Catheter-related thrombosis in a neonatal intensive care unit: a case-control study / Trombose relacionada a cateter em unidade de terapia intensiva neonatal: um estudo de caso-controle

INTRODUCTION: Catheter-related thrombosis (CRT) accounts for most thrombotic events in the neonate. OBJECTIVE: Investigate CRT frequency, association with days of catheter use until diagnosis, and number of catheters used, in a single-center Neonatal Intensive Care Unit. METHODS: A case-control study that included 14 cases and 42 controls. Data collection occurred between January 2017 and December 2020 in a public NICU. Crude odds ratios (COR) were calculated. The study complied with ethical standards from national guidelines. RESULTS: Two hundred and ninety-four neonates used central venous catheters, of which 14 (4.7%) were diagnosed with CRT. Catheter in use when diagnosis was made was centrally inserted central catheters in 8 (57.1%). Before diagnosis, the cumulative duration of catheter use was 34.5 days and the median number of catheters used was three. A higher SNAPPE-II (COR 1.03; 95% CI 1.01-1.06; p=0.03), cumulative days of catheter use >30 (COR 19.11; 95% CI 2.28-160.10; p=0.007) and number of catheters used ≥3 (COR 7.66; 95% CI 1.51-38.70; p=0.01) were associated with CRT. CONCLUSION: CRT cases were associated with clinical severity; number of catheters and cumulative days of catheter use. We suggest that screening for thrombosis should be performed in neonates who need a long time of catheter use and more than three catheters. Reducing the duration and number of venous catheters used will help to reduce CRT.

INTRODUÇÃO: A trombose relacionada ao cateter (TRC) é responsável pela maioria dos eventos trombóticos no neonato. OBJETIVO: Investigar a frequência da TRC, a associação com os dias de uso do cateter até o diagnóstico e o número de cateteres utilizados em uma Unidade de Terapia Intensiva Neonatal unicêntrico. MÉTODOS: Estudo caso-controle que incluiu 14 casos e 42 controles. A coleta de dados ocorreu entre janeiro de 2017 e dezembro de 2020 em uma UTIN pública. Foram calculadas razões de chances brutas (COR). O estudo respeitou os padrões éticos das diretrizes nacionais. RESULTADOS: Duzentos e noventa e quatro neonatos utilizaram cateter venoso central, dos quais 14 (4,7%) foram diagnosticados com TRC. O cateter em uso no momento do diagnóstico foi o cateter central inserido centralmente em 8 (57,1%). Antes do diagnóstico, o tempo acumulado de uso do cateter foi de 34,5 dias e a mediana do número de cateteres utilizados foi de três. Um maior número de dias de uso do cateter >30 (COR 19,11; IC 95% 2,28-160,10; p=0,007) e número de cateteres utilizados >3 (COR 7,66; IC 95% 1,51-38,70; p=0,01). CONCLUSÃO: Os casos de TRC foram associados à gravidade clínica; número de cateteres e dias cumulativos de uso do cateter. Sugerimos que o rastreamento de trombose seja realizado em neonatos que necessitem de longo tempo de uso do cateter e mais de três cateteres. Reduzir a duração e o número de cateteres venosos usados ajudará a reduzir a TRC.

Factores asociados con la infección por el virus de la hepatitis B en comunidades indígenas de Colombia / Factors associated with hepatitis B virus infection in indigenous communities of Colombia

