International expert consensus on the surgical anatomic classification of radical hysterectomies

BACKGROUND

The anatomic descriptions and extents of radical hysterectomy often vary across the literature and operative reports worldwide. The same nomenclature is often used to describe varying procedures, and different nomenclature is often used to describe the same procedure despite the availability of guideline and classification systems. This makes it difficult to interpret retrospective surgical reports, analyze surgical databases, understand technique descriptions, and interpret the findings of surgical studies.

OBJECTIVE

In collaboration with international experts in gynecologic oncology, the purpose of this study was to establish a consensus in defining and interpreting the 2017 updated Querleu-Morrow classification of radical hysterectomies.

STUDY DESIGN

The anatomic templates of type A, B, and C radical hysterectomy were documented through a set of 13 images taken at the time of cadaver dissection. An online survey related to radical hysterectomy nomenclature and definitions or descriptions of the associated procedures was circulated among international experts in radical hysterectomy. A 3-step modified Delphi method was used to establish consensus. Image legends were amended according to the experts' responses and then redistributed as part of a second round of the survey. Consensus was defined by a yes response to a question concerning a specific image. Anyone who responded no to a question was welcome to comment and provide justification. A final set of images and legends were compiled to anatomically illustrate and define or describe a lateral, ventral, and dorsal excision of the tissues surrounding the cervix.

RESULTS

In total, there were 13 questions to review, and 29 experts completed the whole process. Final consensus exceeded 90% for all questions except 1 (86%). Questions with relatively lower consensus rates concerned the definitions of types A and B2 radical hysterectomy, which were the main innovations of the 2017 updated version of the 2008 Querleu-Morrow classification. Questions with the highest consensus rates concerned the definitions of types B1 and C, which are the most frequently performed radical hysterectomies.

CONCLUSION

The 2017 version of the Querleu-Morrow classification proved to be a robust tool for defining and describing the extent of radical hysterectomies with a high level of consensus among international experts in gynecologic oncology. Knowledge and implementation of the exact definitions of hysterectomy radicality are imperative in clinical practice and clinical research.

Cetaceans as bio-indicators revealed the increased risks of triclosan exposure and associated thyroid hormone disruption during the COVID-19 pandemic

The global surge in disinfection practices from the COVID-19 response has raised concerns about the marine exposure to the hazardous ingredients in disinfectant products, including triclosan (TCS) and triclocarban (TCC). However, there are very limited studies on the response of marine TCS and TCC (TCs) loading to the COVID-19 pandemic. Here we used cetaceans as bio-indicators for a long-term retrospective analysis of TCs loading to the South China Sea (SCS) between 2004 and 2022. Hepatic TCs was 100% detected in all nine cetacean species (n = 120). Interestingly, TCS concentrations decreased in Indo-Pacific humpback dolphins (IPHD) before the pandemic from 2010 to 2017. However, after 2019, TCS concentrations in IPHD significantly increased several-fold. Similarly, post-pandemic TCS concentrations in Indo-Pacific finless porpoises (IPFP) and two fish species were significantly higher than pre-pandemic levels. There were significant relationships between thyroid hormones (THs) and TCs in IPHD and IPFP, suggesting that increased TCs may worsen the interference of THs homeostasis and nutritional conditions in cetaceans. These findings demonstrate the profound impact of the surging use of TCs-containing products from the COVID-19 response on marine ecosystems.

Buzz Session as an Active Learning Method in Medical Undergraduate Physiology Teaching-An Institutional-Based Study

Background

In the current era of medical teaching, multiple active teaching-learning strategies are being explored due to drawbacks of conventional didactic learning methodology which are applicable to a typical classroom setting. Our attempt was to introduce short interactive buzz sessions in the midst of a lecture and assess the perception of students and faculty towards the use of these buzz sessions as an active learning method in physiology.

Aim and Objectives

To introduce buzz sessions as a teaching-learning tool in undergraduate medical teaching and to assess the student and faculty perception of this teaching method.

Methodology

This prospective, non-randomized, interventional study was carried out in the Department of Physiology, GMC Srinagar. The participants were 180 students of MBBS 1st Phase and 08 faculty members of the Physiology Department. Both the students and faculty were sensitized about the buzz sessions. Ten lectures of 1 h each were chosen from the Endocrine System, and taught by incorporating the buzz session in the lecture. The study was approved by the Institutional Ethical Committee.

Results

Both the students and the faculty favoured incorporating buzz sessions during the lectures as this teaching method makes the class interesting and interactive and helps to enhance communication, reasoning skills, and collaborative learning among the students.

