Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration

Neuron-specific enolase and Tau protein as biomarkers for sepsis-associated delirium: a cross-sectional pilot study

BACKGROUND

In this study, Pinto et al. identified significantly higher levels of neuron-specific enolase and Tau protein in older patients with sepsis-associated delirium in the emergency department, suggesting the potential of these biomarkers as diagnostic tools in this population.

OBJECTIVE

Sepsis-associated delirium is a common cerebral manifestation in patients with sepsis, potentially caused by a combination of neuroinflammation and other neurophysiological disorders. This study investigated the expression of neuron-specific enolase and Tau protein as biomarkers in patients with sepsis-associated delirium. While neuron-specific enolase and Tau protein are known to be associated with brain injury, their diagnostic potential in patients with sepsis-associated delirium is not well understood.

METHODS

This cross-sectional pilot study evaluated plasma levels of neuron-specific enolase and Tau protein in patients with delirium and sepsis to explore their potential for identifying sepsis in patients admitted to the emergency department.

RESULTS

A total of 25 patients with delirium were analyzed, 56% of whom had sepsis. Patients with sepsis exhibited significantly higher neuron-specific enolase levels (2.7ng/mL [95%CI= 2.2-3.2] versus 1.3 ng/mL [95%CI= 0.8-2.5], p<0.003) and Tau protein levels (96.1pg/mL [95%CI= 77.0-111.3] versus 43.0pg/mL [95%CI= 31.2-84.5], p<0.003) compared to patients without sepsis. Neuron-specific enolase and Tau protein thresholds of >2.08ng/mL and >59.27pg/mL, respectively, demonstrated 90% specificity for identifying sepsis in patients.

CONCLUSION

Neuron-specific enolase and Tau protein levels were significantly higher in patients with sepsis than in those without, underscoring their potential ability to identify the infectious etiology of delirium in older patients admitted to emergency departments. Clinical Trials #RBR-233bct.

BACKGROUND

■ Biomarkers of brain injury, such as neuron-specific enolase and Tau proteins, are higher in older patients with sepsis and delirium.

BACKGROUND

■ Diagnosing sepsis in patients with delirium can be challenging.

BACKGROUND

■ Early identification of sepsis is key to managing sepsisassociated delirium.

Does mean systolic blood pressure less than 130 mm Hg ensure high rates of control to <140/<90 mm Hg? A cross-sectional analysis of two cohorts

OBJECTIVE

The purpose of this study was to determine how strongly mean systolic blood pressure (mSBP, mm Hg) was related to hypertension control and if an mSBP<130 was required to achieve ≥80% control to <140/<90.

DESIGN

mSBP and per cent control to <140/<90 at the last encounter were assessed in a cross-sectional analysis of two cohorts with hypertension: (1) randomised, controlled Systolic blood PRessure Intervention Trial (SPRINT) and (2) real-world American Medical Association's Measure Accurately, Act Rapidly, Partner with patients Hypertension programme.

SETTING

SPRINT randomised participants with hypertension to two SBP targets: <140 (standard treatment, SPRINT-S) and <120 (intensive treatment, SPRINT-I). MAP (Measure Accurately, Act Rapidly, Partner with patients) included adults with hypertension at five healthcare systems incentivised by payers to control BP to <140/<90.

PARTICIPANTS

SPRINT participants with year 2 data. Patients in MAP (had hypertension, were aged≥18 years, had ≥2 healthcare visits from November 2019 through October 2021 and received care from clinicians (n=544) with ≥24 patients.

PRIMARY AND SECONDARY OUTCOME MEASURES

mSBP and control to <140/<90. In MAP, control to <140/<90 was assessed in clinicians grouped by 5 mm Hg increments in the mSBP of their patient panel.

RESULTS

In SPRINT-S (n=4303) and SPRINT-I (n=4323), mSBP values at the last visit were 136.7 and 121.7 with BP<140/<90 in 61% and 88% of participants, respectively. In MAP, mSBP at the last visit (n=168 978 patients) was 132.1 with BP<140/<90 in 70% of participants. Among clinicians with participant mSBP of 120 to <125, 88% of their patients were controlled to <140/<90, similar to SPRINT-I. Control fell to 79% of patients, with clinician-level mSBP of 125 to <130, 71%, with mSBP of 130 to <135 and 57%, with mSBP of 135 to <140 (similar to SPRINT-S); mSBP accounted for 80% of variance in clinician-level hypertension control.

CONCLUSIONS AND RELEVANCE

mSBP is strongly related to hypertension control. Moreover, mSBP<130 is required to attain control rates to <140/<90 in the range of 80% and higher.

Real-world utilization patterns and survival in men with metastatic prostate cancer treated with Radium-223 in the United States

BACKGROUND

The treatment landscape for metastatic castration-resistant prostate cancer (mCRPC) has evolved since radium-223 (Ra-223) was approved in the United States (2013). We examined treatment patterns and real-world overall survival (rwOS) of men with mCRPC treated with Ra-223 in the modern treatment era.

METHODS

A retrospective cohort of men treated with Ra-223 was derived using private insurance data from the Komodo Health dataset from January 1, 2017 to June 30, 2022. Cox-regression analyses examined associations between Ra-223 use and rwOS with adjustment for covariates.

RESULTS

Of 1376 men, the median age was 68 years, 51% were White, and 89% had bone-only metastases. Overall, 17%, 35%, and 25% of men received Ra-223 as first-line, second-line, or third-line treatment for mCRPC, respectively. Thirty-six percent received Ra-223 as combination/layered therapy, mainly with enzalutamide, and 46% completed ≥5 cycles. Overall, median rwOS was 22.9 months. Median rwOS was longer in men who completed ≥5 Ra-223 cycles versus 1-4 cycles (30.3 versus 15.3 months) and combination/layered therapy versus monotherapy (26.6 versus 20.5 months). Combination/layered therapy and completion of ≥5 Ra-223 cycles were associated with 22% and 55% reductions in risk of death in adjusted analyses, respectively. Limitations include some clinical information not captured by claims databases.

CONCLUSIONS

Significant rwOS benefits were identified in men who received Ra-223 as an earlier line of therapy, received Ra-223 in combination with another therapy, and completed ≥5 Ra-223 cycles, underscoring the importance of Ra-223 in the current treatment landscape.

Harms associated with prescription drug misuse in Ireland: A national observational study of trends in treatment demand, non-fatal intentional drug overdoses and drug related deaths 2010-2020

AIMS

To describe the health-related harms associated with the misuse of benzodiazepines/z-drugs, prescription opioids, gabapentinoids, and psychostimulants in Ireland by examining trends in their involvement in treatment demand, non-fatal intentional drug overdoses (IDOs), and drug related deaths (DRDs).

METHODS

A repeated cross-sectional study using data from the National Drug Treatment Reporting System (NDTRS), the National Self-Harm Registry Ireland (NSHRI) and the National Drug Related Deaths Index (NDRDI) between 2010 and 2020. Trends over time (2010-2020) in treatment demand, IDOs and DRDs involving benzodiazepines/z-drugs, prescription opioids excluding opioid agonist therapy drugs, gabapentinoids, or psychostimulants (alone or concurrently), adjusting for age and gender (Negative Binomial Regression).

FINDINGS

A total of 102,661 treatment entry cases; 51,126 people presenting with at least one IDO; and 3626 DRDs included. Benzodiazepines/z-drugs were involved in 341 per 1000 treatment entry cases; 408 per 1000 IDOs; and 546 per 1000 DRDs, followed by prescription opioids (36 per 1000 treatment entry cases; 133 per 1000 IDOs; and 207 per 1000 DRDs) and gabapentinoids (5 per 1000 treatment entry cases; 54 per 1000 IDOs; and 118 per 1000 DRDs). Benzodiazepines/z-drugs, and prescription opioid involvement was stable over time with little or no changes observed in treatment demand, IDOs and DRDs. However, NPS-Benzodiazepines (etizolam) involvement in DRDs increased by 47 % annually (Adjusted Rate Ratio (ARR) 1.47, 95 % Confidence Interval (CI) 1.30-1.65, p < 0.0001). Gabapentinoids (primarily pregabalin) associated with a large annual increase in treatment demand (+44 % annually, ARR 1.44, 95 % CI 1.36-1.52, p < 0.0001), DRDs (+35 % annually, ARR 1.35, 95 % CI 1.25-1.46, p < 0.0001), and IDOs (+9 % annually, ARR 1.09, 95 % CI 1.07-1.10, p < 0.0001). Polysubstance use harms increased with respect to treatment demand, IDOs and DRDs over study period.

CONCLUSIONS

While benzodiazepines account for the greatest overall harm with respect to treatment demand, IDOs and DRDs, gabapentinoids (primarily pregabalin) had the largest annual increase in harm over the study period.

Topographic Localization of Chronic Cerebellar Ischemic Lesions: Implications for Underlying Cause

BACKGROUND

Chronic cerebellar lesions of presumed ischemic origin are frequently found in patients with ischemic stroke and as incidental findings. However, the differentiation of embolic lesions from lesions caused by cerebral small vessel disease (SVD) is unclear. We aimed to investigate whether the location of chronic cerebellar ischemic lesions (deep versus cortical) indicates the underlying cause (embolic versus SVD).

METHODS

This study was a post hoc data analysis from the multinational ELAN trial (Early Versus Late Initiation of Direct Oral Anticoagulants in Patients With Postischemic Stroke With Atrial Fibrillation), which included patients with acute ischemic stroke and atrial fibrillation cohort between 2017 and 2022. For comparison, data from 2 cohorts (DiViNAS [Disease Variability in NOTCH3-Associated SVD] and VASCAMY [Vascular and Amyloid Predictors of Neurodegeneration and Cognitive Decline in Nondemented Subjects]) consisting of participants with hereditary cerebral SVD (ie, Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy) were analyzed (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy cohort). Brain magnetic resonance imaging scans were evaluated for presence and location of chronic cerebellar ischemic lesions. The association between these lesions and the severity of supratentorial SVD was analyzed using univariable and multivariable models, adjusting for key covariables.

RESULTS

In the atrial fibrillation cohort (N=790), 278 (35%) patients had chronic cerebellar ischemic lesions (cortical: n=242; deep: n=36). In multivariable analyses, features of cerebral SVD were associated with deep cerebellar ischemic lesions (summary SVD score; odds ratio per point, 2.5 [95% CI, 1.5-3.5]; P<0.001), while there was no association of SVD markers and cortical cerebellar ischemic lesions (summary SVD score; odds ratio per point, 1.1 [95% CI, 0.9-1.3]; P=0.107). In the Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy cohort (N=257), chronic cerebellar ischemic lesions (n=108 [42%]) were almost exclusively identified in deep cerebellar regions (n=101, 94%).

CONCLUSIONS

Chronic cerebellar ischemic lesions in deep but not cortical regions were associated with supratentorial cerebral SVD. Therefore, cerebral SVD is likely the primary cause of chronic ischemic lesions in deep cerebellar regions, while cortical cerebellar lesions are more likely attributable to embolic etiologies.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03148457.

Amputations in adult burns patients: a 10-year retrospective study

INTRODUCTION

Amputation is an uncommon but potentially life-changing complication of burns. No studies of amputation among UK burns patients currently exist.