Resumen Introducción. Colombia alberga dos millones de indígenas, que viven en condiciones de pobreza y tienen deficiencias en salud, por lo cual están expuestos a contraer infecciones virales como la hepatitis B. El departamento del Amazonas presenta una gran prevalencia del virus y barreras para acceder a la vacunación; por esto, parte de la población es propensa a la infección. Objetivo. Identificar factores asociados con la infección por el virus de la hepatitis B en indígenas colombianos. Materiales y métodos. Se llevó a cabo un estudio de casos y controles en mayores de 18 años de cuatro departamentos del país. Los casos se identificaron mediante el registro nacional de notificación de hepatitis B (2015-2022). Los controles seleccionados de manera concurrente fueron pareados con los casos por edad, sexo, etnia y departamento. En una encuesta se consignaron las características sociodemográficas, los factores asociados con el contacto con sangre y fluidos, las prácticas socioculturales y los antecedentes de vacunación. El proyecto fue aprobado por Comité de Ética de la Universidad de Antioquia. Resultados. Participaron 75 casos y 150 controles de 13 grupos étnicos. El departamento del Amazonas aportó el 49 % de los participantes (83 % mujeres) con una mediana de edad de 30 años (RIC = 27-37). Los factores asociados con una mayor probabilidad de contraer la infección fueron el antecedente de algún familiar infectado con el virus de la hepatitis B (OR ajustado = 2,61) (IC95%: 1,09-6,27) y número de embarazos en mujeres, (OR ajustado = 1,61) (IC95%: 1,02-2,54). La vacunación mostró un efecto protector sin asociación significativa. Conclusión. Los aspectos asociados con la convivencia familiar y el número de embarazos contribuyen a una potencial transmisión vertical y horizontal del virus. No se identificaron prácticas culturales asociadas. Se requieren estrategias novedosas y diferenciales para reducir la transmisión del virus de la hepatitis B en poblaciones indígenas.

Abstract Introduction. Colombia is home to 2 million indigenous people who live in conditions of poverty and with health deficiencies, making them vulnerable to contracting hepatitis B (HBV). Amazonas has a high virus prevalence, and there are barriers to accessing vaccination; thus, part of the population is susceptible to infection. Objective. To identify factors associated with HBV in Colombian indigenous people. Materials and Methods. A case-control study of people over 18 years from four departments of Colombia. Cases were identified through the national hepatitis B notification registry (2015-2022). Controls were selected and matched to cases (2:1) by age, sex, ethnicity, and department. Sociodemographic characteristics, factors associated with contact with body fluids, cultural practices, and vaccination history were identified by means of a survey. The ethics committee of the Universidad de Antioquia approved the project. Results. Seventy five cases and 150 controls from 13 ethnic groups were surveyed. Amazonas contributed 49% of participants, 83% were women, and the median age of cases was 30 years (IQ range: 27-37). The associated factors were a family history of hepatitis B [adjusted OR: 2.61 (95% CI: 1.09-6.27)] and, in women, the number of pregnancies [adjusted OR: 1.61 (95% CI 1.02- 2.54)]. The vaccination history showed a protective effect, but the association was not significant. Conclusion. Aspects associated with family life and unprotected sexual relations seem to be responsible for the potential transmission of the virus. It was not possible to identify associated cultural practices. Innovative and differential strategies are required for indigenous people to achieve a reduction of HBV.

The Correlation between Traditional Chinese Medicine Constitution and the Progression of Abnormal Glucose Metabolism in Community Population： A Case-control Study / 中医杂志

ObjectiveTo investigate the role of traditional Chinese medicine （TCM） constitution in the progression of abnormal glucose metabolism among community population. MethodsA total of 393 community residents who participated in community diabetes screening from 2019 to 2021 and had complete physical examination data at baseline and at the 2nd year follow-up were selected. According to the results of glucose tolerance tests， community residents were divided into the abnormal glucose metabolism progression group and non-progression group， and were matched at the ratio of 1∶2 using the propensity score matching. The influencing factors related to diabetes at baseline were collected for both groups. The traditional Chinese medicine constitution was determined among population in two groups. The differences of influencing factors and traditional Chinese medicine constitution between the two groups were compared. Logistic regression analysis was used to analyze the risk factors for the progression of abnormal glucose metabolism. ResultsFinally， 131 patients were included in the progression group and 262 patients in the non-progression group. Compared to the non-progression group， the progression group had significantly higher proportion of hyperlipidemia history ， hyperglycemia history， phlegm-dampness constitution， and blood stasis constitution （P＜0.05 or P＜0.01）. Univariate logistic regression analysis revealed that the history of hyperlipidemia （P=0.011）， history of hyperglycemia （P＜0.001）， the family history of diabetes （P＜0.001）， yin-deficiency constitution （P=0.047）， phlegm-dampness constitution （P=0.011） and blood-stasis constitution （P=0.008） were risk factors for the progression of abnormal glucose metabolism. Multivariate logistic regression analysis indicated that the history of hyperglycemia （P＜0.001）， yin-deficiency constitution （P=0.026） and blood-stasis constitution （P=0.032） were independent risk factors for the progression of abnormal glucose metabolism. ConclusionThe history of hyperglycemia， yin-deficiency constitution and blood-stasis constitution may be the risk factors for the progression of abnormal glucose metabolism.