Conclusions

The study concludes that learning physiology using buzz sessions is liked and preferred by both students and faculty, and hence the need for buzz sessions in current medical teaching.

Type 2 Diabetes Increases the Risk of Serious and Life-Threatening Conditions Among Adults With Traumatic Spinal Cord Injury

Objective

To compare the incidence of and adjusted hazards for serious and life-threatening morbidities among adults with traumatic spinal cord injury (TSCI) with and without type 2 diabetes (T2D).

Participants and Methods

A retrospective longitudinal cohort study was conducted from September 1, 2022 to February 2, 2023, among privately insured beneficiaries if they had an International Classification of Diseases, 9th Revision or 10th Revision, Clinical Modification diagnostic code for TSCI (n=9081). Incidence estimates of serious and life-threatening morbidities, and more common secondary and long-term health conditions, were compared at 5 years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for serious and life-threatening morbidities.

Results

Adults living with TSCI and T2D had a higher incidence of all of the morbidities assessed as compared with nondiabetic adults with TSCI. Fully adjusted survival models reported that adults with TSCI and T2D had a greater hazard for most of the serious and life-threatening conditions assessed, including sepsis (hazard ratio [HR]: 1.65), myocardial infarction (HR: 1.63), osteomyelitis (HR: 1.9), and stroke or transient ischemic attack (HR: 1.59). Rates for comorbid and secondary conditions were higher for individuals with TSCI and T2D, such as pressure sores, urinary tract infections, and depression, even after controlling for sociodemographic and comorbid conditions.

Conclusion

Adults living with TSCI and T2D have a significantly higher incidence of and risk of developing serious and life-threatening morbidities as compared with nondiabetic adults with TSCI.

Meta-Analysis of COVID-19 Metabolomics Identifies Variations in Robustness of Biomarkers

The global COVID-19 pandemic resulted in widespread harms but also rapid advances in vaccine development, diagnostic testing, and treatment. As the disease moves to endemic status, the need to identify characteristic biomarkers of the disease for diagnostics or therapeutics has lessened, but lessons can still be learned to inform biomarker research in dealing with future pathogens. In this work, we test five sets of research-derived biomarkers against an independent targeted and quantitative Liquid Chromatography-Mass Spectrometry metabolomics dataset to evaluate how robustly these proposed panels would distinguish between COVID-19-positive and negative patients in a hospital setting. We further evaluate a crowdsourced panel comprising the COVID-19 metabolomics biomarkers most commonly mentioned in the literature between 2020 and 2023. The best-performing panel in the independent dataset-measured by F1 score (0.76) and AUROC (0.77)-included nine biomarkers: lactic acid, glutamate, aspartate, phenylalanine, β-alanine, ornithine, arachidonic acid, choline, and hypoxanthine. Panels comprising fewer metabolites performed less well, showing weaker statistical significance in the independent cohort than originally reported in their respective discovery studies. Whilst the studies reviewed here were small and may be subject to confounders, it is desirable that biomarker panels be resilient across cohorts if they are to find use in the clinic, highlighting the importance of assessing the robustness and reproducibility of metabolomics analyses in independent populations.

Pharmacological inhibition of TBK1/IKKε blunts immunopathology in a murine model of SARS-CoV-2 infection

TANK-binding kinase 1 (TBK1) is a key signalling component in the production of type-I interferons, which have essential antiviral activities, including against SARS-CoV-2. TBK1, and its homologue IκB kinase-ε (IKKε), can also induce pro-inflammatory responses that contribute to pathogen clearance. While initially protective, sustained engagement of type-I interferons is associated with damaging hyper-inflammation found in severe COVID-19 patients. The contribution of TBK1/IKKε signalling to these responses is unknown. Here we find that the small molecule idronoxil inhibits TBK1/IKKε signalling through destabilisation of TBK1/IKKε protein complexes. Treatment with idronoxil, or the small molecule inhibitor MRT67307, suppresses TBK1/IKKε signalling and attenuates cellular and molecular lung inflammation in SARS-CoV-2-challenged mice. Our findings additionally demonstrate that engagement of STING is not the major driver of these inflammatory responses and establish a critical role for TBK1/IKKε signalling in SARS-CoV-2 hyper-inflammation.

