoking (OR = 2.20; CI = 1.34-3.62). However, having ever smoked waterpipe was not significantly associated with PPMS risk (OR = 1.19; CI = 0.62-2.26). Those who had all 3 types of smoking had an accumulative OR that was 10.45 times higher than that in individuals without any type of smoking (OR: 10.45; 95% CI = 3.5-31.2). We did not find any significant association between PPMS risk and substance abuse and alcohol consumption. Conclusion: Cigarette smoking and being exposed to passive smoking are important risk factors for developing PPMS; in addition, the use of 3 types of smoking, showed an OR higher than that in those without any smoking. Considering the global increase in tobacco smoking, this finding emphasizes the importance of interventional programs for the prevention of tobacco smoking.

A-20 Chronic Traumatic Encephalopathy Concerns Among Aging Amateur Football and Non-Football players: Preliminary Data from CLEAATS

Abstract Purpose We evaluated self-reported concerns about developing 1) chronic traumatic encephalopathy (CTE) and 2) “permanent memory or thinking problems” due to head-injury exposure among former football and non-football college-level male athletes 50 or older. Methods 188 male participants (Mean age=64.4 years, 90% White) completed a comprehensive online survey for the College Level Aging Athlete Study (CLEAATS). Using chi-squared tests, frequency of self-reported concerns between football players and non-football players for two different survey questions were evaluated: 1) concerns for developing CTE, and 2) concerns for developing “permanent memory or thinking problems” related to a history of concussions and/or head impacts. Level of concern was measured on a 5-point scale ranging from 1=Not at all to 5=extremely. Results Former football players (n=102) endorsed greater concerns about CTE (X2 [1, N=188]=45.86, p<.001) than non-football players (n=86), with 20.5% (21/102) indicating they were “moderately” or “extremely” concerned, compared to 6.9% (6/86) of non-football players Similarly, former football players (n=102) endorsed greater concerns of developing permanent memory/thinking problems, with 32% (31/102) reporting moderate to extreme concerns, compared to 11.6% (10/86) of non-football players (X2 [1, N=188]=30.3, p<.001). Conclusions Preliminary data found that 1/5th of former college football players over age 50 expressed significant concerns of developing CTE. One-third had significant concerns about their long-term cognition. This is despite the unknown prevalence and risk factors for cognitive problems, dementia, or CTE among contact-sports participants. We suggest continued caution when reporting on long-term outcomes in former athletes, given the elevated concerns in the context of currently mixed literature.

Tumor Organoid Model and Its Pharmacological Applications in Tumorigenesis Prevention.

Cancer is a leading cause of death and a severe threat to global public health. Organoid, as a novel 3D in vitro model, has been applied in various tumor related studies due to its apparent advantages. The organoid is mainly constructed by Matrigel-depended 3D culture system, Air-Liquid Interface (ALI) culture, and Microfluidic culture or Organ-on-chips platform. For the application in carcinogenesis studies, the organoid model may favor depicting initiative hallmarks and identifying potential intervening targets, investigating driver genes of carcinogenesis, and identifying known or unknown risk or protective factors. In this review, we discussed different organoid construction methods and their properties. We also noted that tumor organoids can portray initiative hallmarks and identify possible intervening targets, as well as explore carcinogenesis driver genes and uncover known or unknown risks or protective factors. Organoid systems have been used to identify tumor-preventive drugs such as oligomeric proanthocyanidins, Vitamin D, n-3 PUFAs, and pomegranate. The current evidence underscores the organoid model's potential importance in developing innovative tumorprevention techniques.