METHODS

A 10-year review of burns patients with amputations at the Queen Elizabeth Hospital Birmingham was conducted. Descriptive analysis was undertaken to identify patient characteristics. Statistical analysis was conducted to identify relationships between patient and injury details and the number of amputations, and relationships between the number of amputations and patient outcomes.

RESULTS

Thirty-five adult burns patients (mean age 48.1 years, 65.7% male) were identified, 62.9% of whom suffered flame burns. The median total body surface area (TBSA) burned was 24%. The amputation risk among admitted burns patients was 1.2%. Major burns patients (≥25% TBSA burned) underwent more minor (p=0.018) and upper limb amputations (p=0.035) compared with minor burns patients. Median length of hospital stay was 67.5 days. Length of stay was positively correlated with the number of total (p=0.001), minor (p=0.004) and upper limb (p=0.002) amputations. In total, 67.6% of amputees underwent revisional procedures. The number of revisions was positively correlated with the number of major (p=0.010) and lower limb (p=0.001) amputations.

CONCLUSIONS

A minority of adult burns patients underwent amputations. Patient and injury information may predict a greater number of amputations, which in turn may predict longer hospital stays and a requirement for more revisional procedures. This information could be used to better counsel patients about their likely outcomes. A multicentre case-control study is required to clarify risk factors for amputation in burns.

A Neighborhood-Level Hispanic Paradox: The Interaction among Hispanic Density, Neighborhood Disadvantage, and Survival in Patients with Breast Cancer

BACKGROUND

To evaluate the impact of Hispanic ethnic enclaves (EE) on the relationship between neighborhood disadvantage and overall survival in patients with breast cancer.

METHODS

Data from patients with stage I to IV breast cancer diagnosed between 2005 and 2017 were used to analyze the effects of area deprivation index (ADI) scores, a measure of neighborhood disadvantage, and census tract-level Hispanic density, a measure of EE, on overall survival using mixed-effects Cox regression models. The final model included the individual-level factors [age, income, race, Hispanic/Latino origin, nativity, insurance status, and comorbidities (hypertension, diabetes, and body mass index)] and clinical factors (National Comprehensive Cancer Network guideline-concordant treatment, stage, and receptor subtype).

RESULTS

A total of 5,387 patients were analyzed. Fifty-two percent resided in Hispanic EE. Enclave residents were predominantly White (93%), with Cubans the predominant subgroup (37%). Overall, there were 1,040 deaths within the cohort. Patients residing in highly disadvantaged neighborhoods (ADI tertile 3) within Hispanic EE experienced reduced HR compared with those outside of EE, evidenced by the interaction effect {EE × ADI tertile 3 - HR [95% confidence interval (CI)], 0.66 (0.44-0.98)}.

CONCLUSIONS

Hispanic EE may protect against mortality in patients with breast cancer, suggesting that positive social factors help combat negative effects of neighborhood disadvantage for patients. Understanding the protective attributes of EE can help create effective cancer interventions and promote more equitable outcomes in minority populations.

IMPACT

This study found that EE may protect against mortality in patients with breast cancer, suggesting that positive social factors may help mitigate the negative effects caused by the neighborhood.

Validation of the Revised American Physical Therapy Association Physical Therapist Clinical Performance Instrument 3.0

OBJECTIVE

Validation of the revised American Physical Therapy Association (APTA) Physical Therapist Clinical Performance Instrument (PT CPI 3.0) is essential to ensure that we are effectively assessing Doctor of Physical Therapy (DPT) students' clinical performance. The purpose was to validate the revised PT CPI 3.0 for use with DPT students as a measure of clinical performance.

METHODS

A descriptive and exploratory combined cross-sectional retrospective and prospective cohort design was used. University DPT students' clinical education experiences were explored. Participants were selected using a convenience sample of 693 DPT students from 1 US multicampus DPT program(s) during Fall 2023 and Spring 2024 clinical education experiences. DPT students on (1) integrated (ICE) and (2) 2 terminal clinical education experiences (TCE I and TCE II) participated in the study. Clinical instructor PT CPI 3.0 item ratings of DPT students at midterm and final assessments during clinical education experiences were investigated. Descriptive and inferential statistics evaluated differences between clinical instructor PT CPI 3.0 item ratings of DPT students during clinical education experiences.

RESULTS

The PT CPI 3.0 demonstrated good internal reliability, and factor analysis with a 1-factor solution explained 81.3% of variance. Construct validity was supported by significant differences in PT CPI item scores between DPT students on ICE and each of TCE I and TCE II. Construct and convergent validity were supported by significant score increases from midterm to final assessments for DPT students on ICE and TCEs and by moderate to large correlations between prior clinical experiences and remaining didactic coursework.

CONCLUSION

Findings support validity of the revised PT CPI 3.0 as a measure of clinical performance. A limitation is that this study did not assess rater reliability.

IMPACT

This study provides preliminary support for validation of the newly revised APTA PT CPI 3.0 as a measure to assess entry-level physical therapist student clinical performance.

The impact of group music therapy on anxiety, stress, and wellbeing levels, and chemotherapy-induced side effects for oncology patients and their caregivers during chemotherapy: a retrospective cohort study

INTRODUCTION

Cancer is currently the second most common cause of death worldwide and is often treated with chemotherapy. Music therapy is a widely used adjunct therapy offered in oncology settings to attenuate negative impacts of treatment on patient's physical and mental health; however, music therapy research during chemotherapy is relatively scarce. The aim of this study is to evaluate the impact of group music therapy sessions with patients and caregivers on their perceived anxiety, stress, and wellbeing levels and the perception of chemotherapy-induced side effects for patients.

MATERIALS AND METHODS

This is a retrospective cohort study following the STROBE guidelines. From April to October 2022, 41 group music therapy sessions including 141 patients and 51 caregivers were conducted. Participants filled out pre- and post-intervention Visual Analogue Scales (VAS) assessing their anxiety, stress, and wellbeing levels, and for patients the intensity of chemotherapy-induced side effects.

RESULTS

The results show a statistically significant decrease of anxiety and stress levels (p < .001), an increase in well-being of patients and caregivers (p < .001, p = .009), and a decrease in patients' perceived intensity of chemotherapy-induced side effects (p = .003). Calculated effect sizes were moderate for anxiety, stress, and well-being levels, and small for chemotherapy-induced side effects.

DISCUSSION

This is the first study regarding group music therapy sessions for cancer patients and their caregivers during chemotherapy in Colombia. Music therapy has been found to be a valuable strategy to reduce psychological distress in this population and to provide opportunities for fostering self-care and social interaction.

CONCLUSIONS

Music therapy should be considered as a valuable complementary therapy during chemotherapy. However, it is crucial to conduct prospective studies with parallel group designs to confirm these preliminary findings.

Atrial fibrillation inpatient management patterns and clinical outcomes during the conflict in Syria: An observational cohort study

BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia worldwide. However, there is no data on AF inpatient management strategies and clinical outcomes in Syria.ObjectivesThe study aims were to review the inpatient management of patients with AF and assess cardiovascular (CV) mortality in a tertiary cardiology centre in Latakia, Syria.MethodsA single-centre retrospective observational cohort study was conducted at Tishreen's University Hospital, Latakia, Syria, from June 2021 to June 2023. Patients ≥16 years of age presenting and being treated for AF as the primary diagnosis with or without a thromboembolic event were included. Medical records were examined for patients' demographics, laboratory results, treatment plans and inpatient details. Studied outcomes include inpatient all-cause and CV mortality, ischemic and bleeding events, and conversion to sinus rhythm (SR).ResultsThe study included 596 patients. The median age was 58, and 61% were males. 121 patients (20.3%) were known to have AF. A rhythm control strategy was pursued in 39% of patients. Ischemic and bleeding events occurred in 62 (11%) and 12 (2%), respectively. CV and all-cause mortality occurred in 28 (4.7%) and 31 patients (5%), respectively. The presence of valvular heart disease (VHD) (adjusted odds ratio (aOR) = 9.1, 95% confidence interval (CI): 1.7 to 55.1, p < .001), thyroid disease (aOR: 9.7, 95% CI = 1.2 to 91.6, p < .001) and chronic obstructive pulmonary disease (COPD) (aOR: 82, 95% CI: 12.7 to 71, p < .001) were independent risk factors of increased CV inpatient mortality.ConclusionSyrian inpatients admitted with AF in Latakia are relatively younger than those in other countries. Active thyroid disease, COPD and VHD were independent risk factors of inpatient CV mortality with AF.

Cardiometabolic disease risk in relation to objectively measured physical activity, sedentary behaviour in South African adults with knee and hip osteoarthritis

PURPOSE

This study aimed to investigate the relationship between cardiometabolic disease risk and time spent in device-measured activity behaviours in a cohort of people with advanced osteoarthritis (OA) awaiting joint replacement surgery.

MATERIALS AND METHODS

Cardiometabolic risk biomarkers were assessed in people with OA (n = 96; hip n = 38, knee n = 58; mean (SD) age = 64.3 (9.8) years; 71% female). Physical activity (PA) and sedentary behaviour (SB) were measured by accelerometer over seven days (24 h/day).

RESULTS

There were similar patterns of PA and SB between the hip and knee OA participants except for total number of steps (hip = 3365 (2926) vs knee 4344 (2836) steps/day; p = 0.018) and total stepping time (hip = 50.8 (38.2) vs knee = 67.2 (38.5) min/day; p = 0.005). Each additional cardiometabolic risk factor accumulated was associated with a 26.3 min/day increase in sedentary behaviour (p = 0.032; 95% CI: 2.3, 50.2), a 26.3 min/day decrease in upright time (p = 0.032; -50.2, -2.3) and a 23.6 min/day decrease in standing time (p = 0.032; -45.1, -2.1).

CONCLUSIONS

In people with hip or knee OA, increased cardiometabolic disease risk was associated with more sitting and less upright and standing time. Findings support targeting reductions in sedentary behaviour for improvements in cardiometabolic health in people with osteoarthritis. IMPLICATIONS FOR REHABILITATIONKnee and hip osteoarthritis is a condition which is associated with an increased risk of cardiometabolic disease but also due to the low levels of physical activity and high levels of sedentary behaviour.Offsetting sedentary behaviour with light physical activity offers a feasible interventional target to reduce the risk of cardiometabolic disease in people with hip and knee osteoarthritis.