Influence of the Extraction Solution on the Removal of Heavy Metals from Polluted Soils

Soil pollution with heavy metals is a problem for the whole geosystem. The aim of the research is to identify new solutions for extracting heavy metals from polluted soils so that they can be further exploited. To this end, investigations of the physicochemical characteristics of the soil sample under study were carried out. Following the analyses, the soil was characterised as lute-coarse sand (UG) with a strongly acidic pH (4.67), a hygroscopicity coefficient (CH = 4.8% g/g), and a good supply of nutrients: nitrogen (Nt): 0.107%; mobile phosphorus (PAL): 6 mg kg-1 and mobile potassium (KAL): 26 mg kg-1, but is low in humus (2.12%). The metal content of the soil was determined by atomic absorption spectrometry (AAS), and the analyses showed high concentrations of metals (Pb: 27,660 mg kg-1; Cu: 5590 mg kg-1; Zn: 2199 mg kg-1; Cd: 11.68 mg kg-1; Cr: 146 mg kg-1). The removal of metals (Pb, Cu, Zn, Cd, and Cr) from polluted soil by different extraction agents (water, humus, malic acid, chitosan, and gluconic acid) was investigated. Metal extraction experiments were carried out in a continuous orbital rotation-oscillation stirrer at a solid/liquid/ (S/L ratio; g:mL) of 1:4, at two concentrations of extraction solution (1% and 3%), and at different stirring times (2, 4, 6, and 8 h). The yield of the extraction process is very low for all proposed extraction solutions. The maximum values of extraction efficiency are: 0.5% (Pb); 3.28% (Zn); and 5.72% (Cu). Higher values were obtained in the case of Cr (11.97%) in the variant of using humus 3% as an extraction solution at a stirring time of 6 h. In the investigated experimental conditions, the best removal efficiencies were obtained in the case of cadmium (26.71%) when using a 3% malic acid solution. In conclusion, it is considered that, from case to case, the type of extraction solution as well as the nature of the metal influence the mechanism of the depollution process, i.e., the capacity of the fine soil granules to free themselves from the pollutant metal that has adhered to them, and further research is considered necessary in the future.

Streptococcus zooepidemicus Meningitis in an HIV-Positive Horse Breeder Patient: A Case Study and Literature Review

Streptococcus equi subsp. zooepidemicus is a rare etiologic agent of bacterial meningitis in humans. The disease is a zoonotic infection and is transmitted through close contact with domestic animals, mainly horses. Only 37 cases of Streptococcus zooepidemicus meningitis have been reported in the literature until July 2023. The aim of this study is to present a rare clinical case of S. zooepidemicus-related meningitis in a human immunodeficiency virus (HIV)-positive patient and analyze the literature. We present a 23-year-old horse breeder patient with advanced immunosuppression due to acquired immunodeficiency syndrome (AIDS) and S. zooepidemicus meningitis, admitted at the Clinic of Infectious Diseases, St. George University Hospital, Plovdiv. The course of meningitis was severe since the beginning, with significant cerebral edema, disturbances in consciousness, persistent fever, and the development of complications against the background of AIDS-related conditions. S. zooepidemicus was microbiologically detected from cerebrospinal fluid culture. After prolonged treatment and a long hospital stay, the patient's condition improved, and eventually he was discharged and recovered from the acute neuroinfection. Although extremely rare, S. zooepidemicus should be considered in patients with clinical and laboratory evidence of bacterial meningitis who have contact with animals, especially horses, other domestic animals, and their dairy products, as well as in immunocompromised patients. To the best of our knowledge, the current clinical case is the first report of S. zooepidemicus-related meningitis in a patient with HIV/AIDS.

Cardiovascular morbidity and mortality in patients in Wales, UK with resistance to thyroid hormone β (RTHβ): a linked-record cohort study

BACKGROUND

Individuals with resistance to thyroid hormone owing to mutations in the thyroid hormone receptor β gene (RTHβ) exhibit impaired tissue sensitivity to thyroid hormones, but retain sensitivity in cardiac tissue. Long-term health and survival outcomes in this rare disorder have not been evaluated. We investigated all-cause mortality and cardiovascular event risk in a cohort of patients with RTHβ, followed-up in UK endocrine clinics.

METHODS

In a retrospective cohort design, we linked genetically confirmed patients with RTHβ and age-matched and sex-matched population controls to outcomes in datasets within the Welsh Secure Anonymised Information Linkage (SAIL) Databank. Kaplan-Meier and Cox regression models analysed associations of RTHβ with all-cause mortality and cardiovascular events.