An Intelligent System for Predicting the Breast Cancer Threat Using Health Data Registry and Awareness: A Review

Breast cancer is the most frequently diagnosed life-threatening cancer in women worldwide, with about 2.1 million new cases every year according to World Health Organization. Breast cancer represents about 34.1% of all reported cancer cases in Omani females, with an average age of 34.7 and high mortality rates of 11 per 100,000 populations (GLOBOCAN 2018). The main cause of breast cancer is changing lifestyle and the risk factors such as age, family history, early mensural age, late menopause, obesity and contraceptive pills. Observations of recent literature informed that the prevalence of breast cancer is due to combination of risk factors. Occasionally unknown risk factors will also be the cause for the occurrence of breast cancer. Also, the impact of contribution of each of the risk factors in the cancer occurrence varies among the females. The aim of this research is to review the supervised machine learning techniques specifically Logistic Regression, Neural Networks, Decision Trees and Nearest Neighbors in order to predict the possibility of occurrence of breast cancer among the female population.

Oral hygiene as a cardiovascular risk factor - review of the literature


 Introduction and Objective. Cardiovascular diseases are the main cause of death in Poland and around the world. An important aspect of managing patients with cardiovascular diseases is their proper diagnosis and treatment. An important element is also the prevention of cardiovascular diseases. Prevention of the occurrence of cardiovascular diseases mentioned above consists of the elimination of so-called cardiovascular risk factors. A relatively unknown risk factor for cardiovascular disease is the lack of oral hygiene. The authors of the work analyze what elements are related to the lack of oral hygiene affect the cardiovascular risk and try to present the mechanisms of the oral cavity condition that may affect the cardiovascular system.
 
 
 Review Methods. A review of the recent literature was conducted using PubMed, Google Scholar databases.
 
 
 Brief description of the state of knowledge. The oral cavity is a site colonised by many species of microorganisms.Bacteria from periodontal pockets can travel to other systems as well as enter the bloodstream, and that way to distant organs. A normal endocardial endothelium provides a barrier for bacteria and prevents colonisation and the development of inflammation. However, in cases where it is damaged, it can provide a gateway for microorganisms to infect the valve, which may lead to the development of infective endocarditis. 
 
 
 Summary. In case of periodontitis in patient with ischemic heart disease, myocardial infarction or stroke, active dental or periodontal treatment should be undertaken. Bacteria from periodontal pockets can travel to other systems causing pathological changes in them.
 
 
 Key words
 
 
 Oral hygiene, periodontitis, infective endocarditis

Coronary Stent Infections — A Systematic Review and Meta-Analysis

BackgroundCoronary stent infection (CSI) represents a rare but potentially fatal complication of percutaneous coronary interventions (PCI). A systematic review and meta-analysis of published reports was performed to profile CSI and its management strategies. MethodsOnline database searches were performed using MeSH and keywords. The primary outcome of the study was in-hospital mortality. A unique Artificial Intelligence-based predictive model was developed for need for delayed surgery and probability of survival on medical therapy alone. ResultsA total of 79 subjects were included in the study. Twenty eight (35.0 %) patients had type 2 diabetes mellitus. Subjects most commonly reported symptoms within the first week of the procedure (43 %). Fever was the most common initial symptom (72 %). Thirty eight percent of patients presented with acute coronary syndrome. The presence of mycotic aneurysms was described in 62 % of patients. Staphylococcus species were the most common (65 %) isolated organism. The primary outcome of in-hospital mortality was seen in a total of 24 patients out of 79 (30.3 %). A comparative univariate analysis comparing those encountering in-hospital mortality versus otherwise revealed the presence of structural heart disease (83 % mortality vs 17 % survival, p = 0.009), and the presence of non ST elevation acute coronary syndrome (11 % mortality vs 88 % survival, p = 0.03), to be a statistically significant factor predicting in-hospital mortality. In an analysis between patients with successful versus failed initial medical therapy, patients from private teaching hospitals (80.0 % vs 20.0 %; p = 0.01, n = 10) had a higher survival with medical therapy alone. ConclusionCSI is a highly under-studied disease entity with largely unknown risk factors and clinical outcomes. Larger studies are needed to further define the characteristics of CSI. (PROSPERO ID CRD42021216031).