Associations of combined accelerated biological aging and genetic susceptibility with incidence of heart failure in a population-based cohort study

The global aging population raises concerns about heart failure (HF), yet its association with accelerated biological age (BA) remains inadequately understood. We aimed to examine the longitudinal association between BA acceleration and incident HF risk, assess its modifying effect on genetic susceptibility, and how much BA acceleration mediates the impact of modifiable health behaviors on incident HF. We analyzed 274,608 UK Biobank participants without HF at baseline. Two BA accelerations (Biological Age Acceleration [BioAgeAccel] and Phenotypic Age Acceleration [PhenoAgeAccel]) were calculated by regressing clinical biomarker-based BA on chronological age, with higher values indicating accelerated aging. Health behavior scores were computed based on diet, physical activity, tobacco/nicotine, sleep, and BMI. Genetic risk scores (GRS) were calculated by 12 HF-associated loci. During a median follow-up of 13.5 years, 8915 HF cases were documented. Each standard deviation increase in BioAgeAccel and PhenoAgeAccel was associated with an increased incident HF risk, yielding HRs of 1.45 (95% CI, 1.42-1.48) and 1.42 (95% CI, 1.40-1.45), respectively. Participants with high GRS and highest quartile of BioAgeAccel had an HR of 2.69 (95% CI, 2.42-2.99), and for PhenoAgeAccel, an HR of 2.83 (95% CI, 2.52-3.18), compared to those with low GRS, and lowest quartile. Additive interactions were observed between GRS and BA accelerations. Health behaviors reduced HF risk, with 21.1% (95% CI, 19.5%-22.8%) mediated by decreased BioAgeAccel and 20.9% (95% CI, 19.5%-22.6%) by decreased PhenoAgeAccel. Accelerated BA is associated with an increased incident HF risk, with an additive effect when combined with genetic susceptibility. Maintaining health behaviors may help mitigate BA aging and reduce HF risk.

The Direct Anterior Approach for AO/OTA43B and 43C Pilon Injuries

BACKGROUND

Pilon fractures carry high rates of early wound healing, infectious complications, and late posttraumatic arthrosis. When reconstructive procedures are indicated, these patients are at further risk for early complications. Perhaps using the same direct anterior (DA) approach for initial repair and later reconstruction might mitigate these risks, but the DA approach has not been explored for initial repair. This study aimed to evaluate the performance of the DA approach for internal fixation of pilon fractures. We hypothesized that the reoperation rate for fractures treated with the DA approach would not differ from other surgical approaches in our series.

METHODS

A retrospective chart and radiographic review of operative Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 43B and C fractures from 2013 to 2022 were undertaken. Using Kaplan-Meier estimations, the likelihood of reoperation within 1 year of index surgery was analyzed. Reoperation risk factors were determined using multivariable logistic regression analyses created using a backward stepwise process.

RESULTS

A total of 135 fractures in 130 patients were eligible for review. The overall reoperation rate was 40.7%. There was no significant difference between DA and all other approaches for rate of reoperation for infection (2.3% vs 10%, P = .21), nonunion (15.9% vs 16.5%, P > .99), posttraumatic osteoarthritis (PTOA) (9.1% vs 7.8%, P > .99), and removal of symptomatic hardware (25% vs 36.3%, P = .27). In multivariate regression analysis, DA approach was associated with a lower rate of reoperation within 1 year (odds ratio 0.25, 95% CI 0.07-0.71, P = .015).

CONCLUSION

The direct anterior approach can perform well for fixation of AO/OTA 43B and C fractures. Our retrospective series showed a favorable risk of reoperation at 1 year and a similar overall reoperation rate compared with all other combinations of approaches. Many factors determine the surgical approach to pilon fractures. This study has shown that the DA approach merits consideration as an option for open reduction and internal fixation.

Emergency department visits for undiagnosed pelvic organ prolapse

OBJECTIVES

To describe women presenting to the emergency department (ED) for previously undiagnosed pelvic organ prolapse (POP). Secondary objective was to determine rates of outpatient specialty follow-up and factors associated with accessing follow-up care.

STUDY DESIGN

Retrospective study of patients who presented at 3 EDs affiliated with an urban academic health system that received a new diagnosis of POP between January 2016 and September 2022. Data on demographics, chief complaint, evaluation and interventions performed in the ED, and follow-up care within 3 months post-ED discharge were abstracted from the medical chart. Descriptive statistics and bivariate analyses were used to compare characteristics of women who did and did not follow-up for specialty or subspecialty care.

RESULTS

56 patients met inclusion criteria. Mean age was 61.2 ± 17.1 years. The majority identified as either non-Hispanic Black (51.8 %) or Hispanic or Latino (25.0 %). 57.1 % of patients had public insurance. Less than half (42.8 %) of patients underwent follow-up care with a urogynecologist or gynecologist within 3 months after ED discharge. Race was found to be significantly associated with follow-up rates (P = 0.03), with non-Hispanic Black women experiencing the lowest rates (20.7 %) of follow-up.

CONCLUSIONS

POP causes sufficient distress to prompt an ED encounter. A subset of women overrepresented by Black and publicly insured women utilize the ED for initial POP evaluation, when compared to patients who access initial outpatient POP care. A minority of patients underwent outpatient follow-up. Further research is needed to understand care-seeking behaviors for POP and barriers to timely outpatient follow-up care.

High-impact trials with genetic and -omics information focus on cancer mutations, are industry-funded, and less transparent

OBJECTIVES

To assess how genetics and -omics information is used in the most cited recent clinical trials and to evaluate industry involvement and transparency patterns.

STUDY DESIGN AND SETTING

This is a meta-research evaluation using a previously constructed database of the 600 most cited clinical trials published from 2019 to 2022. Trials that utilized genetic or -omics characterization of participants in the trial design, analysis, and results were considered eligible.

RESULTS

132 (22%) trials used genetic or -omics information, predominantly for detection of cancer mutations (n = 101). Utilization included eligibility criteria (n = 59), subgroup analysis (n = 82), and stratification factor in randomization (n = 14). Authors addressed the relevance in the conclusions in 82 studies (62%). 102 studies (77%) provided data availability statements and six had data already available. Most studies had industry funding (n = 111 [84.0%]). Oncology trials were more likely to be industry-funded (90.1% vs 64.5%, P = .001), to have industry-affiliated analysts (43.6% vs 22.6%, P = .036), and to favor industry-sponsored interventions (83.2% vs 58.1% P = .004). When compared to other trials, genetic and -omics trials were more likely to be funded by industry (84% vs 63.9%, P < .001) and tended to be less likely to have full protocols (P = .018) and statistical plans (P = .04) available.

CONCLUSION

Our study highlights the current underutilization of genetic and -omics technologies beyond testing for cancer mutations. Industry involvement in these trials appears to be more substantial and transparency is more limited, raising concerns about potential bias.

Cow Hitch Cerclage Suture Fixation of the Greater Tuberosity in Reverse Total Shoulder Arthroplasty Performed for Proximal Humerus Fractures: A Retrospective Cohort Study With a Minimum Follow-up of 2 Years

Background

Reverse total shoulder arthroplasty (RTSA) is a well-established treatment option for complex proximal humeral fractures in older patients, with greater tuberosity (GT) healing being critical for achieving optimal clinical outcomes. We compared the clinical and radiological outcomes between 2 GT fixation techniques: the "cow hitch" (CH) cerclage suture fixation technique and conventional suture fixation technique.

Methods

This retrospective cohort study compared 20 consecutive patients who underwent RTSA using the CH cerclage suture fixation technique (CH group) with 29 consecutive patients who underwent RTSA using the conventional suture fixation technique (control group). Radiological healing of the GT was defined as the primary outcome parameter and assessed using standard radiographs at the last follow-up visit. Clinical outcomes were assessed as secondary outcome parameters and measured using the absolute and relative Constant-Murley scores (aCS and rCS), Subjective Shoulder Value (SSV), range of motion (ROM), and patient-reported outcome satisfaction (PROS).

Results

At a mean follow-up at 47 ± 30 (range, 24-120) months, the radiographic findings revealed a 95% healing rate of the GT in the CH group compared with a 66% healing rate in the control group (p = 0.03). No secondary displacement was observed in the CH group, whereas 5 cases (17%) were observed in the control group (p = 0.14). Overall, aCS, rCS, SSV, ROM (flexion, abduction, external rotation), and PROS were significantly higher in the CH group than in the control group (p-values: 0.03, 0.002, 0.004, 0.03, 0.01, 0.01, 0.047, respectively).

Conclusion

Compared with the conventional suture GT fixation technique, the CH cerclage suture fixation technique in RTSA performed for complex proximal humerus fractures resulted in higher healing rates with no secondary displacement of the GT, improved clinical outcomes, and enhanced patient satisfaction.

Level of Evidence

Level III (Retrospective cohort study). See Instructions for Authors for a complete description of levels of evidence.

Predicting disease-free survival following curative-intent resection of right-sided colon cancer using a pre- and post-operative nomogram: a prospective observational cohort study

INTRODUCTION

Disease prognostication can be achieved through the derivation of biologically and clinically integrated prediction models. The present study reports 1-, 3-, and 5-year disease-free survival (DFS) in patients undergoing right hemicolectomy for curative intent and both derives and validates a pre- and post-operative prediction tool for DFS for prognostication and risk stratification purposes.

METHOD

Consecutive patients undergoing right-sided curative-intent resection for colorectal cancer (2010-2020) in a tertiary care unit were followed-up prospectively for recurrence and survival outcomes. Survival analyses were used to derive pre- and post-operative models predicting 1-, 3-, and 5-year DFS. Calibration was reported and internal validation was performed using bootstrapping.

RESULTS

A total of 822 patients underwent resection and 528 had ≥5-year follow-up. The 1-, 3-, and 5-year DFS rates were 85.6%, 72.5% and 57.6%, respectively. Variables associated with death/recurrence included: increasing age (HR > 1.95, P = 0.037), male gender (HR 1.62, P < 0.001), ASA ≥3 (HR 1.79, P < 0.001), low albumin (HR 1.54, P < 0.001), T4 stage (HR 2.35, P = 0.023), R1 status (HR 1.63, P = 0.024), ≥4 positive lymph nodes (HR > 1.74, P < 0.001) and Clavien-Dindo ≥3 (HR 2.83, P < 0.001). The pre- and post-operative models contained 9 and 13 demographic, clinical, biochemical, operative and pathological variables, respectively (C-index 0.75 and 0.79, respectively). Excluding demographic, clinical and operative variables significantly reduced the C-index of the pre- (0.62) and post-operative models (0.70).

CONCLUSION

The presented prediction tools for DFS will help clinicians stratify risk, offer appropriate adjuvant treatment and predict long-term DFS following curative-intent right-sided colon cancer resection.

The Rate and Risk Factors of Deep Brain Stimulation-Associated Complications: A Single-Center Experience

BACKGROUND AND OBJECTIVES

Deep brain stimulation (DBS) is an established neurosurgical treatment of a variety of neurological disorders. DBS is considered a safe and effective neurosurgical procedure; however, surgical complications are inevitable, and clinical outcomes may vary. The aim of this study was to describe DBS complications at a large clinical center in the United States and to investigate the relationship between patients' baseline characteristics, surgical technique, and operative complications.

METHODS

We identified all patients who underwent DBS lead implantation at our center between 1st January 2012 and 1st January 2020. We extracted relevant information regarding patient demographics, surgical details, clinical complications, and clinical outcomes from the electronic medical records.

RESULTS

A total of 859 leads were implanted in 481 patients (153 men, 328 women). The mean patient age at the time of the surgery was 65 years, with the mean disease duration of 13.3 years. There were no mortalities and 57 readmissions within 30 days (mean = 14.2 days). The most common complications included pneumocephalus (n = 661), edema (n = 78), altered mental state (n = 35), implantable pulse generator discomfort (n = 34), hemorrhage (n = 26), and infection (n = 23). Most notably, the use of general anesthesia, hypertension, heart disease, and depression were associated with significantly longer postoperative stay. High preoperative body mass index was associated with higher rates of surgery-related infections and lead revision/explantation. The intraoperative mean arterial pressure, anesthesia type, and frame apparatus were all important predictors of postoperative pneumocephalus.