Nested case-control study on children with severe birth defects in Shanghai / 上海预防医学

ObjectiveTo design a prospective nested case-control study based on a city-wide birth cohort of Shanghai， so as to understand their health status and explore the influencing factors of birth defects. MethodsBased on the birth registration covering the entire city of Shanghai， the nested case-control study of children with severe birth defects was designed. Children born with severe birth defects were selected as the case group， and healthy children were matched as the control group. Basic information， health status， maternal pregnancy history， and survival outcome of children both in the case group and the control group were collected through medical history review and home visits. The logistic regression model was used for multivariate analysis. ResultsA total of 18 875 infants born between January 1， 2011， and December 31， 2021， were included， among which 11 500 （60.93%） were children with severe birth defects and 7 375 （39.07%） were healthy children. The logistic regression model analysis showed that being male （OR=1.20， 95%CI：1.13‒1.29）， non-Shanghai residency （OR=1.16， 95%CI： 1.06‒1.25）， multiple births （OR=8.41， 95%CI：6.25‒11.30）， artificial insemination （OR=2.31， 95%CI：1.34‒3.99）， in vitro fertilization （IVF） （OR=1.85， 95%CI：1.44‒2.38）， maternal exposure to radiation （OR=1.83， 95%CI：1.07‒3.14）， maternal illness during pregnancy （OR=1.61， 95%CI：1.49‒1.74）， experiencing a traumatic event during pregnancy （OR=2.34， 95%CI：1.88‒2.92）， paternal chemical exposure （OR=1.88， 95%CI：1.32‒2.69）， paternal radiation exposure （OR=1.65， 95%CI： 1.18‒2.33）， family history of birth defects （OR=8.18， 95%CI： 3.96‒16.89）， being overweight before pregnancy （OR=1.16， 95%CI： 1.07‒1.27）， being obese before pregnancy （OR=1.15， 95%CI：1.03‒1.30）， and being excessively obese before pregnancy （OR=1.52， 95%CI：1.26‒1.83） were risk factors for the occurrence of birth defects. Analysis by type of birth defect found that prematurity was a risk factor for cardiac malformations and cheilopalatoschisis （OR=27.87， 95%CI： 20.84‒37.27）， especially ranking first in cardiac malformations. ConclusionAfter controlling for influencing factors， maternal overweight， obesity， and excessive obesity before pregnancy， artificial insemination， and IVF are independent risk factors for the occurrence of birth defects. Choosing a healthy lifestyle， improving physical and mental health during pregnancy， and controlling BMI during pregnancy are beneficial in reducing the risk of birth defects.

Epidemiological characteristics and influencing factors of adenovirus-associated acute conjunctivitis in Shenzhen，2014‒2022 / 上海预防医学