E. coli Secretome Metabolically Modulates MDA-MB-231 Breast Cancer Cells’ Energy Metabolism

Breast cancer (BC) is commonly diagnosed in women. BC cells are associated with altered metabolism, which is essential to support their energetic requirements, cellular proliferation, and continuous survival. The altered metabolism of BC cells is a result of the genetic abnormalities of BC cells. Risk factors can also enhance it, including age, lifestyle, hormone disturbances, etc. Other unknown BC-promoting risk factors are under scientific investigation. One of these investigated factors is the microbiome. However, whether the breast microbiome found in the BC tissue microenvironment can impact BC cells has not been studied. We hypothesized that E. coli, part of a normal breast microbiome with more presence in BC tissue, secretes metabolic molecules that could alter BC cells' metabolism to maintain their survival. Thus, we directly examined the impact of the E. coli secretome on the metabolism of BC cells in vitro. MDA-MB-231 cells, an in vitro model of aggressive triple-negative BC cells, were treated with the E. coli secretome at different time points, followed by untargeted metabolomics analyses via liquid chromatography-mass spectrometry to identify metabolic alterations in the treated BC cell lines. MDA-MB-231 cells that were not treated were used as controls. Moreover, metabolomic analyses were performed on the E. coli secretome to profile the most significant bacterial metabolites affecting the metabolism of the treated BC cell lines. The metabolomics results revealed about 15 metabolites that potentially have indirect roles in cancer metabolism that were secreted from E. coli in the culture media of MDA-MB-231 cells. The cells treated with the E. coli secretome showed 105 dysregulated cellular metabolites compared to controls. The dysregulated cellular metabolites were involved in the metabolism of fructose and mannose, sphingolipids, amino acids, fatty acids, amino sugar, nucleotide sugar, and pyrimidine, which are vital pathways required for the pathogenesis of BC. Our findings are the first to show that the E. coli secretome modulates the BC cells' energy metabolism, highlighting insights into the possibility of altered metabolic events in BC tissue in the actual BC tissue microenvironment that are potentially induced by the local bacteria. Our study provides metabolic data that could be as a basis for future studies searching for the underlying mechanisms mediated by bacteria and their secretome to alter the metabolism of BC cells.

The future of sickle cell disease therapeutics rests in genomics.

Sickle cell disease (SCD) is the most-common monogenic recessive disease in humans, annually affecting almost 300,000 newborns worldwide, 75% of whom live in Africa. Genomics research can accelerate the development of curative therapies for SCD in three ways. First, research should explore the missing heritability of foetal haemoglobin (HbF) - the strongest known modifier of SCD clinical expression - among highly genetically heterogenous and understudied African populations, to provide novel therapeutics targets for HbF induction. Second, SCD research should invest in RNA therapies, either by using microRNA to target the production of HbF proteins by binding to the transcription machinery in a cell, or by directly mediating production of HbF or adult haemoglobin through injection of messenger RNA. Third, investigators should aim to identify currently unknown genetic risk factors for SCD cardiovascular complications, which will address mortality, particularly in adults. Now is the time for global research programs to uncover genomic keys to unlock SCD therapeutics.

Kidney dysfunction: prevalence and associated risk factors in a community-based study from the North West Province of South Africa