CONCLUSION

In this report, we described the rates and types of complications associated with DBS surgery at a large neurosurgical center in the United States. The novel insights highlighted in this study present an opportunity to further improve the clinical outcomes and patient selection in DBS surgery.

Impact loading exercise induced osteogenesis from childhood to early adulthood in tennis players aged 8-30 years

Osteogenesis with impact-loading exercise is often assessed by the extra bone growth induced in the loaded arm of tennis players. We used PRISMA to explore % bone mineral content (BMC) and area (BA) asymmetry in players 8-30 years according to weekly training hours, age, sex, maturity, and bone segment. Proper statistics for 70 groups were extracted by two reviewers from 18 eligible studies of low risk of bias (< 35, STROBE) and good quality (> 70%). The quality of the review was high (AMSTAR, 81%). Using "random effects" we tested moderation-specific meta-comparisons and meta-regressions. The loaded bones % hypertrophy was higher in BMC (19%) than BA (10%), and, with BMC and BA merged, in boys (17%) than girls (13%), in humerus (19%) than radius-ulna (14%), and in pubertal (19%) players. Weekly training hours were more important (43%) than sex (17%), puberty (14%) and bone (15%) in BMC, and puberty (48%) was more important than weekly training hours (19%), sex (12%), and radius-ulna (5%) in BA. The loaded bones % hypertrophy correlated with weekly training hours highly (> 0.60) in all maturity groups for BMC and BA, and moderately (0.41) in early adults for BA; it also correlated with age (≥ 0.60) in children and peripubertal players, but not (0.037) with starting age. Impact loading exercise favors mineralization twice than bone expansion, while puberty favors bone expansion about three times more than mineralization. The bone gains are higher for boys than girls, and for peripubertal than older players. The bone growth implications are discussed considering limitations and future research.

Investigating the synergistic effects of immunochemotherapy in esophageal squamous cell carcinoma

BACKGROUND

Although combinations of immune-checkpoint inhibitors (ICI) with chemotherapy have been approved for esophageal squamous cell carcinoma (ESCC), it remains unclear whether immunochemotherapy (ICT) offers advantages over the simple addition of individual monotherapies. This study aimed to investigate whether ICT exhibits a synergistic effect in patients with advanced ESCC.

METHODS

Reconstructed individual patient data of 3330 patients were electronically extracted from the Kaplan-Meier (KM) curves of eight randomized-controlled trials (ATTRACTION-3, CheckMate648, KEYNOTE-181, KEYNOTE-590, RATIONALE-302, RATIONALE-306, ESCORT, and ESCORT-1st). The observed progression-free survival (PFS) curve of each constituent monotherapies was used to estimate simulated PFS curves expected under a model of independent drug action. If the observed curve demonstrated significantly better PFS than the simulated curve, the combination of ICI and chemotherapy may have a synergistic effect, implying a superior outcome compared to simply adding the component monotherapy.

RESULTS

The 1-year, 2-year, and median PFS of the observed and simulated KM curves were 26.3% vs. 24.8%, 14.6% vs. 12.0%, and 6.9 vs. 6.4 months, respectively. The one-sample log-rank test showed no significant differences between the observed and simulated KM curves (p = 0.073).

CONCLUSIONS

The observed PFS with ICT was comparable to the simulated PFS estimated from the data for each monotherapy. Although it is unclear whether potential synergies exist for ICT, these findings suggest that the benefits of ICI and chemotherapy do not interfere with each other, thereby providing theoretical support for the efficacy of ICT.

Breastfeeding and Early Infant Feeding Practices Among Women in the Hunter New England Region of New South Wales, Australia: A Cross Sectional Study

ISSUE ADDRESSED

Exclusive breastfeeding to 6 months of age is recommended. Currently, there is a lack of Australian data exploring infant feeding behaviours and the sources of information women use to guide infant feeding decisions. This study aimed to describe (i) infant feeding practices (breastfeeding, infant formula/other fluids, introduction of solids) of women with infants aged 6-8 months; and (ii) the information sources women use most frequently and find most helpful to make decisions regarding infant feeding practices.

METHODS

Between August and October 2021, 356 mother-infant dyads in the Hunter New England region of New South Wales, Australia, were surveyed. Descriptive statistics and Kaplan-Meier survival analyses were used to describe infant feeding practices and their timing (age in months).

RESULTS

While breastfeeding was initiated in 97% of infants, only 1% were exclusively breastfed to 6 months of age. In the first month of life, 21% of infants received formula, increasing to 51% by 6 months. The mean age of introducing solids was 5.3 months. The most frequently used and helpful sources of information for infant feeding included friends and family, child and family health nurses, and digital sources (e.g., websites).

CONCLUSIONS

Infant feeding practices reported by Australian mothers remain inconsistent with the recommendations and should remain a key focus of public health nutrition efforts. SO WHAT?: Opportunity exists to provide consistent, credible, and evidence-based information via various modalities for both families and their support networks to promote best practice infant feeding.

The relationship between job stress and the perception of patient safety culture among Palestinian hospital nurses

BACKGROUND

Patient safety is a global concern, with high rates of medical errors reported annually. Understanding the relationship between nurses' job stress and patient safety culture (PSC) is crucial. Despite their pivotal role in healthcare, nurses face stress due to demanding job roles and the challenging healthcare system in Palestine. This study aims to explore the relationship between nurses' job stress and PSC in Palestinian hospitals, identifying predictors that impact PSC to enhance healthcare outcomes and support healthcare professionals.

METHODS

This study employed a quantitative cross-sectional approach. Data collection took place from June to September 2023. The study utilized self-report surveys, including the Hospital Survey of Patient Safety Culture (HSOPSC) and the Nursing Stress Scale (NSS), administered to 355 nurses working in 16 North West Bank hospitals in Palestine. The data collected were analyzed via descriptive and inferential analysis.

RESULTS

Overall, 47% of the nurses reported having positive PSC. The areas with the most positive perception were "teamwork" and "organizational learning-continuous improvement", with mean percentages of positive responses of 63.1% and 55.8%, respectively. Conversely, the composites with the lowest positive response scores included "Response to Error" and "Staffing and Work Pace", with mean percentages of positive responses of 30.9% and 34.8%, respectively. Furthermore, the most common sources of job stress perceived by nurses were "workload" and "death and dying", with mean scores of 1.42 and 1.20, respectively. However, the lowest-scoring sources of stress were in the subscales "Uncertainty concerning treatment" and "Inadequate preparation", with mean scores of 1.02 and 1.06, respectively. Statistical tests revealed that six factors were significantly associated with the perception of PSC. Among these factors, income, hospital type, activities to improve PSC, patient safety ratings of work areas, and weekly night shifts emerged as predictors of PSC. Additional tests revealed nine factors significantly associated with job stress. Among these factors, gender, educational level, engagement in stress relief activities, participation in PSC improvement activities, and patient safety ratings emerged as predictors of job stress. Moreover, the study revealed negative correlations between job stress and PSC.

CONCLUSION

This study identified the need for tailored policies and interventions that address nurses' specific stressors to enhance PSC within hospital settings. Moreover, the study shed light on the unique challenges faced by nurses in Palestine, such as limited resources, unemployment concerns, staffing, and transportation issues, which further exacerbated job stress levels and potentially compromised patient safety. Understanding these contextual factors is crucial for developing targeted interventions and support systems that prioritize the holistic well-being of nurses and the quality of patient care delivery.

Evaluating the accuracy and reliability of non-piezo portable ultrasound devices in postpartum care

INTRODUCTION

The early diagnosis of hemorrhage via postpartum ultrasound is crucial to initiate therapy and, thus, prevent maternal death. In these critical situations rapid availability and simple transport of ultrasound devices is vital, paving the way for a  new generation of portable handheld ultrasound devices (PUD) consisting of transducers and tablets or smart phones. However, evidence to confirm the diagnostic accuracy of these new devices is still scarce.

METHODS

The accuracy and reliability of these new devices in relation to established standard ultrasound devices is analyses in this pilot study by comparing diagnoses and by applying statistical analysis via Bland-Altman plots, intraclass correlation coefficients (ICC), and Pearson correlation coefficients (PCC). One hundred patients of a university hospital were included in this study.

RESULTS

In all cases, the same diagnosis was made regardless of the applied ultrasound device, confirming high accuracy. There was a high correlation (PCC 0.951) and excellent agreement (ICC 0.974) in the assessment of the cavum, while the assessment of the diameters of the uterus showed only a good correlation and a good agreement. Subgroup analysis for maternal weight, mode of delivery and day after delivery was performed  CONCLUSION: The same diagnosis independent of the used devices and excellent results of the cavum assessment promote the use of PUDs in a clinical setting. The slightly lower accuracy in the measurement of the uterus may be caused by the PUD's small acoustic window, reflecting one of its weaknesses. Therefore, the patient may benefit from the short time to diagnosis and the unbound location of examination, either in the delivery room, on the ward, or at home.

Catastrophizing and fear avoidance beliefs in chronic low back pain: a cross-sectional study

BACKGROUND

Chronic low back pain continues to be a challenge in everyday rehabilitation services as improvement keeps being unpredictable.

AIM

To evaluate the role of pain coping strategies, fear-avoidance beliefs, anxiety and depression in pain and disability in patients with chronic low back pain.

DESIGN

A cross sectional study.

SETTING

Rehabilitation and Orthopedic departments in four tertiary hospitals in Spain.

POPULATION

Overall, 276 patients (200 women) with nonspecific low back pain according COST-B13 guidelines and lasting more than 6 months.

METHODS

Pain, disability, coping strategies, catastrophizing, anxiety, depression and fear-avoidance beliefs were evaluated with validated questionnaires. Predictive associations of disability and pain were analyzed by Pearson's test and by multivariate regression.

RESULTS

Catastrophizing is the pain coping strategy with the highest association with disability (r=0.52, P<0.01). Low back pain and disability showed little correlation in between (r=0.40, P<0.01). The correlation between fear-avoidance ideas and pain and disability was slight (r=0.20, P<0.01). No association was found between anxiety and depression with low back pain and disability. In the regression model, catastrophizing, kinesiophobia and gender explained 35% of the variance in disability. In the subanalysis of patients with surgical indication the influence of catastrophizing was maintained. However, correlation between pain and disability is lower than in patients without surgical indication.

CONCLUSIONS

The limited correlation between pain and disability suggests that pain alone cannot explain the variability of disability. Catastrophizing and kinesiophobia are predictors of the degree of disability in chronic low back pain and are cognitions potentially modifiable.

CLINICAL REHABILITATION IMPACT

These results support the biopsychosocial model in the pathogenesis of chronic low back pain and support the use of cognitive behavioral therapy to modify maladaptive beliefs and attitudes as part of medical or surgical treatment in low back pain.

Beyond the guidelines: original research on real-world outcomes of anticoagulation and corticosteroid in COVID-19

BACKGROUND

The COVID-19 pandemic has led to the widespread use of anticoagulation (AC) and corticosteroids (CCS) for hospitalized patients, but real-world outcomes may differ from clinical trial findings due to diverse patient populations and treatment variability.