ObjectiveTo investigate the epidemic characteristics and influencing factors of acute conjunctivitis caused by human adenovirus（HAdv）in Yantian District of Shenzhen City， Guangdong Province from 2014 to 2022， and to provide evidence for formulating effective prevention and control measures. MethodsDescriptive epidemiology was used to analyze the epidemiological characteristics of acute hemorrhagic conjunctivitis （AHC） cases reported from the Chinese disease prevention and control information system. Etiological characteristics of laboratory-confirmed cases were analyzed， and a case-control study method of test-negative design （TND） was conducted as well. According to the result of HAdv detection， analysis was used to identify the influencing factors of morbidity. ResultsA total of 1 005 AHC cases were reported in Yantian District， Shenzhen City from 2014 to 2022， with an average annual incidence rate of 49.49/105. The incidence rate ranged from 4.67/105 to 117.28/105. The peak incidence occurred from July to October each year， with a male-to-female ratio of 1.42∶1. The median （P25，P75） age of onset was 29（12，40） years. A total of 716 eye swabs were collected for etiological detection from 2014 to 2022. HAdv positive detection rate was 36.45% （263/716）， Cox 24v positive detection rate was 0.28% （2/716）， while EV70 was not detected. The longest viral shedding time in eye swabs was 10 days， with a median of 2 days. The highest HAdv positive detection rate （47.47%） was observed when the sampling-to-onset interval was 4‒5 days， and the difference was statistically significant （P<0.05）， with a trend of first increasing and then decreasing. Multivariate logistic regressing analysis showed that aged 18‒ years， and average temperature higher than 24.90 ℃ 3 days before onset （P<0.05） were the risk factors for acute HAdv conjunctivitis. ConclusionAHC in Yantian District， Shenzhen City showed a low level of prevalence from 2014 to 2022， with HAdv being the predominant pathogen. The peak period of viral shedding occurred on the 4th to 5th day after symptom onset， suggesting the importance of adherence to strict home isolation for infected persons. Aged18‒ years and average temperature increased 3 days before onset are associated with an increased risk of adenoviral conjunctivitis. It is recommended to strengthen personal protection and keep doing a good job of AHC surveillance and early warning， so as to timely prevent the outbreaks of AHC.

Assessing the impact of cognitive competencies on the success in physician licensure examination: A case-control study / Health Sciences Journal

Introduction@#In the realm of education and professional licensure, the assessment of individuals’ competencies is pivotal in determining eligibility for entry into various fields of practice. Medical school assessments encompass cognitive and non-cognitive measures. The Philippines’ Physician Licensure Examination (PLE) relies solely on cognitive assessment. This study explored the predictive power of cognitive assessment in the passing the Physician Licensure Examinations.@*Methods@#A case-control study design was done. Cognitive examination grade was defined as the average cumulative grade of written examinations in specific subjects, while the dependent variable was PLE scores.@*Results@#The study revealed a positive association between failing written examinations and failing the Physician Licensure Examination. In all subjects, there is an observed association, but only Pharmacology reached statistical significance (OR: 2.30 CI:1.01,5.24). For the remaining subjects, although there is an association, it did not reach statistical significance (Biochemistry OR:1.42, CI: 0.43, 4.72; Medicine 3 OR:1.56, CI: 0.81, 3.0; Surgery 3 OR:1.28 CI: 0.63, 2.58). There was no association seen between failing the written examination and failing the PLE in Obstetrics (OR:0.98 CI: 0.47, 2.03). Furthermore, there was a weak positive correlation (0.18-0.31) between written examination grades and corresponding board exam subject grades for all subjects, highlighting the importance of cognitive assessments in predicting success. The research also found a statistically significant difference in PLE grades between those who failed the written examinations and those who passed.@*Conclusion@#These findings emphasized the crucial role of cognitive assessments in predicting success in the PLE and its associated board subjects. The study underscored the need for medical institutions to focus on strengthening cognitive competencies and to align the content and rigor of written examinations with the PLE. Addressing these issues would better prepare students for the licensure examination and enhance the quality of healthcare professionals entering the workforce. The results may contribute to the ongoing discussion on the effectiveness of assessment methods in medical education and licensure examinations.

Tracking observation of fine motor development in children aged 6-8 with attention deficit hyperactivity disorder / 中国学校卫生