BackgroundGlobally, the World Health Organization ranks chronic kidney disease (CKD) as one of the top 10 causes of mortality. In South Africa, where noncommunicable diseases have become leading causes of mortality, the true population prevalence of CKD is unknown and associated risk factors remain understudied. This study aimed to describe the prevalence of kidney dysfunction and associated risk factors in a community from the North West province of South Africa.MethodsThis cross-sectional study included 1999 participants older than 30 years. Kidney dysfunction was defined as (i) estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73m2, or (ii) urine albuminuria-to-creatinine ratio (uACR) ≥ 3.0 mg/mmol, or a combination (i and ii). Risk factors included age, sex, urban/rural locality, body mass index (BMI), blood pressure (BP), lipid profile, haemoglobin A1c (HbA1C), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), tobacco use, and HIV status.ResultsMean age of participants was 48 (42;56) years, and 655/1999 (33%) had eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol. Compared to those with normal kidney function, participants with eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol were older, female, had higher measures of adiposity, systolic, diastolic, and mean arterial blood pressure, serum lipids and C-reactive protein (CRP) (all p ≤ 0.024). In multiple regression analyses eGFR was associated with systolic BP (β = 0.11) and HIV infection (β = -0.09), and albuminuria was associated with elevated CRP (β = 0.12) and HIV infection (β = 0.11) (all p < 0.026). In both groups (individuals with and without kidney dysfunction respectively), eGFR was associated with age (β = -0.29, β = -0.49), male sex (β = 0.35, β = 0.28), BMI (β = -0.12, β = -0.09), low-density/high-density lipoprotein cholesterol ratio (β = -0.17, β = -0.09) and CRP (β = 0.10, β = 0.09) (all p < 0.005); and uACR was associated with female sex (β = 0.10, β = -0.14), urban locality (β = -0.11, β = -0.08), BMI (β = -0.11, β-0.11), and systolic BP (β = 0.27, β = 0.14) (all p < 0.017).ConclusionIn this study from the North West province, South Africa, eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol was prevalent and associated with modifiable risk factors. The findings may inform screening strategies for kidney disease prevention, focusing on women, obesity, blood pressure control, dyslipidaemia, identifying and treating inflammation, and HIV diagnosis and treatment.

Ancestral origins are associated with SARS-CoV-2 susceptibility and protection in a Florida patient population.

COVID-19 is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The severity of COVID-19 is highly variable and related to known (e.g., age, obesity, immune deficiency) and unknown risk factors. The widespread clinical symptoms encompass a large group of asymptomatic COVID-19 patients, raising a crucial question regarding genetic susceptibility, e.g., whether individual differences in immunity play a role in patient symptomatology and how much human leukocyte antigen (HLA) contributes to this. To reveal genetic determinants of susceptibility to COVID-19 severity in the population and further explore potential immune-related factors, we performed a genome-wide association study on 284 confirmed COVID-19 patients (cases) and 95 healthy individuals (controls). We compared cases and controls of European (EUR) ancestry and African American (AFR) ancestry separately. We identified two loci on chromosomes 5q32 and 11p12, which reach the significance threshold of suggestive association (p<1x10-5 threshold adjusted for multiple trait testing) and are associated with the COVID-19 susceptibility in the European ancestry (index rs17448496: odds ratio[OR] = 0.173; 95% confidence interval[CI], 0.08-0.36 for G allele; p = 5.15× 10-5 and index rs768632395: OR = 0.166; 95% CI, 0.07-0.35 for A allele; p = 4.25×10-6, respectively), which were associated with two genes, PPP2R2B at 5q32, and LRRC4C at 11p12, respectively. To explore the linkage between HLA and COVID-19 severity, we applied fine-mapping analysis to dissect the HLA association with mild and severe cases. Using In-silico binding predictions to map the binding of risk/protective HLA to the viral structural proteins, we found the differential presentation of viral peptides in both ancestries. Lastly, extrapolation of the identified HLA from the cohort to the worldwide population revealed notable correlations. The study uncovers possible differences in susceptibility to COVID-19 in different ancestral origins in the genetic background, which may provide new insights into the pathogenesis and clinical treatment of the disease.