OBJECTIVE

To evaluate the real-world impact of AC and CCS therapies on key clinical outcomes in hospitalized COVID-19 patients.

DESIGN

Multicenter, retrospective observational cohort study conducted across 11 hospitals in a Midwest health system.

PARTICIPANTS

The study included 4754 hospitalized COVID-19 patients treated with AC, CCS, both (AC+CCS), or neither. The 'neither' group served as the reference for comparisons.

INTERVENTIONS

Interventions included administration of AC, CCS, both AC+CCS, or no intervention.

MAIN MEASURES

Primary outcomes included thromboembolism (TE), bleeding events, ICU admissions, invasive mechanical ventilation (IMV), and in-hospital mortality.

KEY RESULTS

Compared to the reference group, the AC+CCS group had significantly lower odds of TE (aOR 0.61, 95% CI 0.43-0.87) and bleeding events (aOR 0.15 95% CI (0.08, 0.27)). The AC-only group demonstrated the lowest ICU admission, IMV, and mortality rates (aHR 0.30 95% CI (0.17, 0.53)). The CCS-only group had the highest rates of adverse outcomes, likely reflecting greater baseline illness severity.

CONCLUSIONS

This study emphasizes the importance of individualized treatment strategies in hospitalized COVID-19 patients, showing that real-world outcomes of AC and CCS can differ significantly from controlled trials. These findings provide crucial insights for adapting clinical guidelines to diverse patient settings.

Evaluating the impact of severe hypoglycaemia definition wording on severe hypoglycaemia history assessment

AIM

Several wordings of the definition of severe hypoglycaemia (SH) exist. This study aims to evaluate how different SH definition wordings affect SH history assessment.

METHODS

In this cross-sectional study, surveys were emailed to registrants of the T1D Exchange, a U.S. national type 1 diabetes patient registry. Participants' demographic information was collected. Six-month SH history was evaluated with questionnaires including SH definition wordings from either (1) professional societies, (2) a diabetes community website, or (3) a hypoglycaemia research questionnaire. Analyses included the McNemar test, pairwise Wilcoxon signed-rank test, logistic regression analysis, Kappa statistics, and Spearman correlation.

RESULTS

A total of 1580 valid responses were obtained from participants (52% female; mean ± SD age: 46 ± 15 years; 95% White; mean ± SD diabetes duration: 25 ± 16 years). Questionnaires with four different SH definition wordings yielded significant variations in the prevalence of SH (i.e., having developed at least one episode of SH) and the number of SH episodes: the ADA/ENDO 2013 definition wording yielded the highest results on both metrics, whereas HypoA-Q and ADA 2023 yielded the lowest. Among participants reporting at least one SH episode, the number of episodes identified with the different SH definition wordings was poorly correlated (Rs: 0.09-0.37; p < 0.001). Race, education level, and household income were associated with higher odds of discrepancies in SH history (p < 0.05).

CONCLUSION

This U.S. national survey with individuals living with type 1 diabetes demonstrated significant discrepancies in SH history when assessed with different SH definition wordings. Race and socioeconomic status were associated with these discrepancies.

Implications of an individualized resuscitation strategy using continuous rhythm and physiologic status assessment during ongoing CPR

BACKGROUND

Prior studies have proposed defibrillator biosignal algorithms which characterize cardiac arrest rhythm and physiologic status. We evaluated whether a novel, individualized resuscitation strategy that integrates multiple ECG and impedance-based algorithms could reduce CPR interruptions and better align rescuer actions with patient-specific physiology.

METHODS

In a retrospective cohort of ventricular fibrillation out-of-hospital cardiac arrests, observed rescuer actions (rhythm analysis, shock delivery, pulse checks, and drug therapy) were compared to hypothetical actions recommended by the proposed individualized strategy. Misdirected drug therapy was defined as either (1) epinephrine when the algorithm predicted a spontaneous pulse or (2) antiarrhythmic during predicted bradyasystole. Clinically avoidable actions included delivering a shock without restoring return of spontaneous circulation (ROSC) and interrupting CPR for pulse assessment when no spontaneous pulse was present.

RESULTS

Of 390 cases, 46% survived to hospital discharge. The individualized treatment strategy achieved comparable shock decision accuracy (95% sensitivity, 98% specificity) to observed care while decreasing median CPR interruption for shock from 12 to 6 s. The individualized strategy also identified 17% of 597 epinephrine and 9% of 248 antiarrhythmic administrations as misdirected. Following 1334 ventricular fibrillation shocks, the frequency of post-shock ROSC was 4% when its predicted probability was low versus 22% when not. During 1088 pulse checks, pulse was present in 5% when predicted probability of spontaneous pulse was low versus 35% when not.

CONCLUSIONS

An individualized resuscitation strategy could improve CPR interruption, medication administration, shock delivery, and pulse assessment. Prospective evaluation is required to assess clinical benefit.

Relapses in giant cell arteritis treated with tocilizumab. Retrospective multicenter study of 407 patients in clinical practice

OBJECTIVE

Tocilizumab (TCZ) is the only biologic approved in Giant Cell Arteritis (GCA). In clinical trials around a quarter of patients relapse during TCZ treatment. We assess the frequency, features and factors associated with relapses in a wide series of GCA patients in a real-world setting.

METHODS

National multicenter observational study of GCA patients treated with TCZ between 2016 and 2021. The variables collected at TCZ initiation were demographic, clinical, laboratory, temporal artery biopsy, and imaging findings, corticosteroids dose, previous therapies and TCZ therapeutic schedule. We perform a comparative study between patients with/ without relapses (bivariate analysis) and a study of factors associated with relapse (multivariate logistic).

RESULTS

We study 407 patients (295 women; mean age 73.6 ± 8.9 years). After a mean follow-up of 25.3 ± 21.7 months, relapses were observed in 63 of 407 (15.5 %) patients. At TCZ initiation, no differences were observed between both groups (with/without relapses) in demographic, clinical and laboratory features or corticosteroid dose. The median time to the first relapse was 12 [6-24] months being the most frequent manifestations polymyalgia rheumatica (47.6 %), and headache (12.7 %). In multivariate logistic regression analysis, the set of variables associated with GCA relapses were TCZ initiation later than 6 weeks (OR 3.446 [1.196- 9.931]), optimization (OR 2.803 [1.507-5.215]) and administration of IV TCZ (OR 2.327 [1.244-4.353]) and previous therapies to TCZ (OR 5.062[2.402-10.665]).

CONCLUSION

In this series, GCA relapses were observed in 15 % of patients, all of them non-severe. Relapses were associated with TCZ therapeutic schedule, such as IV administration, optimization, delayed initiation and previous therapies to TCZ.

Respiratory morbidity before and during the COVID-19 pandemic from birth to 18 months in a Swedish birth cohort

BACKGROUND

Respiratory infections in early life are an identified risk factor for asthma. We hypothesized that infection-prevention measures during the coronavirus disease 2019 (COVID-19) pandemic influenced the risk of respiratory morbidity and aeroallergen sensitization in early childhood.

OBJECTIVE

We compared respiratory morbidity and aeroallergen sensitization in children born before and during the pandemic.

METHODS

We compared a COVID-19 category (exposed children; n = 1661) to a pre-COVID-19 category (nonexposed children; n = 1676) by using data from the prospective population-based NorthPop Birth Cohort study in Sweden. Data on respiratory morbidity and concomitant medication were retrieved from national registers. Prospectively collected data on respiratory morbidity using web-based questionnaires at 9 and 18 months of age were applied. At age 18 months, serum IgE levels to aeroallergens were determined (n = 1702).

RESULTS

The risk of developing any respiratory tract infection (adjusted odds ratio [aOR] = 0.33 [95% CI, 0.26-0.42]), bronchitis (aOR = 0.50 [95% CI, 0.27-0.95]) and croup (aOR = 0.59 [95% CI, 0.37-0.94]) were decreased in the COVID-19 category. The risk of wheeze in the first 9 months was lower in the COVID-19 category (aOR = 0.70 [95% CI, 0.55-0.89]). There were also fewer prescriptions of antibiotics in the COVID-19 category. The prevalence of aeroallergen sensitization was similar between categories.

CONCLUSION

Children born during the COVID-19 pandemic demonstrated significantly decreased risks of respiratory infections and prescribed antibiotics until 18 months of age compared to children born before the COVID-19 pandemic. Whether this will affect the risk of developing asthma in childhood is being followed.

Validation of a generative artificial intelligence tool for the critical appraisal of articles on the epidemiology of mental health: Its application in the Middle East and North Africa

Mental health disorders have a high disability-adjusted life years in the Middle East and North Africa. This rise has led to a surge in related publications, prompting researchers to use AI tools like ChatGPT to reduce time spent on routine tasks. Our study aimed to validate an AI-assisted critical appraisal (CA) tool by comparing it with human raters. We developed customized GPT models using ChatGPT-4. These models were tailored to evaluate studies using the Newcastle-Ottawa Scale (NOS) or the Jadad Scale in one model, while another model evaluated STROBE or CONSORT guidelines. Our results showed a moderate to good agreement between human CA and our GPTs for the NOS for cohort, case control and cross-sectional studies and for the Jadad scale, with an ICC of 0.68 [95 %CI: 0.24-0.82], 0.69 [95 %CI: 0.31-0.88], 0.76 [95 %CI: 0.47-0.90] and 0.84 [95 %CI: 0.57-0.94] respectively. There was also a moderate to substantial agreement between the two methods for STROBE in cross sectional, cohort, case control studies, and for CONSORT in trial design, with a K of 0.63 [95 %CI: 0.56-0.70], 0.57 [95 %CI: 0.47-0.66], 0.48 [95 %CI: 0.38-0.50] and 0.70 [95 %CI: 0.63-0.77] respectively. Our custom GPT models produced hallucinations in 6.5 % and 4.9 % of cases, respectively. Human raters took an average of 19.6 ± 4.3 min per article, whereas our customized GPTs took only 1.4. ChatGPT could be a useful tool for handling repetitive tasks yet its effective application relies on the critical expertise of researchers.

Cancer risk subsequent to cardiovascular disease: a prospective population-based study and meta-analysis

BACKGROUND

Previous preclinical studies have revealed the biological links between cardiovascular diseases (CVD) and cancer. However, population-based evidence remained inconclusive.

METHODS

We assessed cancer incidence among individuals with and without CVD condition in a prospective cohort from the UK Biobank (UKB). Multivariable Cox regression and competing risk models were fitted to estimate hazard ratios (HR). A systematic literature search was conducted in Medline, Embase and Cochrane Library databases to identify published population-based cohort studies (last updated on 1 October 2023) investigating the associations between CVD status and subsequent cancer risk. Random-effects meta-analysis was employed to pool relative effect estimates reported by eligible cohorts. Subgroup and sensitivity analyses were conducted to evaluate the associations across various CVD and cancer subtypes.