FINDINGS

We identified 61 patients with a genetic diagnosis of RTHβ between Jan 1, 1997, and Dec 31, 2019, and matched them with 2750 controls. Compared with controls, patients exhibited increased risks for all-cause mortality (hazard ratio [HR] 2·84, 95% CI 1·59-5·08), atrial fibrillation (10·56, 4·72-23·63), heart failure (HR 6·35, 95% CI 2·26-17·86), and major adverse cardiovascular events (MACE), comprising cardiovascular death, acute myocardial infarction, heart failure, or strokes (HR 3·49, 95% CI 2·04-5·99). The median age of first occurrence of any adverse event was 11 years earlier in patients (56 years, 95% CI 44-65) compared with controls (67 years, 65-70). Cubic spline analyses showed positive associations between FT4 concentrations at diagnosis and mortality or MACE, with FT4 concentration of 30 pmol/L or greater conferring increased risk. Compared with no intervention, treatment with antithyroid drugs, surgery or radioiodine gland ablation, or thyroxine did not control thyroid hormone excess.

INTERPRETATION

We have documented reduced survival and increased cardiovascular morbidity in a cohort of patients with RTHβ for the first time. These outcomes might be driven by lifelong cardiac exposure to thyroid hormone excess; and effective therapies, targeting hormone resistant pathways, could potentially curtail this risk.

FUNDING

Royal College of Physicians, Wellcome Trust Investigator Award, and NIHR Cambridge Biomedical Research Centre.

Retrospective Evaluation of the Impact of Dose Escalation Using Pre-operative Simultaneous Integrated Boost Volumetric Modulated Arc Therapy on the Outcome of Locally Advanced Rectal Cancer Patients

PURPOSE

Evaluating the outcome of pre-operative simultaneous integrated boost volumetric modulated arc therapy (SIB-VMAT) concomitant with capecitabine in patients diagnosed with locally advanced rectal cancer (LARC) at King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Saudi Arabia, during the period January 2013-December 2019.

RESULTS

A total of 134 patients were enrolled. The median age at diagnosis was 59 years. All patients received pre-operative concurrent chemo-radiation therapy (CCRT) using SIB-VMAT with oral capecitabine. Neoadjuvant chemotherapy was administered prior to CCRT in 32 patients (23.9%). The dose of radiation was 55 Gy in 94 patients (70.1%), while 40 patients (29.9%) received 50 Gy. All patients completed the CCRT treatment without breaks. No records of acute and late grade III and IV toxicities. Curative surgery was performed in all patients with a median interval of 11 (6-52) weeks between the end of CCRT and the date of surgery. No reported 30-day postoperative mortality and no grade III and IV Clavien-Dindo complications. PCR was reported in 26 patients (19.4%), while pathologically negative nodes (pN0) were achieved in 103 patients (76.9%). Adjuvant chemotherapy was utilized in 57 patients (42.5%). The 5-year local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were 93.2%, 67.1%, and 87.3%, respectively. Only tumor regression grade (TRG) was significantly correlated with LRFS, (p value 0.043). On multivariate analysis, only TRG and achievement of pN0 were significantly correlated with DFS (p value < 0.001).

CONCLUSION

Dose escalation utilization (SIB-VMAT) in the pre-operative treatment of LARC is well tolerated and provides effective local control.

Sleep Duration and Stress Level in the Risk of Gastric Cancer: A Pooled Analysis of Case-Control Studies in the Stomach Cancer Pooling (StoP) Project

The association between sleep and stress and cancer is underinvestigated. We evaluated these factors in association with gastric cancer (GC). Five case-control studies from the Stomach Cancer Pooling (StoP) Project were included. We calculated the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for sleep duration and stress level in association with GC through multiple logistic regression models adjusted for several lifestyle factors. The analysis included 1293 cases and 4439 controls, 215 cardia and 919 noncardia GC, and 353 diffuse and 619 intestinal types. Sleep duration of ≥9 h was associated with GC (OR =1.57, 95% CI = 1.23-2.00) compared to 8 h. This was confirmed when stratifying by subsite (noncardia OR = 1.59, 95% CI = 1.22-2.08, and cardia OR = 1.63, 95% CI = 0.97-2.72) and histological type (diffuse OR = 1.65, 95% CI = 1.14-2.40 and intestinal OR = 1.24, 95% CI = 0.91-1.67). Stress was associated with GC (OR = 1.33, 95% CI = 1.18-1.50, continuous). This relationship was selectively related to noncardia GC (OR = 1.28, 95% 1.12-1.46, continuous). The risk of diffuse (OR = 1.32, 95% CI = 1.11-1.58) and intestinal type (OR = 1.23, 95% CI = 1.07-1.42) were higher when stress was reported. Results for the association between increasing level of stress and GC were heterogeneous by smoking and socioeconomic status (p for heterogeneity = 0.02 and <0.001, respectively). In conclusion, long sleep duration (≥9 h) was associated with GC and its subtype categories. Stress linearly increased the risk of GC and was related to noncardia GC.