Human MD2 deficiency—an inborn error of immunity with pleiotropic features

Toll-like receptors (TLRs) are important pattern recognition receptors that sense microbes and control host defense. Myeloid differentiation protein 2 (MD2) is the indispensable coreceptor for TLR4, facilitating the binding to the gram-negative bacterial cell wall component LPS and activation of downstream signaling. We sought to provide phenotypic and mechanistic insights into human MD2 deficiency. To elucidate the genetic cause in a patient with very early onset inflammatory bowel disease, we performed whole-exome sequencing and studied the functional consequences of the identified mutation in LY96 (encoding for MD2) in genetically engineered induced pluripotent stem cell-derived macrophages with knockout of MD2 or knockin of the patient-specific mutation, including TLR4-mediated signaling, cytokine production, and bacterial handling. Whole-exome sequencing identified a homozygous in-frame deletion in the LY96 gene (c.347_349delCAA; p.Thr116del) in a patient with very early onset inflammatory bowel disease and a sibling presenting with pneumonia and otitis media. Induced pluripotent stem cell-derived macrophages with knockout of MD2 or expression of the Thr116del mutation showed impaired activation of nuclear factor kappa B and mitogen-activated protein kinase signaling as well as TLR4 endocytosis on challenge with LPS or bacteria. In addition, MD2-deficient macrophages showed decreased cytokine expression (eg, IL-6, TNF, and IL-10) in response to LPS or gram-negative but not gram-positive bacteria. Human MD2 deficiency causes defective TLR4 signaling in response to LPS or gram-negative bacteria. The clinical manifestations and expressivity might be variable due to unknown secondary risk factors. Because TLR4 represents a therapeutic target for multiple inflammatory conditions, our study may provide insights into potential side effects of pharmacological TLR4 targeting.

A mixed methods approach to analyze and predict supply disruptions by combining causal inference and deep learning

In today's complex supply networks, disruptions caused by diverse events represent major unknown operational conditions and risk factors requiring research on supply chain risk management. Hereby, operations management (OM) researchers are traditionally focusing on defining analytical and mathematical risk mitigation strategies characterized by a variety of different constraints, such as capacities, timeliness, or relations, leading to limited transferability into practice. Given the complexity of modern supply chains we argue that a data-driven approach to supply chain risk management enhances the assessment and comparability of risk mitigation strategies. Thereby an approach that allows conclusions about causal relationships between supply chain interventions and potential outcomes is of particular importance. Inspired by deep learning as well as causal learning theory and following a design science research approach, we design an analytical model that can predict supply disruptions based on external and internal data and quantify causal effects on delivery reliability. The model is evaluated in a single case study using data from a large first tier automotive supplier. The results show that the model has a high predictive performance and can learn causalities from observed data and analyze interventions effecting supply disruptions. The identification of causal relationships offers the potential to identify lacking supplier relationships and consequently bundle supply chain risk management activities. Building on the empirical and analytical insights, we discuss implications for both theory and practice.

Leveraging Citizen Science to Improve Urban Public Health

Abstract Background Mobile health approaches in community based participatory projects keep the promise to encourage sustainable behavior in citizens by engaging communities in data collection and connecting their individual level behavior to larger level community health. This review evaluates the effectiveness of the implementation of citizen science for health promotion of non-communicable diseases in urban community-based participatory research projects. Methods A scoping review was conducted using PRISMA-ScR. Pubmed and Web of Science were searched for citizen science studies. We included research 1.) conducted in an urban setting, 2.) related to environmental sustainability, 3.) focused on non-communicable diseases, and 4.) applied citizen science methodology. Results 32 community-based participatory research projects were identified using the following data collection technologies: mobile applications (n = 7), photovoice (n = 6), Stanford Healthy Neighborhood Discovery Tool (n = 6), monitoring (n = 6), mixed-methods (n = 4) and sensors (n = 3). The Stanford Healthy Neighborhood Discovery Tool was most effective at delivering real time data collection, exploring new communication and dissemination opportunities for remote and marginalized communities, and at offering a flexible and cost-effective approach to identify health promotion interventions. Studies that implemented photovoice tools and mobile applications had challenges with regard to recruitment and retention of participants as well as privacy concerns. Conclusions Mobile health technologies in community-based participatory research projects may be a promising way to uncover unknown local risk factors, raise awareness and identifying targeted policy solutions to promote healthy and sustainable environments in urban spheres. The effectiveness of mobile health applications for health promotion of non-communicable diseases may vary between community-based participatory studies by data collection method. Key messages • Mobile health technologies in communities may be a promising way to promote healthy and sustainable environments by raising awareness and offering targeted policy solutions in urban spheres. • The effectiveness of mobile health applications for health promotion of non-communicable diseases may vary between community-based participatory studies by data collection method.