RESULTS

For the cohort study in the UKB, after a median follow-up of 11.58 years, a total of 18,471 and 66,891 cancer cases occurred among 94,845 CVD patients and 368,695 non-CVD individuals (Incidence rate: 25.62 vs. 15.41 per 1000 person-years). Individuals with prior CVD exhibited higher overall cancer risk (HR 1.14, 95% CI 1.12-1.17, p < 0.001), and we observed consistently higher cancer risk after adjusting for competing risk from non-cancer deaths. The effect size of CVD on cancer risk was greater among younger individuals (< 65 years) than those ≥ 65 years (p for interaction < 0.001). The meta-analysis included 47 population-based cohort studies where a total of 1.49 million cancer cases were documented among over 45 million participants (9.49 million CVD patients). A 13% higher risk of overall cancer was observed among individuals with prior CVD (pooled RR 1.13, 95% CI 1.11-1.15, p < 0.001). The associations remained significant between various CVD subtypes and cancer risk at multiple sites.

CONCLUSIONS

Our study identified a significantly higher cancer risk among individuals with CVD conditions compared with the non-CVD population, underpinning the need for continued cancer surveillance among CVD patients and further exploration of the possible etiological relation between CVD and cancer.

Disparities in troponin and ECG testing among emergency department patients with chest pain

BACKGROUND

Prior studies have highlighted disparities in the evaluation of chest pain based on patient race and sex. However, these studies were limited by small sample sizes and may not represent national practice patterns. This study evaluated differences in electrocardiogram (ECG) and troponin testing among emergency department (ED) patients presenting with chest pain or anginal-equivalent symptoms, focusing on variations by sex, race, ethnicity, and primary spoken language.

METHODS

A retrospective cohort study of patients presenting with chest pain or anginal-equivalent symptoms from 01/01/2016-12/31/2023 was conducted by searching the Epic Cosmos research platform separately for ECG and troponin testing. ECG and troponin testing rates were stratified and analyzed by age, sex, race, ethnicity, and primary language. Conditional logistic regression was used to calculate odds ratios (OR) with 95 % confidence intervals (CI).

RESULTS

Among 205,526,173 adult ED visits, 37,138,334 (18.1 %) met the inclusion criteria for chest pain or anginal-equivalent symptoms. For patients with full demographic data available, 30,648,879 of 36,672,008 (83.6 %) and 26,615,155 of 36,672,075 (72.6 %) underwent ECG and troponin testing, respectively. ECG testing was more frequent in male patients (OR:1.059; 95 %CI:1.058-1.060), Asian patients (OR:1.006; 95 %CI:1.004-1.009), and patients primarily speaking Spanish (OR:1.039; 95 %CI:1.040-1.042) or other non-English languages (OR:1.054; 95 %CI:1.051-1.056). However, it was less frequent among Black or African American patients (OR:0.955; 95 %CI:0.954-0.956) and individuals identifying as other races (OR:0.961; 95 %CI:0.959-0.963). Troponin testing was also more common in male patients (OR:1.087; 95 %CI:1.086-1.087) and those primarily speaking Spanish (OR:1.016; 95 %CI:1.014-1.019) or other non-English languages (OR:1.064; 95 %CI:1.061-1.067), but less common among Hispanic or Latino patients (OR:0.923; 95 %CI:0.921-0.924) and non-white patients (OR range:0.918-0.950).

CONCLUSIONS

Disparities in ECG and troponin testing were identified among ED patients presenting with chest pain or anginal-equivalent symptoms. Testing rates were lower in female and non-white patients, while patients primarily speaking non-English languages had higher testing rates.

Oral adverse effects of head and neck radiotherapy with/without chemotherapy in a southern Brazil hospital

The aim of this study was to evaluate the main oral adverse effects and their relationship with dental care before radiotherapy (RT) and combined RT and chemotherapy (RT+CT). Additionally, we assessed the association of other risk factors with the development of these adverse effects. This paper is a retrospective cross-sectional analytical study of data from medical records of patients with head and neck cancer (HNC) who underwent RT or RT+CT attended at the stomatology unit in a southern Brazil hospital. The records of 78 patients with HNC were accessed. Demographic data, tumor characteristics, cancer treatment, follow-up data, adverse effects, and dental treatment prior to RT were evaluated individually for descriptive analysis. Kaplan-Meier survival curves were plotted. Risk factors were assessed using chi-square or Mann-Whitney test. The results showed that most patients were male (88.3%) in their 6th decade of life. Tumors were mostly located in the oral cavity (52.6%) and squamous cell carcinoma was the main diagnosis (94.8%). Most cases were diagnosed in advanced stages (67.9%). RT was of 2D or 3D types in 93.6% of patients. Oral adverse effects were observed in 94.7% of patients treated with RT or RT+CT. Osteoradionecrosis (ORN), oral mucositis (OM), candidiasis, and xerostomia were the main complications. Patients who received 2D RT had higher risk of developing ORN and xerostomia compared to those who received 3D RT. The risk of developing ORN was higher in smokers compared to non-smokers and in patients who had not previously consulted a dentist. This study showed that patients who underwent RT for HNC have a high occurrence of oral complications. Dentists play a key role in the management of these oral side effects.

Use of healthcare administrative claims data in observational studies of antirheumatic drug effects on pregnancy outcomes: A scoping review

The safety of antirheumatic drugs in pregnancy and their impact on maternal and neonatal outcomes are understudied. Despite pregnant individuals being excluded from clinical trials, their continued use of medications raises the importance of addressing knowledge gaps regarding safety and impact on outcomes. A scoping review was conducted following JBI methodology and PRISMA reporting guidelines to describe how antirheumatic drugs and associated adverse pregnancy outcomes have been investigated in observational studies using claims data. Electronic databases (MEDLINE (Ovid), Embase (Ovid), and CINAHL (EBSCO)) and grey literature were searched for observational studies using claims data to evaluate antirheumatic drug effects on pregnancy outcomes in individuals with rheumatic diseases. Of 4,325 articles identified, 38 eligible articles were included. The effects of conventional synthetic disease-modifying antirheumatic drugs (n =  37, 97.4%) and tumor necrosis factor inhibitor biological agents (n =  23, 60.5%) were extensively reported. Preterm birth (n =  25, 65.8%), preeclampsia (n =  17, 44.7%), stillbirth (n =  17, 44.7%), caesarean delivery (n =  16, 42.1%), and congenital anomalies (n =  14, 36.8%) were the most reported adverse pregnancy outcomes. Of 14 studies reporting congenital anomalies, 12 (85.7%) specified ICD codes and 4 (28.6%) specified validated definitions for identification in claims data, the most of any reported adverse pregnancy outcome. We found considerable ambiguity and heterogeneity in adverse pregnancy outcome definitions in claims data. There is a need for greater transparency and consistency in outcome reporting in observational studies using claims data. Protocol registration details: OSF, https://osf.io/5e6tp.

Microsatellite Instability as a Risk Factor for Occult Lymph Node Metastasis in Early-Stage Endometrial Cancer: A Retrospective Multicenter Study

OBJECTIVES

This study investigates the association between microsatellite instability (MSI) and the risk of occult lymph node metastases (LNMs) in patients with early-stage endometrial cancer (EC) who showed no evidence of nodal involvement on preoperative imaging.

METHODS

A retrospective multicenter cohort study was conducted, including 237 patients with EC who underwent primary staging surgery between January 2022 and October 2024. The patients were stratified into two groups based on MSI status. The primary outcome was the prevalence of occult LNMs. Statistical analyses included univariate and multivariate logistic regression models, adjusting for potential confounders such as tumor grading and lymphovascular space invasion (LVSI). The significance of the models was assessed using the maximum likelihood method and Bayesian Information Criterion (BIC). Measures to reduce bias included blinding the data analyst, standardization of histopathological evaluation, and exclusion of patients with genetic conditions predisposing to MSI.

RESULTS

The MSI group had a significantly higher incidence of occult LNMs compared to the MSS group (19% vs. 6.7%, p = 0.005). The multivariate analysis confirmed MSI as an independent risk factor for LNMs (OR = 1.105, 95% CI 1.016-1.202, p = 0.020). The sub-analysis showed that loss of MLH1/PMS2 or both MLH1/PMS2 and MSH2/MSH6 heterodimers further increased LNMs risk, independently from other risk factors.

CONCLUSIONS

MSI is independently associated with a higher risk of occult LNMs in early-stage EC, suggesting a potential role for MSI profiling in refining lymph node staging strategies. Future prospective studies should assess the prognostic impact of this association and its implications for surgical decision-making.

The surgical clinical training measurement: developing and evaluating the quality of surgical clinical training among Syrian surgical residents

BACKGROUND

Evaluation tools for training programs vary, necessitating a standardized tool for assessing surgical clinical training quality to enhance program effectiveness, pinpoint improvement areas, and ensure resident readiness for independent practice. We present a new tool designed to provide a reliable and consistent framework for evaluating the effectiveness of surgical clinical training.

METHODS

The Surgical Clinical Training Measurement (SCTM) was developed using the modified Delphi method to evaluate ten variables, including core competencies specific to surgical training. It employs a 5-point Likert scale, with scores ranging from 40 to 200. General surgery residents completed the SCTM twice to evaluate training levels. Results were categorized based on score ranges. Statistical analysis via SPSS included descriptive statistics, group comparisons, internal consistency assessments, correlations, and reliability tests to evaluate the SCTM scores, demographic characteristics, and language versions. ANOVA, Chi-Square, Cohen Kappa, and Spearman's rho tests were employed for data analysis.

RESULTS

74 general surgery residents at Aleppo University Hospital have participated in this study. The SCTM scores indicated a mean total score of 131.42, with most residents falling into the good satisfactory category. Analysis showed no significant differences in total scores across specialty years, but post-hoc tests revealed differences between specific years. The SCTM demonstrated strong reliability, with a Kappa value of 0.884 indicating high agreement between English and Arabic versions (p < 0.05). Test-retest reliability was also high (r = 0.964, p < 0.01). Internal consistency was excellent across various domains, reinforcing its validity in surgical education. The analysis of variables showed different levels of reliability and mean scores among the various factors. The Pre-Operative Clinical variable had the highest performance, while the Evidence-Based Quality Clinical Training variable indicated the most potential for improvement. The strong positive correlations between various domains of SCTM emphasize the interconnected nature of skill development, with proficiency in patient care closely linked to competency in other areas such as Medical Knowledge, Practice-based Learning and Improvement, and Evidence-Based Quality Clinical Training.

CONCLUSION

SCTM offers a standardized and cohesive method for evaluating the quality of surgical clinical training. It's a valuable resource for program directors, educators, and residents to assess and enhance training programs, and identify specific areas for improvement. Additional research is required to validate the SCTM in different settings and explore its applicability in other fields.

CLINICAL TRIAL NUMBER

Not applicable.

Impact of Manual Therapy on Plantar Pressures in Patients with Fibromyalgia: A Single-Arm, Non-Randomized Pilot Clinical Trial

BACKGROUND

Fibromyalgia (FM) is a chronic disorder causing widespread musculoskeletal pain, often leading to physical deconditioning that affects posture and gait. This study evaluates the effects of a manual therapy protocol targeting dorsal muscles in the lower back on plantar pressure modifications, considering body mass index (BMI) influence.