Comparison of Biochemical, Haematological and Plasmatic Butyrylcholinesterase Parameters in Farmers and Non-Farmers, Morocco

Background

The long-term use of pesticides can cause harmful consequences to both human health and the environment. In the present research, we aimed to compare biochemical, hematological, and plasmatic measurements of butyrylcholinesterase (BChE) between farmers and non-farmers.

Materials and Methods

The study is cross-sectional and included 270 participants, with 135 farmers using pesticides and a control population of 135 non-farmers. The recruitment of the participants was conducted from August 2017 to the end of December 2019. Blood samples from participants were collected for the evaluation of biochemical markers of the function of the liver and determination of BChE activity. A whole blood sample with ethylenediamine tetraacetic anticoagulant (EDTA) was also taken for a complete blood count.

Results

The results showed a statistically significant (P = 0.03) decrease in mean corpuscular hemoglobin (MCH) in the cases (28.45 ± 2.94 pg) as compared with controls (29.17 ± 2.54 pg). The statistical analysis of the renal parameters between the two groups determined that the uremia value was significantly higher in cases (34 ± 12 mg/dL) when compared to the control group (29 ± 8 mg/dL) P < 0.001. The cases recorded a significant increase in aspartate aminotransferase (AST) (26.22 ± 11.59 U/L) and alanine aminotransferase (ALT) (25.63 ± 13.47 U/L) enzyme activities among cases versus controls. The results obtained showed a significantly decreased BChE activity in the group of cases exposed to pesticides (7554.52 ± 2107 U/l) compared to the unexposed control group (10135.58 ± 1909 U/l) (t-test, P < 0.001).

Conclusion

The education of the farmers on correct practices concerning phytosanitary use has the potential of reducing their exposure to these products.

Trends of Contraceptive Usage among Women in Tertiary Hospital in Nnewi, Nigeria: A Five-Year Retrospective CrossSectional Study

Background: Maternal and infant mortality can be reduced with use of contraceptives which protects against unplanned pregnancies, high parity and high fertility and ensuring proper spacing between child births. Nigeria’s fertility rate is high, with 5.7 children per woman while the contraceptive prevalence rate is low, with a rate of 15%. Studying the trend will provide information on the uptake of diverse contraception approaches and provide information for counseling. Objective: To determine the trend and preferred methods of contraceptive usage among patients who attend the family planning clinic at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Nigeria. Method: This is a retrospective cross-sectional study involving collection of data from the family planning register of women who attended family planning clinic at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria, from 1st April 2014 to 1st March 2019. The information obtained from the case files were socio-demographic data such as the age and parity including the contraceptive methods, and yearly uptakes. The data obtained were analysed using statistical package SPSS version 26. Result: The total number of deliveries at the study center in the studied period was 3457, while the total number of contraceptive methods used was 578, giving an overall contraceptive prevalence rate of 16.7%. The prevalence rate showed a rise from 15.7% in 2014/2015 to as high as 19.1% in 2018/2019. The age group with most of the women from the study was 30 to 34 (29.2%) years. Majority of the women (251; 43.4%) used sub-dermal implants, 219 (37.9%) women used intrauterine contraceptive device (CUT380A), and this was followed by 96 (16.6%) women that used injectable hormonal contraceptive. We also observed an increase in preference for use of hormonal contraceptive methods (implants) as compared to the non hormonal methods (CUT380A). Conclusion: The trend so far, shows a rise in contraceptive use with the sub-dermal implants in the study center, with a notable improvement in the prevalence of contraceptive use within the last 5 years of the study. There is need for health information on the use of contraceptives to improve the uptake.

Uncommon Presentation of Leprosy: A Report of Two Cases

Lazarine leprosy is an unusual expression of usually borderline tuberculoid (BT) form characterized by spontaneous ulceration of skin lesions. This is presumably the result of an exaggerated type 1 reaction. It commonly occurs in the BT, borderline lepromatous forms and rarely in the lepromatous forms of leprosy. We report two cases of lazarine leprosy in the BT and BT downgrading to borderline lepromatous spectrum in healthy and immunocompetent males.

Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

Importance

Continuous glucose monitoring (CGM) is associated with improvements in hemoglobin A1c (HbA1c) in youths with type 1 diabetes (T1D); however, youths from minoritized racial and ethnic groups and those with public insurance face greater barriers to CGM access. Early initiation of and access to CGM may reduce disparities in CGM uptake and improve diabetes outcomes.

Objective

To determine whether HbA1c decreases differed by ethnicity and insurance status among a cohort of youths newly diagnosed with T1D and provided CGM.

Design, Setting, and Participants

This cohort study used data from the Teamwork, Targets, Technology, and Tight Control (4T) study, a clinical research program that aims to initiate CGM within 1 month of T1D diagnosis. All youths with new-onset T1D diagnosed between July 25, 2018, and June 15, 2020, at Stanford Children's Hospital, a single-site, freestanding children's hospital in California, were approached to enroll in the Pilot-4T study and were followed for 12 months. Data analysis was performed and completed on June 3, 2022.

Exposures

All eligible participants were offered CGM within 1 month of diabetes diagnosis.

Main Outcomes and Measures

To assess HbA1c change over the study period, analyses were stratified by ethnicity (Hispanic vs non-Hispanic) or insurance status (public vs private) to compare the Pilot-4T cohort with a historical cohort of 272 youths diagnosed with T1D between June 1, 2014, and December 28, 2016.

Results

The Pilot-4T cohort comprised 135 youths, with a median age of 9.7 years (IQR, 6.8-12.7 years) at diagnosis. There were 71 boys (52.6%) and 64 girls (47.4%). Based on self-report, participants' race was categorized as Asian or Pacific Islander (19 [14.1%]), White (62 [45.9%]), or other race (39 [28.9%]); race was missing or not reported for 15 participants (11.1%). Participants also self-reported their ethnicity as Hispanic (29 [21.5%]) or non-Hispanic (92 [68.1%]). A total of 104 participants (77.0%) had private insurance and 31 (23.0%) had public insurance. Compared with the historical cohort, similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were observed for Hispanic individuals (estimated difference, -0.26% [95% CI, -1.05% to 0.43%], -0.60% [-1.46% to 0.21%], and -0.15% [-1.48% to 0.80%]) and non-Hispanic individuals (estimated difference, -0.27% [95% CI, -0.62% to 0.10%], -0.50% [-0.81% to -0.11%], and -0.47% [-0.91% to 0.06%]) in the Pilot-4T cohort. Similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were also observed for publicly insured individuals (estimated difference, -0.52% [95% CI, -1.22% to 0.15%], -0.38% [-1.26% to 0.33%], and -0.57% [-2.08% to 0.74%]) and privately insured individuals (estimated difference, -0.34% [95% CI, -0.67% to 0.03%], -0.57% [-0.85% to -0.26%], and -0.43% [-0.85% to 0.01%]) in the Pilot-4T cohort. Hispanic youths in the Pilot-4T cohort had higher HbA1c at 6, 9, and 12 months postdiagnosis than non-Hispanic youths (estimated difference, 0.28% [95% CI, -0.46% to 0.86%], 0.63% [0.02% to 1.20%], and 1.39% [0.37% to 1.96%]), as did publicly insured youths compared with privately insured youths (estimated difference, 0.39% [95% CI, -0.23% to 0.99%], 0.95% [0.28% to 1.45%], and 1.16% [-0.09% to 2.13%]).

Conclusions and Relevance

The findings of this cohort study suggest that CGM initiation soon after diagnosis is associated with similar improvements in HbA1c for Hispanic and non-Hispanic youths as well as for publicly and privately insured youths. These results further suggest that equitable access to CGM soon after T1D diagnosis may be a first step to improve HbA1c for all youths but is unlikely to eliminate disparities entirely.

Trial Registration

ClinicalTrials.gov Identifier: NCT04336969.

Liver and renal biochemical parameters in preeclampsia: a cross sectional study

Background: Pre-eclampsia is a multisystem disorder of human pregnancy with a genetic predisposition. It occurs more frequently in first pregnancies and leads to elevation in blood pressure and mainly affects maternal renal, cerebral, hepatic and clotting functions. This study evaluated biomarkers of renal and liver function among preeclamptic women. Methods: This was a cross-sectional study conducted among 150 preeclamptic women and 150 normotensive healthy pregnant women in hospital. The baseline data comprising age, gestational age, and blood pressure were obtained. Serum urea, creatinine, and plasma levels of liver enzymes ALT and AST, total protein, albumin, globulin and glucose were measured. Results: The plasma total protein, and albumin in preeclamptic group were significantly decreased (p<0.05) when compared with control. There was statistically significant increase (p<0.05) in urea creatinine, glucose, serum AST, and ALT activities in preeclamptic group. Conclusions: Preeclampsia has harmful effects on renal and liver function as shown by alteration of these parameters.