Intervention research in health promotion: policy issues, the example of the ten-year cancer strategy in France

Abstract Prevention research covers a wide domain of studies, including identification of unknown risk factors for certain cancers, for example prostate cancer; or health promotion with approaches by population, by living environment or by territory. This research focuses in particular on identified carcinogenic factors (e.g. tobacco, alcohol, certain pesticides) but also on the causes of the prevalence of these factors in certain populations. PHIR makes it possible to meet these challenges. In 2010, the French National Cancer Institute was a pioneer in the development of PHIR in France and decided in 2021 to make it one of the spearheads of its ten-year strategy. This presentation will aim to give an account of this policy of developing RISP as a relevant tool for thinking about health promotion policies and actions, by targeting the issue of inequalities as one of the priority research objects as well as certain audiences (young people, vulnerable populations). The presentation will discuss four challenges for the implementation of this research policy: the development of the French scientific community in order to be able to respond to priority issues; the structuring and animation of this community; the evaluation of research projects and the mobilisation of a still timid global community; the articulation of academic and concrete/experiential knowledge. Through a concrete example of a national research development policy, the aim of this presentation is to help participants understand the challenges of RISP (its obstacles and levers, not limited to financial issues), the organisation of research, and the links between the actors involved (researchers and field workers, beneficiaries, health professionals). The first part will focus on identifying the participants’ representations of the obstacles to the development of RISP. The second part will be an interactive presentation of 12 minutes, the last 2-3 minutes will be devoted to final questions.

Population attributable fraction of risk factors for low birth weight in the Japan Environment and Children’s Study

BackgroundLow birth weight (LBW), which is considered a birth weight of <2500 g, poses significant health problems for children. However, population attributable fraction (PAF) of risk factors for LBW have not been well studied. ObjectiveWe aimed to re-evaluate associations between risk factors for LBW reported in previous studies that used the Japan Environment and Children’s Study (JECS) data, and to estimate the magnitude of risk using PAF. MethodsData including 91,559 mother–child dyads were obtained from JECS. Risk factors identified by previous studies that used JECS data were used to calculate odds ratios for LBW using a Bayesian logistic regression model. Based on calculated odds ratios, the PAF was calculated. ResultsParity, history of adenomyosis, hypertension disorder of pregnancy, maternal age at birth, prepregnancy body mass index, gestational weight gain (GWG), maternal smoking and lead (Pb) exposure were all significantly associated with LBW. The sum of the PAF of all factors was 79.4 %, with the largest PAF among single risk factors being GWG (16.5 %); the environmental portion of the PAF (Pb exposure, 14.6 % + maternal smoking, 12.1 %) surpassed the PAF of GWG. ConclusionOur findings suggest that the number of births classified as LBW can be reduced by approximately 27% if Pb exposure is reduced to the lowest quartile and maternal smoking is eliminated. Further investigations are needed to identify unknown risk factors for LBW.

AML-285 Association Between Myeloid Malignancies With MECOM Rearrangement and Ocular Adnexal Leukemic Infiltration