Objective@#To examine the developmental trajectory of fine motor ability in schoolage children with attention deficit hyperactivity disorder (ADHD) for two years, so as to provide scientific evidence to promote motor development in ADHD children.@*Methods@#From April to June 2019, 31 children aged 6-8 years old were selected from a public elementary school. They were diagnosed with ADHD by two psychiatric professionals according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Additionally, 31 typical developmental children, matched for age, sex and IQ with the ADHD group, were recruited as the control group. Fine motor ability was assessed with tasks of hand manual dexterity in Movement Assessment Battery for Children-2 (MACB-2), and a followup assessment was conducted from April to June 2021. The development changes of fine motor ability between two groups of children were compared by using t test and repeated measures analysis of variance.@*Results@#Between baseline and followup periods after two years, the total score of hand fine motor in the ADHD group did not show significant improvement (7.4±3.0, 8.0±3.4; t=-1.05, P>0.05), while there was a small effect size improvement in typically developing control group (9.5±2.1, 10.5±2.4; t=-2.12, effect size=0.38, P<0.05). Followup after two years, coin/peg throwing scores with dominant hand improved between ADHD group and control group (7.0±3.3, 9.5±3.2; 8.4±2.8, 11.6±1.6) (t=-3.74, -6.33, P<0.01; effect size=0.67, 1.14), with a smaller improvement in the ADHD group. The score for threading beads/threads decreased in between ADHD group and control group (7.9±2.4, 5.8±3.1; 9.2±1.1, 8.2±1.9) (t=3.89, 2.78, P<0.01; effect size=0.70, 0.50), with a greater decrease in the ADHD group.@*Conclusions@#The development speed of fine motor ability in children with ADHD aged 6-8 is slow and continues to lag behind normal developmental children. Fine motor development in children with ADHD should be closely monitored, and targeted interventions should be implemented when necessary.

A spatial case-control study on symptomatic and inapparent primary dengue infections in an endemic city in Brazil

ABSTRACT We conducted a spatial case-control study nested in a dengue incidence cohort to explore the role of the spatial and socioeconomic factors in the proportion of symptomatic (cases) and inapparent primary dengue virus infections (controls). Cohort participants were children and adolescents (2 to 16 years of age) at the beginning of the follow-up. Case definitions were, for symptomatic cases, fever plus a positive lab result for acute dengue (NS1, RT-PCR, ELISA IgM/IgG), and for inapparent infection a positive result for dengue IgG (ELISA) in subjects without symptoms and with a previously negative result at baseline. The covariates included sociodemographic factors, residential location, and socioeconomic context variables of the census tracts of residence of cases and controls. We used principal component analysis to reduce the contextual covariates, with the component values assigned to each one based on their residences. The data were modeled in a Bayesian context, considering the spatial dependence. The final sample consisted of 692 children, 274 cases and 418 controls, from the first year of follow-up (2014-2015). Being male, older age, higher educational level of the head of the family and having a larger number of rooms in the household were associated with a greater chance of presenting dengue symptomatic infection at the individual level. The contextual covariates were not associated with the outcome. Inapparent dengue infection has extensive epidemiological consequences. Relying solely on notifications of symptomatic dengue infections underestimates the number of cases, preserves a silent source of the disease, potentially spreading the virus to unaffected areas.

Biological, social, and healthcare factors for death due to influenza A(H1N1) during the 2009 epidemic in Brazil

ABSTRACT OBJECTIVE To identify risk factors for death from influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. METHODS A case-control of incident cases of influenza A(H1N1) reported in the epidemiological information systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. RESULTS 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas, 9 cases/10 controls; Pará, 22 cases/77 controls, São Paulo, 19 cases/49 controls; Paraná, 10 cases/54 controls; Rio Grande do Sul, 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among the cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from influenza A(H1N1) were identified. CONCLUSION The risk factors identified in this investigation not only allowed subsidizing the elaboration of clinical conducts but also indicate important aspects for facing "new" influenza epidemics that are likely to occur in our country.

Thromboembolic events in people with cancer during the COVID-19 pandemic: case-control study / Eventos tromboembólicos em pessoas com câncer na pandemia da COVID-19: estudo caso-controle / Eventos tromboembólicos en personas con cáncer durante la pandemia de COVID-19: estudio de caso-control

Abstract Objective: to analyze the association between coronavirus disease infection and thromboembolic events in people with cancer in the first year of the pandemic. Method: case-control study carried out by collecting medical records. The selected cases were adults with cancer, diagnosed with a thromboembolic event, treated in the selected service units during the first year of the pandemic. The control group included adults with cancer without a diagnosis of a thromboembolic event. Pearson's chi-square test was applied to verify the association between risk factors and the outcome and logistic regression techniques were applied to identify the odds ratio for the occurrence of a thromboembolic event. Results: there were 388 cases and 440 control cases included in the study (ratio 1/1). Females predominated, who were white, with mean age of 58.2 (±14.8) years. Antineoplastic chemotherapy was the most used treatment and coronavirus disease was identified in 11.59% of participants. In the case group, deep vein thrombosis was more prevalent. Conclusion: the study confirmed the hypothesis that coronavirus disease infection did not increase the chance of thromboembolic events in people with cancer. For the population studied, the factors that were associated with these events were those related to cancer and its treatment.