Lung Cancer and Risk Factors in Lebanon: Epidemiology, Temporal Trends, and Comparison to Countries From Different Regions in the World

BACKGROUND

Lung cancer (Lca) is the leading cause of cancer morbidity and mortality worldwide. This study examines the Lca incidence and trends in Lebanon and compares them to regional and global ones. It also discusses Lca risk factors in Lebanon.

METHODS

Lung cancer data from the Lebanese National Cancer Registry for 2005 to 2016 was obtained. The age-standardized incidence rates (ASRw) and age-specific rates per 100 000 population were calculated.

RESULTS

Lung cancer ranked second for cancer incidence in Lebanon from 2005-2016. Lung cancer ASRw ranged from 25.3 to 37.1 per 100 000 males and 9.8 to 16.7 per 100 000 females. Males 70-74 and females 75+ had the highest incidence. Lung cancer ASRw in males increased significantly at 3.94% per year from 2005 to 2014 (P > .05), then decreased non-significantly from 2014 to 2016 (P < .05). Lung cancer ASRw in females increased significantly at 11.98% per year from 2005 to 2009 (P > .05), then increased non-significantly from 2009 to 2016 (P < .05). Males' Lca ASRw in Lebanon was lower than the global average in 2008 and became similar in 2012 (34.1 vs 34.2 per 100 000); However, females' Lca ASRw was almost comparable to the global average in 2008 and exceeded it in 2012 (16.5 vs 13.6, respectively, per 100 000). Males' and Females' Lca ASRw in Lebanon were among the highest in the Middle East and North Africa (MENA) region but lower than those estimated for North America, China and Japan, and several European countries. The proportion of Lca cases attributed to smoking among Lebanese males and females was estimated at 75.7% and 66.3% for all age groups, respectively. The proportion of Lca cases attributed to air pollution with PM₁₀ and PM_2.5 in Lebanon was estimated at 13.5% for all age groups.

CONCLUSION

Lung cancer incidence in Lebanon is among the highest in the MENA region. The leading known modifiable risk factors are tobacco smoking and air pollution.

Pre-eclampsia and platelet indices: a cross sectional study

Background: Pre-eclampsia is a complex disease process originating at the maternal- fetal interface that affects multiple organ systems. The exact pathophysiology of preeclampsia is not known but it is considered to be associated with endothelial cell dysfunction, increased inflammatory responses and hypercoagulability. The receptors located on platelets are activated in pre-eclampsia by several proteases plus the vasoconstriction associated with preeclampsia leads to platelet activation which can be evaluated by platelet indices like platelet count, mean platelet volume (MPV), platelet distribution width (PDW) and palteletcrit (PCT). The objective of this study was to compare the platelet count and platelet indices- MPV, PDW, and PCT in patients with pre-eclampsia and normotensive pregnant women.Methods: A cross sectional study which included a total of 204 patients divided into two groups (102 pre-eclampsia and 102 control. The patients were compared for platelet count and platelet indices like MPV, PDW and PCT.Results: The platelet count (PC) was decreased in pre-eclampsia group as compared to control group with statistically significant difference in means between the two groups (p<0.05). The MPV and PDW also showed significant difference between the two groups (p<0.05) with preeclampsia group having increased MPV and PDW values. The PCT value was lower in pre-eclampsia group as compared to control group but it did not reach statistically significant level.Conclusions: In pre-eclampsia patients while as MPV and PDW showed increased value as compared to control group and the difference between the two had statistical significance, platelet count was lower in them and had statistical significance when compared to control group. Therefore these platelet indices and platelet count can be used to predict and prevent complications arising from preeclampsia.