Leukemic infiltration of the eye and ocular adnexal site is rare with unknown risk factors and clinical outcomes. To describe the clinical characteristics of extramedullary ocular adnexal (OA) leukemia in patients with myeloid malignancies. In a retrospective analysis, we screened all patients treated at our center between 1993 and 2022. We identified 50 patients with myeloid malignancies who presented with vision changes with available magnetic resonance imaging of the orbits. Among all 50 patients, 38 had their symptoms attributed to an infection, 2 to retinal hemorrhage with thrombocytopenia, 1 to chronic graft-vs-host disease and 1 to dacrocystocele. The remaining 8 patients (7 AML, 1 MDS) had leukemic infiltration of the eye and OA, diagnosed by imaging (7/8) or biopsy (1/8). The median age was 47 years (18-82), 6 (75%) were females. The optic nerve was most frequently affected in 7/8 patients, followed by infiltration of the cranial nerve (CN) III and intraconal soft tissues in 2/8 patients, each. Infiltration of the retina, lateral rectus muscle, CN IV, CN VI, and extraconal soft tissue was seen in 1/8 patient, each. Spinal fluid evaluation identified no evidence of leukemia in all 8 patients. Interestingly, 4/8 patients (50%) had abnormalities in chromosome 3q26 or MDS1 and EVI1 complex locus (MECOM) rearrangements, 2 (25%) had Lysine Methyltransferase 2A (KMT2A) rearrangement and the remaining two had trisomy 8 and a diploid karyotype respectively. Patients with KMT2A rearrangement also had other sites of extramedullary disease, while orbital adnexal involvement was the only extramedullary leukemia site in those with MECOM rearrangements. Intrathecal chemotherapy and concurrent local radiation were given to 6/8 patients while the other 2 received either intrathecal chemotherapy or radiation. Symptoms improved or resolved following these measures in 4/8 patients. These visual findings were detected during salvage therapy (median 4, range 1-9 lines). Overall survival following appearance of these findings was short with a median of 5.8 months (range: 0.4-17.5). Leukemic infiltration of the orbital adnexa in myeloid malignancies is rare and associated with an inordinately high proportion of MECOM rearrangements in addition to adverse outcomes.

Management of Chemotherapy-Induced Nausea and Vomitting in Breast Cancer Patients: A Prospective Cohort Study

Through a prospective cohort study we aimed to optimize prevention and management of chemotherapy-induced nausea and vomiting (CINV) in the emergence of new therapies for breast cancer patients. We included breast cancer patients treated with moderate emetogenic (MEC) or highly emetogenic chemotherapy (HEC) all stages combined, from April 2021 to November 2021. Patients were required to answer a survey of 32 questions in order to analyze the potential involvement of known and unknown risk factors in the occurrence of CINV. The acute phase of CINV was defined as nausea and vomiting that developed ≤ 24 hours after the start of chemotherapy. Delayed phase of CINV was defined as nausea and vomiting that developed &gt; 24 hours after the start of chemotherapy. The severity of nausea and vomiting was evaluated with common terminology criteria for adverse events (CTCAE) v5.0; publish to date: November 27, 2017. Analysis and results were performed using JAMOVI statistical software. In total, 177 patients received chemotherapy, 103 patients(58%) received (HEC), and 74 patients (42%) received (MEC). All patients were female (100%). Risk factors associated to occurrence of CINV included previously known factors: Younger age than 50 years (29,8%), history of pregnancy-related nausea and vomiting (74,7%), alcohol use (no patient reported previous alcohol consumption), failure to adhere to antiemetic treatment guidelines (9,6%). The compliance with treatment score (90,4%) showed a good commitment of the patients in the process of their medical healthcare. Other potential risk factors have been also explored to determine their involvement or not in the occurrence of CINV (cancer stage, performance status, education level, chemotherapy protocols, the use of traditional herbs known as an antibacterial agent and immunity booster in our context). In the acute phase, (78%) of patients experienced nausea and (47,8%) experienced vomiting. In the delayed phase, (37,1%) of patients experienced nausea and only (15,3%) experienced vomiting. The severity of nausea and vomiting was evaluated according to CTCAE v5.0 in both groups HEC and MEC. Only (8,7%) had to stop treatment for non-tolerance (table 1-2). The present study demonstrated that high compliance to treatment guidelines for CINV and individualized care could lead to more optimal management of CINV.