Resumo Objetivo: analisar a associação entre a infecção por coronavírus e os eventos tromboembólicos em pessoas com câncer, durante o primeiro ano da pandemia. Método: estudo caso-controle realizado mediante coleta em prontuários. Os casos estudados foram de adultos com câncer, com diagnóstico de evento tromboembólico, atendidos nas unidades do serviço selecionado durante o primeiro ano da pandemia. O grupo controle contou com adultos com câncer sem diagnóstico de evento tromboembólico. Teste qui-quadrado de Pearson foi aplicado para verificar associação entre fatores de risco e o desfecho de técnicas de regressão logística foram aplicadas para identificar a razão de chance de ocorrência de evento tromboembólico. Resultados: 388 casos e 440 controles foram incluídos no estudo (proporção 1/1). Prevaleceu o sexo feminino, raça branca, média de idade de 58,2 (±14,8) anos. A quimioterapia antineoplásica foi o tratamento mais utilizado e a doença por coronavírus foi identificada em 11,59% dos participantes. No grupo caso, trombose venosa profunda foi mais prevalente. Conclusão: o estudo confirmou a hipótese de que a infecção por doença por coronavírus não aumentou a chance de eventos tromboembólicos em pessoas com câncer. Para a população estudada, os fatores que tiveram associação com os eventos foram os relacionados ao câncer e seu tratamento.

Resumen Objetivo: analizar la asociación entre la infección por enfermedad por coronavirus y eventos tromboembólicos en personas con cáncer durante el primer año de la pandemia. Método: estudio caso-control realizado mediante la recolección de datos en historiales médicos. Los casos fueron adultos con cáncer, diagnosticados con evento tromboembólico, atendidos en las unidades del servicio seleccionado durante el primer año de la pandemia. El grupo control estuvo compuesto por adultos con cáncer sin diagnóstico de evento tromboembólico. Se aplicó la prueba de chi-cuadrado de Pearson para verificar la asociación entre factores de riesgo y el resultado, y se utilizaron técnicas de regresión logística para identificar la razón de posibilidades de ocurrencia de evento tromboembólico. Resultados: se incluyeron en el estudio 388 casos y 440 controles (proporción 1/1). Prevaleció el género femenino, raza blanca, con una edad media de 58,2 (±14,8) años. La quimioterapia antineoplásica fue el tratamiento más utilizado y la enfermedad por coronavirus fue identificada en el 11,59% de los participantes. En el grupo de casos, la trombosis venosa profunda fue más prevalente. Conclusión: el estudio confirmó la hipótesis de que la infección por enfermedad por coronavirus no aumentó la probabilidad de eventos tromboembólicos en personas con cáncer. Para la población estudiada, los factores que tuvieron asociación con estos eventos fueron los relacionados con el cáncer y su tratamiento.

The unexpected silent manifestation of myocardial infarctions in ischemic heart failure patients: Insights from a case-control study