Comparison of serum electrolytes with preeclampsia severity: a cross sectional study

Background: Preeclampsia is a common complication of pregnancy that put women and their fetuses at significant risk and result in life long sequelae. The pathogenesis of this important disease is complex as such the role of different serum electrolytes is being investigated as they are considered important for blood pressure regulation.Methods: A hospital based cross-sectional study of 100 diagnosed cases of preeclampsia divided into mild and severe according to latest International Society for the Study of Hypertension in Pregnancy (ISSHP) guidelines and equal number of age, parity and gestational age matched women (n=100), that acted as control group, with singleton normal pregnancies. Data was analyzed in SPSS V:26. Statistical tests to find out mean standard deviation and One-way ANOVA test were applied to find the significance of associations.Results: In severe preeclampsia group, the mean values of Na+, K+ and Cl- were 134.50±4.24, 4.28±0.74, 106.48±3.41 meq/l respectively in comparison to control group which had 135.57±3.29, 4.12±0.53, 108.20±3.19 meq/l respectively. Results from one way ANOVA showed that there was statistically significant difference between means of the three groups for systolic blood pressure (SBP), diastolic blood pressure (DBP), potassium and chloride levels with p<0.05. A post hoc analysis was used to distinguish the differences in means of these parameters.Conclusions: Estimation of readily available serum electrolytes of sodium potassium and chloride during the course of pregnancy can help to identify and treat preeclampsia and thus reduce the burden of morbidity and mortality in pregnant women.

Prevalence of dental anomalies in a sample of growing subjects: a retrospective study

BACKGROUND

dental anomalies are a group of disorders characterized by alterations in tooth number, shape, size, structure, development, and timing of eruption due to genetic and environmental factors.

OBJECTIVES

to identify the prevalence of dental anomalies in a large sample of non-orthodontic subjects.

DESIGN

a retrospective chart review was conducted based on digital panoramic radiographs by two examiners who assessed the presence of displacement of the maxillary canines (DMC), impacted teeth (IT), tooth agenesis (TA), supernumerary/supplementary teeth (ST), and tooth transpositions (TT).

SETTING AND PARTICIPANTS

radiographs of subjects aged between 8 and 18 years were analysed. A chi2 test was employed to assess possible associations between the number and type of dental anomalies and patients' gender. When an association was present, a binary logistic regression was conducted to calculate the odds ratio between the variables. The significance level was set at p<0.05.

RESULTS

a total of 1,124 subjects (25.7%) showed at least one dental anomaly. DMC (12.1%) and IT (12%) were the most frequent dental anomalies. The most represented impacted teeth were the upper canine (9.2%) and the upper central incisor (1.3%). TA was detected in 296 radiographs (6.8%), with 134 showing two or more TA. The prevalence of ST and TT in the total sample was 2.2% and 0.7%, respectively. Associations were found between ST and IT, between TA and DMC, and between TA and IT.

CONCLUSIONS

the results obtained encourage the radiographic investigation of dental anomalies at an early stage.

Qureshi W, Tanvir M, Ashraf A, S.M K. EVALUATION OF PREDIABETES IN HIGH RISK POPULATION OF KASHMIR VALLEY

Background: To evaluate pre diabetes and diabetes in patients with clinical risk factors and or symptoms who have been previously undiagnosed. Methods: A cross-sectional cohort study of 783 patients, carried at a tertiary health care centre using diagnostic tools of oral glucose challenge test (GCT), overnight fat standard oral glucose tolerance test (OGTT) and HbA1C estimation, and criteria of standard guidelines applied for diagnosis of individual at risk of prediabetes and diabetes. Results: Among the studied subjects, 588 (75.1%) were hypertensive, 67 (8.6%) had history of vascular disease, 84 (10.7%) had dyslipidemia and 78 (10%) carried family history of diabetes. On GCT, 266 (34%) subjects had levels of plasma glucose more than cut off of 140mg/dl. A high sensitivity (92.59%), specificity (84.56%) was seen among diabetes, while as it was 75.58% and 84.56% among the subjects with pre-diabetes, and HbA1c > 5.5% was observed in 298 (38.1%) patients. The diabetics had mean BMI of 27.75kg/m2 compared to 26.04kg/m2 in pre-diabetics, and mean age for diabetic and pre-diabetics was 52.68 and 51.7 years, respectively. Conclusion: GCT screening would be an accurate, convenient and relatively in expensive way to detect pre-diabetes and previously unrecognized diabetes. Large scale surveys are suggested for better outcome.

Editorial of ARIS2 - Advanced Research on Information Systems Security, an International Journal

As the year 2022 enters its middle range, the world is assisting an abnormal event with a heavy impact on cyber security, the Russian-Ukraine conflict. Since the beginning of this conflict that two immense groups have been created and explore security flaws within each side and to do so with success, they resort to vulnerabilities, coercion, or social engineering techniques. Protecting information, actors, and their frameworks has emerged as a critical struggle and science has an immense role in performing and maintaining security actors one step forward in this scenario.