Awareness, treatment, and practices of lifestyle modifications amongst diagnosed hypertensive patients attending the tertiary care hospital of Karachi: A cross-sectional study

BackgroundDespite massive research guidelines, high blood pressure remains a major public health concern since barriers to treatment and control are on the rise. Lack of awareness is one of the serious impediments to managing hypertension. Therefore, this study is designed to gauge awareness, beliefs, and practices related to hypertension amongst diagnosed subjects. MethodsA total of 425 hypertensive patients were recruited from the wards and outpatient department of Jinnah Medical College Hospital located in Korangi district, Karachi. Data was obtained regarding socio-demographics, comorbidity, duration of HTN, current BP readings, and BMI. Additionally, awareness, practices, treatment, and control of hypertension were also assessed. Using IBM SPSS version 25.0, a chi-square test was run for categorical variables to analyze the differences in demographic variables, awareness, practices, and treatment between controlled and uncontrolled hypertensive patients. Multivariate regression model was used to identify the risk factors associated with uncontrolled hypertension. A p-value of less than 0.05 was considered significant. Results65.6% of the total study population was females, of which, 70.7% had uncontrolled hypertension, with a p-value of 0.007. Majority of the candidates were between the ages of 50 and 59 and there was a significant difference in age groups of controlled and uncontrolled hypertensive patients (p-value = 0.019). Co-morbidities and duration of hypertension yielded no significant results. Awareness, treatment, and practices of lifestyle modifications amongst controlled or uncontrolled hypertension groups were not statistically significant. Age and female gender were the only risk factors significantly linked with uncontrolled hypertension. ConclusionOverall, there was no significant difference in the statistics of controlled and uncontrolled hypertensive patients. This requires further investigation and evaluation to identify the unknown risk factors and co-morbid contributing to these findings. Most of the patients are on treatment and still not controlled, and this could be considered under treatment. Health professional's advice and counseling skills, social media, internet, and public awareness sessions can play an active role in the management of BP and its associated complications.

Exploring Unknown Predictors of Maternal Anemia Among Tribal Lactating Mothers, Andhra Pradesh, India: A Prospective Cohort Study.

IntroductionAnemia is a serious public health issue in India, especially among women, adolescent girls, and young children. Tribal people reside mostly in remote underserved regions with little or no basic civic amenities which makes them a highly vulnerable group of Indians. The study aimed to identify unknown risk factors for anemia among tribal lactating mothers.MethodologyIt was a mixed method prospective cohort study for 10 months carried out among 340 scheduled tribes (ST) mothers in 10 clusters in Guntur district, Andhra Pradesh, India. Data collection using a questionnaire, 24 hours dietary recall, anthropometric measurement, and hemoglobin estimation was done. Weekly local recipe talk in the mother’s kitchen, informal group discussions, was conducted for 12 weeks after baseline data collection. The audio and video tapes of the weekly local recipe talk in the mothers kitchen were transcribed verbatim and then translated into English. The individual responses were grouped as barriers related to acceptability, availability, accessibility, use and utilization, appropriateness, and nutrition environment.ResultsA total of 340 mothers were enrolled initially of which 315 mothers were studied in an end-line survey with an attrition rate of 7.3%. Over 80% mothers belonged to Yerukula, Yenadis, Lambadi/Sugali tribes, respectively. A total of 345 weekly local mother kitchen recipe talks were conducted in 10 clusters. In the present study, only few mothers mentioned food accessibility and availability issues. Surprisingly, lack of skill to cook the commonly consumed local food item among Indian mothers were recorded. Lack of time for cooking, lack of knowledge of nutritious benefits of food, and use of ready to eat food were other important key findings.ConclusionThe study documents initiation of transition of the tribal lactating mothers towards urbanization. The lack of knowledge of cooking, coupled with lifestyles of urban areas exposes the early aged, poor, low literate mothers to the trap of anemia.

Munich atopy prediction study (MAPS): protocol for a prospective birth cohort addressing clinical and molecular risk factors for atopic dermatitis in early childhood

IntroductionThe pathogenesis of atopic diseases is highly complex, and the exact mechanisms leading to atopic dermatitis (AD) onset in infants remain mostly enigmatic. In addition to an interdependent network of...