METHODS

A single-arm, non-randomized clinical trial included 24 women diagnosed with FM for at least three years. They underwent an eight-session manual therapy protocol over four weeks, applying moderate pressure to dorsal muscles in the lower back. Baropodometric analyses were conducted pre- and post-intervention under dynamic conditions. Statistical analyses used paired t-tests and effect size calculations to assess intervention effects and BMI impact.

RESULTS

Significant improvements in plantar pressure distribution were observed in both the left foot (p = 0.01, d = -0.54) and the right foot (p = 0.008, d = -0.59). However, strength and peak pressure metrics showed no significant changes. Patients with normal BMI exhibited greater improvements than those in the overweight category.

CONCLUSIONS

Preliminary findings suggest that manual therapy positively influenced plantar pressure distribution in FM patients, particularly in those with normal BMI. Further research is needed to explore long-term effects and broader clinical applications.

The impact of initiation timing of continuous renal replacement therapy on outcomes in critically ill patients with acute kidney injury a retrospective study from the MIMIC-IV database

Acute kidney injury (AKI) is common in critically ill patients, optimal timing for initiation of renal replacement therapy (RRT) for AKI but without life-threatening indications is unclear. A retrospective study was performed using the medical information mart for intensive care (MIMIC-IV), including AKI patients identified based on kidney disease improving global outcomes (KDIGO) definition. The time to initiate CRRT was defined as the interval from first diagnosis of AKI to the initiation of CRRT, analyzed as a continuous variable. The primary outcome was 28-day mortality, restricted cubic splines (RCS) to assess the relationship between CRRT initiation timing intervals and clinical outcomes. The study included 673 patients, with a 28-day mortality rate of 38.78%. RCS analysis revealed no significant association between variations in CRRT timing intervals and 28-day mortality (P > 0.05). In the subgroup of patients with non-renal SOFA scores < 8, observed an increase in 28 day mortality (OR 1.011 [95% CI 1.001-1.021], P < 0.05), along with a greater likelihood of reduced 28-day CRRT, mechanical ventilation (MV), and ICU-free days for each 1-h delay in CRRT initiation (OR - 0.037 [95% CI - 0.064 to - 0.010], P < 0.05; OR - 0.051 [95% CI - 0.078 to - 0.024], P < 0.05; OR - 0.056 [95% CI - 0.082 to - 0.003], P < 0.05). The findings indicate that while no significant relationship exists between mortality and the timing of CRRT initiation, patients with lower non-renal SOFA scores who initiate RRT promptly may experience improved clinical outcomes. Further exploration and validation require the adoption of novel research methodologies and more pertinent clinical studies.

Real-World Type 2 Diabetes Second-Line Treatment Allocation Among Patients

Objective

This study aimed to evaluate the impact of socioeconomic disparities on the allocation of second-line treatments among patients with type 2 diabetes (T2D).

Materials and Methods

We conducted an observational study using real-world data from over 9 million patients across five University of California Health centers. The study included patients who initiated a second-line T2D medication after metformin, with hemoglobin A1c (HbA1c) measurements within ±7 days of treatment initiation from 2012 through September 2024. Multinomial regression models assessed the association between socioeconomic status and second-line treatment choices. Additionally, we used the GPT-4 large language model with a zero-shot learning approach to analyze 270 clinical notes from 105 UCSF patients. GPT-4 identified adverse social determinants of health (SDOH) across six domains: transportation, housing, relationships, patients with children, support, and employment.

Results

Among 15,090 patients (56.7% male, 43.3% female; mean age 59.3 years; mean HbA1c 8.91%), second-line treatments included sulfonylureas (SUs; n = 6,732), DPP4 inhibitors (n = 2,918), GLP-1 receptor agonists (n = 2,736), and SGLT2 inhibitors (n = 2,704). Patients from lower socioeconomic neighborhoods were more likely to receive SUs over other medications: DPP4i (OR = 0.96, [95% CI, 0.95-0.98]), GLP-1RA (OR = 0.94, [95% CI, 0.92-0.96]), SGLT2i (OR = 0.95, [95% CI, 0.93-0.97]). In UCSF clinical notes, we identified adverse SDOH including housing (n=8), transportation (n=1), relationships (n=22), employment (n=12), support (n=1), and patients with children (n=25).

Conclusions

Socioeconomic factors influence second-line T2D treatment choices. Addressing these disparities is essential to ensuring equitable access to advanced T2D therapies.

Gynecologic health of women with multiple sclerosis: An overview on the current status and findings of Pap tests in a low-income setting

BACKGROUND

Women with MS (wwMS), particularly ones in low-income settings, and exposed to disease-modifying therapy (DMT), could have specific gynecological health-related issues.

AIM

To assist policy making and lead further research by describing the current status of gynecological health and Pap test results in wwMS.

METHODS

Cross-sectional study on wwMS living in Isfahan, Iran. Participants were surveyed and referred for a Pap test, results of which were compared with 1:2 age- and socioeconomic status-matched healthy controls (HC). Primary outcome was the degree of non-benign squamous/glandular cell abnormalities. Secondary outcomes were presence of evidence of infection, and the degree of benign inflammatory/reactive changes. Logistic regression models were utilized for analyses.

RESULTS

197 wwMS were included (mean age [SD], 41.2 [8.3]; median EDSS (IQR) 1.5 [0.5]). 74.1% reported having sexual activity more than once per week in the past year. For contraception, 21.6% and 16.8% used calendar-based methods and male condoms, respectively. 7% had contracted a gynecological infection in the past. Only 1% had received HPV vaccination. Compared to HC, benign reactive/inflammatory changes in Pap tests were less frequently seen in the wwMS (OR: 0.3; 95% CI: 0.2, 0.4; p <  0.001), while evidence of infection was seen more frequently (OR: 11.5, 95% CI: 3.3, 40; p <  0.001). Results were consistent across DMT groups except anti-CD20 therapies. Additionally, the frequency of non-benign changes in wwMS was two times of that in the HC, but the study lacked adequate power to confirm statistical significance (1.5% vs. 0.8%, OR: 2; 95% CI: 0.4, 10.1; p =  0.39).

CONCLUSION

There is room for improvement of the gynecological health status of wwMS who live in low-income settings. Also, findings support an immune dysfunction in the cervices of DMT-exposed wwMS. Additionally, further research is merited to determine the risk of changes of malignant potential in cervices of wwMS.

Association between Body Roundness Index and Depression Among Middle-aged and Older Adults in Chinese Communities: An Empirical Analysis Based on CHARLS Data

BACKGROUND

The relationship between depression and obesity has been confirmed by multiple studies. Compared to conventional measurement indicators such as body mass index or waist circumference, the body roundness index (BRI) demonstrates higher accuracy in assessing body fat content, especially visceral adiposity. Nevertheless, despite the advantages of BRI in measuring fat, the specific link between BRI and depression remains unclear. This study aims to clarify the potential correlation using data from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

This study used CHARLS data from 2015 and 2020. We screened and included 7,258 middle-aged and older adults without depressive symptoms at baseline. We explored the connection between BRI and depression risk through logistic regression analyses, restricted cubic spline analyses, subgroup analyses, and interaction tests.

RESULTS

After adjusting for covariates, a positive correlation was observed between BRI and depression risk. Specifically, a one-unit increase in BRI led to a 14% increase in depression risk (OR =  1.14, 95% CI: 1.09-1.20, P <  0.001).

CONCLUSION

BRI is linked to a higher risk of depression in middle-aged and older adults in China and can be used as a simple indicator to predict depression.

Prevalence and factors associated with knowledge of HIV Self-Test kit and HIV-Self Testing among Ghanaian women: multi-level analyses using the 2022 Ghana demographic and health survey

BACKGROUND

The Ghana AIDS Commission reported in 2022 that out of 354,927 people living with HIV, 67.5% were females. While considerable progress has been made in expanding access to HIV testing services, a significant proportion of individuals remain unaware of their HIV status, presenting a significant barrier to effective prevention and treatment. Although HIV Self-Testing (HIVST) has emerged as a promising approach to increase the uptake of HIV testing, its adoption and utilisation have been limited by various sociodemographic factors. We investigated the knowledge of HIV Self-Testing Kit as well as prevalence of HIVST and their associated factors among Ghanaian women.

METHODS

This was a cross-sectional study among 15,014 women of their reproductive age using data from the 2022 GDHS. The data were analysed using STATA version 17.0. Simple frequencies were used to summarise the data. A multilevel binary logistic regression using four models (Models I-IV) was used to examine the association between the two outcome variables and the explanatory variables, controlling for individual- and contextual-level factors. Statistical significance was set at p < 0.05 at 95% CI.

RESULTS

We discovered that only 18.2% [95% CI = 17.1-19.3] and 2.4% [95% CI = 2.1-2.8] of Ghanaian women in their reproductive age had adequate knowledge of HIV Self-Testing Kit (HIVSTK) and had used the HIVSTK for HIV testing respectively. The odds of knowledge of HIVSTK were higher among women aged 20-24 years (aOR = 1.33, 95% CI = 1.07, 1.64; p = < 0.01), those with a higher level of education (aOR = 6.14, 95% CI = 4.41, 8.55; p < 0.001), those who listen to radio (aOR = 1.41, 95% CI = 1.20, 1.65; p < 0.001) and use the internet at least once a week (aOR = 1.49, 95% CI = 1.24, 1.78; p < 0.001). The odds of knowing about HIVSTKs increased with higher levels of wealth distribution with the highest recorded among those in the wealthiest group (aOR = 1.85, 95% CI = 1.32, 2.58; p < 0.001). Compared with women with no formal education, the odds of HIVST were higher among those with higher education (aOR = 20.29, 95% CI = 9.16, 44.97; p < 0.001). The odds of HIVST were also higher among those who listen to radio (aOR = 1.51, 95% CI = 1.05, 2.17; p < 0.05) and those who use the internet at least once a week [aOR = 1.80, 95% CI = 1.15, 2.83; p < 0.001). Furthermore, the odds of self-testing for HIV were higher among women with a history of HIVST (aOR = 6.73, 95% CI = 3.34, 13.55; p = < 0.001) and those with the wealthiest wealth quintiles (aOR = 4.31, 95% CI = 1.31, 13.02; p = < 0.001).

CONCLUSION

Our study revealed a shallow knowledge of HIV Self-Testing Kit as well as a low prevalence of HIV self-testing among women in their reproductive age in Ghana. The evidence suggests that more than nine in ten women had never undertaken an HIV self-test. The observed HIVST in this study may have implications for achieving the objectives of the HIVST policy. This may impede the achievement of SDG 3.3 which seeks to end the AIDS epidemic by 2030. Practical strategies including education and awareness, may be utilized through electronic media as well as radio and television, especially among those with little or no education. Additionally, the government can subsidise testing kits to create opportunities for those in the low-wealth quintiles to purchase and self-test themselves.