Abstract Background: Recent studies show Silent Myocardial Infarction (SMI) as a quite frequent event. However, regarding severe tertiary care patients that frequently present consequences of Coronary Artery Disease (CAD) and Left Ventricular Dysfunction (LVD), the occurrence of this manifestation is unexpected and its associated factors aren't clear in the literature. Aim: To compare clinical, laboratorial, ventricular and angiographic factors between silent and classical presentation of MI in patients with CAD and LVD. Methods: Patients with multivessel CAD with over 70 % obstructive lesions and LVD with EF less than 35 % were evaluated for MASS VI trial and later included in the present study. The ventricular function and coronary assessment were measured by echocardiography and SYNTAX score, respectively. The population was stratified in a SMI group and Clinically Manifested Myocardial Infarction (CMMI) group based on MI presentation for a comparison of medical parameters. Results: From 132 patients, 47 (35.6 %) were classified as SMI and 85 (64.4 %) as CMMI. No differences were observed between groups regarding age, sex, diabetes mellitus, SYNTAX score, or collateral circulation. Higher proportion of NYHA II classification, inferior wall MI and lower creatinine clearance were found in SMI group. After multivariate analysis, peripheral diabetic neuropathy (OR = 4.6 [1.1-12.7] p = 0.032) and inferior wall MI (OR = 4.1 [1.5-11.4] p = 0.007) were significantly associated with SMI. Conclusion: Peripheral diabetic neuropathy and inferior wall MI were associated with SMI presentation. Overall, associated factors tend to be similar comparing SMI and CMMI, but in the specific population of diabetic patients with chronic neuropathy a special care should be taken.

Iron deficiency anemia as a risk factor for pulp disease in children from the central Peruvian jungle: a case‒control study

Abstract Aim To investigate iron-deficiency anemia as a risk factor for dental pulp disease in children from the central Peruvian jungle. Methodology A case-control study was carried out with 270 children, of which 90 referred to cases and 180, to controls. Patients with pulp disease were diagnosed according to the criteria of the Association of Endodontists and the American Board of Endodontics. A specific questionnaire was used to assess ferrous sulfate consumption, maternal education level, maternal age, occupation, and household income. Data were analyzed using Pearson's correlation coefficient and a binary logistic regression. Results Iron deficiency anemia offers a risk factor for pulp disease in children (OR 7.44, IC 95% 4.0-13.8). According to multivariate analysis using binary logistic regression, ferrous sulfate consumption (OR 13.8, IC 95% 5.6.33.9), maternal education level (OR 2.4, IC 95% 1.1-5.3), maternal age (OR 7.5, IC 95% 2.9-19.4), household income (OR 4.0, IC 95% 1.6-9.6), and caries (OR 10.7, IC 95% 4.5-25.7) configured independent factors that were statistically associated with pulp disease. Conclusion Iron deficiency anemia, ferrous sulfate consumption, maternal education level, maternal age, household income, and dental caries were positively associated with pulp disease in children

Impact on quality of life among health care workers: a case-control study of COVID-19 pandemic situation

Background: Quality of Life (QoL) as an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. Methods: A Case-control study was conducted to assess the QoL among health care workers (HCW) during the Covid-19 Pandemic and to compare QOL in cases and controls among HCW. The sample size was calculated to be 98 in each group comes around 196. QOL was assessed by using WHOQOL-BREF scale. The QoL comparison in both Covid-19 positive and negative and its association was done by mean and standard deviation with correlation coefficient using unpaired T test. Results: Among 196, majority 157 (79.2%) were doctors and 39 (19.8%) were other health care providers like lab technicians and nursing staff. The health care workers with COVID-19 positive were had low QoL than the negative with respect to physical (46.90±9.60 vs 59.01±15.60), psychological (44.51±7.44 vs 51.13±15.68), social (39.82±15.98 vs 56.11±23.92), and environmental (48.33±10.28 vs 57.57±20.22) domains and all the domains showing highly statistically significant result with the P-value <0.001. The correlation coefficient between four domains was statistically significant and with overall QOL and satisfaction on health. Conclusions: The QoL was poor among COVID-19 positive patients compared to negative with respect to physical, social, psychological, and environmental and age, marital status and occupation during the covid-19 pandemic.