Blood-based biomarkers of Alzheimer's disease and incident dementia in the community

Evidence regarding the clinical validity of blood biomarkers of Alzheimer's disease (AD) in the general population is limited. We estimated the hazard and predictive performance of six AD blood biomarkers for incident all-cause and AD dementia-the ratio of amyloid-β 42 to amyloid-β 40 and levels of tau phosphorylated at T217 (p-tau217), tau phosphorylated at T181 (p-tau181), total tau, neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP)-in a cohort of 2,148 dementia-free older adults from Sweden, who were followed for up to 16 years. In multi-adjusted Cox regression models, elevated baseline levels of p-tau181, p-tau217, NfL, and GFAP were associated with a significantly increased hazard for all-cause and AD dementia, displaying a non-linear dose-response relationship. Elevated concentrations of p-tau181, p-tau217, NfL, and GFAP demonstrated strong predictive performance (area under the curve ranging from 70.9% to 82.6%) for 10-year all-cause and AD dementia, with negative predictive values exceeding 90% but low positive predictive values (PPVs). Combining p-tau217 with NfL or GFAP further improved prediction, with PPVs reaching 43%. Our findings suggest that these biomarkers have the potential to rule out impending dementia in community settings, but they might need to be combined with other biological or clinical markers to be used as screening tools.

Nationwide incidence of anterior cruciate ligament reconstruction in higher-level athletes in Sweden: a cohort study from the Swedish National Knee Ligament Registry linked to six sports organisations

OBJECTIVE

To determine and compare the incidence rate (IR) of anterior cruciate ligament reconstruction (ACL-R) among higher-level athletes across six sports in the Swedish National Knee Ligament Registry (SNKLR).

METHODS

Patient data from the SNKLR, between 2005 and 2020, was linked to team and event data of six sports (football, handball, basketball, ice hockey, floorball and alpine sports) to identify higher-level athletes aged 15-40 with ACL-R. Unadjusted and adjusted IR ratios (IRRs) with 99% CIs were calculated between sports, sex, age and divisions.

RESULTS

Female athletes had a 3.3 times higher ACL-R IR compared with males (1.08 vs 0.32, IRR=3.33, 99% CI: 2.65 to 4.19) per 1000 athlete exposures (AE). Basketball had the largest difference in ACL-R IR per 1000 AE between females and males (1.26 vs 0.22, IRR=5.69, 99% CI: 2.79 to 11.60). Female second-division athletes had higher ACL-R IR per 1000 AE compared with female highest-division athletes (1.27 vs 0.76, IRR=1.67, 99% CI: 1.30 to 2.15). No significant association between age and IR was observed. Compared with football, lower ACL-R IR was observed in floorball and ice hockey in females, as well as in floorball, basketball and ice hockey in males.

CONCLUSION

Female athletes had higher ACL-R IRs than males and second-division female athletes had higher ACL-R IRs than highest-division female athletes. Lower ACL-R IRs were observed in floorball and ice hockey compared with football for both sexes. The remaining sports had ACL-R IRs similar to football, except basketball where rates were lower for male athletes.

Higher estimated dietary intake of live microbes is associated with lower mortality in US adults

Background

Few studies have discussed the health benefits of total dietary intake of live microbes (TDIIM). We investigated the relationship between daily estimated TDIIM and mortality in US adults.

Materials and methods

This cohort study included subjects ≥18 years from the 1999-2018 NHANES and their mortality data through December 31, 2019. The TDIIM counts were estimated based on a prior classification system, with foods categorized into low (<10^7 CFU/g), medium (10^7-10^10 CFU/g), and high (>10^10 CFU/g) levels of live microbes. Individual intakes were calculated by multiplying the microbial levels by the corresponding grams of food consumed. Weighted Cox regression models, Kaplan-Meier survival curves, and restricted cubic splines (RCS) were used to estimate the association between all-cause and cardiovascular (CVD) mortality and TDIIM.

Results

Among 52,383 participants, during a median follow-up period of 118.75 months, a total of 7,711 deaths were recorded, of which 1,985 were CVD deaths. In the weighted Cox regression model, compared to participants with low TDIIM, those with high intake have lower risks of all-cause mortality (HR 0.91; 95% CI, 0.82-1.00; P for trend, 0.01), and CVD mortality (HR 0.77; 95% CI, 0.63-0.95; P for trend, 0.005). In the RCS analysis, the relationship between TDIIM and all-cause mortality exhibited a non-linear pattern with a gradual decline followed by a plateau at higher intakes, while a linear decreasing trend was observed with CVD mortality. Kaplan-Meier survival curves showed that participants with low TDIIM had a higher risk of all-cause mortality and CVD mortality.

Conclusion

In this cohort study of US adults, a higher estimated TDIIM reduced the risk of all-cause and CVD mortality. These findings suggest that the ingestion of live microbes in the diet may be advantageous for human health.

Systematic review of search for meaning in life assessment tools: highlighting the need for a quest for significance scale

Objective

This systematic review aims to evaluate the adequacy of existing assessment tools in measuring the search for meaning in life and the quest for significance, with a focus on identifying gaps in capturing the quest for significance as a distinct construct.

Methodology

Following the PRISMA protocol, we conducted a comprehensive search across ProQuest, Web of Science, and Scopus, identifying 23 relevant studies. Methodological quality was assessed using the Downs and Black checklist and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. A bibliometric analysis was also performed to explore research trends and collaboration patterns.

Key findings

While numerous instruments exist, none fully address the quest for significance as a standalone construct. Key limitations include insufficient differentiation between personal and social significance, lack of predictive validity, and limited cultural adaptability.

Conclusion and implications

The findings underscore the need for a dedicated Quest for Significance Scale to advance psychological research and practice. Future efforts should focus on developing robust, culturally adaptable instruments to better understand the quest for significance across diverse contexts.

Post-colonoscopy colorectal cancer and the association with endoscopic findings in the Danish colorectal cancer screening programme

OBJECTIVE

Colorectal cancer (CRC) is the third most common cancer in Denmark, with a 5-year mortality of 40%. To reduce CRC incidence and mortality, a faecal immunochemical test (FIT)-based screening programme was introduced in 2014. Adenoma detection rate (ADR) is an established quality marker inversely associated with post-colonoscopy CRC (PCCRC), but evidence mainly stems from non-FIT populations. Using ADR in a FIT-based setting may be costly due to histopathological examination. Alternative markers like polyp detection rate (PDR) and sessile serrated lesion detection rate (SDR) could be viable but lack evidence for their association with PCCRC.

METHODS

We conducted a nationwide cohort study of 77 009 FIT-positive participants undergoing colonoscopy (2014-2017). National registry data on CRC outcomes were linked, and endoscopy units were grouped by ADR, PDR and SDR levels. Poisson regression adjusted for age, sex and comorbidities was used to assess PCCRC risk.

RESULTS

Among 70 009 colonoscopies within 6 months of FIT positivity, 4401 (92.7%) had CRC, while 342 (7.2%) were PCCRC cases. PCCRC risk was inversely associated with ADR, PDR and SDR. High ADR endoscopy units had a 35% lower PCCRC risk than low ADR units. Similar associations were found for PDR and SDR, with high SDR units showing a 33% lower PCCRC risk than low SDR units.

CONCLUSIONS

ADR, PDR and SDR predict PCCRC risk, with SDR emerging as a feasible, cost-efficient quality marker in FIT-based screening. This study supports SDR as a primary performance indicator in future protocols.

Association between myosteatosis or sarcopenia based on abdominal CT and hypertension in systemic lupus erythematosus patients

BACKGROUND

Hypertension and obesity are common in systemic lupus erythematosus (SLE) patients, with obesity-related changes potentially driving hypertension. However, the specific adiposity measures associated with hypertension in SLE patients remain unclear. This study assessed the association between myosteatosis and sarcopenia detected on abdominal CT and hypertension in SLE patients. Mediators of the association between myosteatosis and hypertension were also investigated.

METHODS

This was a retrospective study involving SLE patients enrolled from January 2017 to August 2023 and who underwent abdominal CT at the L3 level to track myosteatosis and sarcopenia based on the skeletal muscle mean radiodensity (SMD) and skeletal muscle index considered as binary and continuous variables. The association between these body composition measures and hypertension was tested using logistic regression analyses, while mediation modeling was used to assess the mediators.

RESULTS

A total of 279 adult SLE patients (median age, 41.00 [30.00, 51.00] years; 245 women) were included in this study. Hypertension was associated with myosteatosis (adjusted OR: 3.54; 95% CI: 1.18-10.61 for the binary variable and 1.31; 95% CI: 1.02-1.68 for the continuous variable). No statistically significant association was observed between hypertension and sarcopenia (adjusted OR: 0.48; 95%CI: 0.23-1.01 for the binary variable and 0.95; 95%CI: 0.78-1.16 for the continuous variable). Mediation analyses revealed eGFR could mediate the association between myosteatosis (considered as a continuous variable) and hypertension in SLE patients when taken alone (95% CI: 0.0177-0.2765) or in combination with the TyG index (95% CI: 0.0032-0.0614).

CONCLUSIONS

Myosteatosis was associated with hypertension in SLE patients. eGFR alone or in combination with the TyG index may mediate this association.

Epidemiology of urinary tract infections in adults among United States emergency departments from 2016 to 2023

INTRODUCTION

Infections of the urinary tract, including cystitis and pyelonephritis, are common reasons for presentation to the Emergency Department (ED). However, there are limited recent data on incidence and admission rates. Moreover, with changes in resistance rates, advances in antibiotic options, and increasing antimicrobial stewardship, there is a need to better understand the current management. This study reports the incidence, admission rates, and antibiotic distribution among a nationwide cohort of adult ED patients with cystitis and pyelonephritis over an eight-year period.

METHODS

This was a cross-sectional study of adult ED patients with a diagnosis of cystitis or pyelonephritis from 1/1/2016 to 12/31/2023. Using the Epic Cosmos database, ED visits for the above were identified using ICD-10 codes. Outcomes included total ED presentations, admission rates, outpatient antibiotic prescriptions, and antibiotics administered in the ED for admitted patients with cystitis or pyelonephritis. Data were analyzed with binary logistic regression models to measure the relationship between time and dependent variables.

RESULTS

There were 205,526,173 total ED encounters, with cystitis occurring in 8,768,481 (4.3 %) and pyelonephritis in 1,044,742 (0.5 %). 23.9 % of those with cystitis were admitted and 33.4 % of those with pyelonephritis were admitted, with a slight rise over time. The most common antibiotics for patients admitted with cystitis and pyelonephritis were third-generation cephalosporins (50.6 % and 55.6 %, respectively). There was a rise in third-generation and fourth-generation cephalosporins, while fluoroquinolone use declined. For discharged patients with cystitis, the most common antibiotics were first-generation cephalosporins (36.4 %), nitrofurantoin (17.9 %), and trimethoprim/sulfamethoxazole (10.7 %). There was a rise in first-generation, second-generation, and third-generation cephalosporins, while nitrofurantoin, trimethoprim/sulfamethoxazole, and ciprofloxacin use declined. For discharged patients with pyelonephritis, the most commonly prescribed antibiotics were first-generation cephalosporins (28.6 %), third-generation cephalosporins (19.5 %), ciprofloxacin (17.0 %), and trimethoprim/sulfamethoxazole (11.5 %). The largest rise was in third-generation cephalosporins, while there was a decline in fluoroquinolones.

CONCLUSION

Cystitis and pyelonephritis remain common ED presentations with a rise over time. There have been notable shifts in antibiotics, with an overall increase in cephalosporins while fluoroquinolone use has declined. Understanding the current epidemiology can inform public health planning and antibiotic stewardship in the ED.