Early vs. Standard Loop Ileostomy Closure: An Unmatched Case-Control Study / Cierre Temprano vs Estándar de Ileostomía en Asa. Estudio de Casos y Controles no Emparejado

SUMMARY: Early closure of a loop ileostomy (ECI) is a relatively new practice, for which there is insufficient evidence regarding its effectiveness in relation to closure at conventional times. The aim of this study was to report postoperative complications (POC) and hospital mortality in patients with loop ileostomy (LI) who underwent ECI, compared with patients with LI who underwent late closure. Un- matched case-control study. Patients with LI who underwent surgery at Clínica RedSalud Mayor Temuco (2010-2022) were included. Cases were defined as patients with LI who underwent early closure and controls as subjects who underwent closure at the usual times. No matching was performed, but a 1:1 relationship between cases and controls was considered. Outcome variables were postoperative complications and hospital mortality. Other variables of interest were surgical time and hospital stay. Descriptive statistics were applied with calculation of proportions and measures of central tendency. Subsequently, t-test and Pearson Chi2 for comparison of averages and proportions was applied, and odds ratios and their respective 95 % CI were calculated. In this study 39 patients with AI were operated on (18 cases and 21 controls). Age and BMI average of the studied subjects was 71.3±7.1 years and 27.3±19.8 kg/m2 respectively. Mean LI closure time, surgical time, and hospitalization were: 10.0±0.7 months; 62.5±10.6min; 3.8±0.1 days respectively. POC were only surgical site infections. Three in cases (16.7 %) and 3 in controls (14.3 %). No anastomotic dehiscence or hospital mortality was observed in either cases or controls. There were no differences in comorbidities or surgical site infection between cases and controls (OR of 0.6 and 1.2 respectively) In this experience, the results of performing the CTI were similar to the late closing in relation to the variables studied.

El cierre temprano de una ileostomía en asa (IA), es una práctica relativamente nueva, sobre la que no hay suficiente evidencia respecto de su efectividad en relación con el cierre en tiempos convencionales. El objetivo de este estudio fue verificar diferencias en la tasa de complicaciones postoperatorias (CPO) y de mortalidad hospitalaria en pacientes con IA sometidos a cierre temprano comparados con pacientes con IA sometidos a cierre tardío. Estudio de casos y controles sin emparejamiento. Se incluyeron pacientes con IA que fueron sometidos a cirugía en la Clínica RedSalud Mayor Temuco (2010-2022). Los casos se definieron como pacientes con IA sometidos a cierre temprano y los controles como sujetos con IA sometidos a cierre en tiempos habituales. No se realizó emparejamiento. Se consideró una relación 1:1 entre casos y controles. Las variables de resultado fueron CPO y mortalidad hospitalaria. Otras variables de interés fueron: tiempo quirúrgico y hospitalización. Se aplicó estadísticas descriptivas (cálculo de proporciones y medidas de tendencia central). Posteriormente, se aplicó prueba t-test y Chi2 para comparación de promedios y proporciones; y se calcularon odds ratios e intervalos de confianza del 95 %. Se operaron 39 pacientes con IA (18 casos y 21 controles). El promedio de edad e IMC fue 71,3±7,1 años y 27,3±19,8 kg/m2, respectivamente. El tiempo promedio de cierre de IA, tiempo quirúrgico y hospitalización fueron: 10,0±0,7 meses; 62,5±10,6 minutos; 3,8±0,1 días, respectivamente. Las CPO fueron infecciones del sitio quirúrgico (3 casos; 16,7 % y 3 controles; 14,3 %). No se observó dehiscencia anastomótica ni mortalidad hospitalaria en casos ni controles. No hubo diferencias en comorbilidades ni en infecciones del sitio quirúrgico entre casos y controles (OR de 0,6 y 1,2, respectivamente). No se evidenciaron diferencias entre realizar cierre temprano o tardío de IA, respecto de las variables CPO y de mortalidad hospitalaria.

Drug-resistant tuberculosis in Colombia, 2013-2018: Case-control study / Tuberculosis multirresistente en Colombia, 2013-2018: estudio de casos y controles

Introduction. Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is difficult to control, has high morbidity and mortality, and demands priority public health intervention. In Colombia, MDR/RR-TB has been becoming more widespread annually. Before the COVID-19 pandemic, over an 8-year period, the number of cases of multidrug-resistant tuberculosis in Colombia was close to a thousand cases. Timely identification of the different risk factors for MDR/RR-TB will contribute fundamentally to the systematic management. Objective. To determine which risk factors were associated with the presentation of MDR in Colombia between 2013 and 2018. Materials and methods. A retrospective case-control study was carried out, for which the data from the routine surveillance of MDR/events in the country were used. Results. The cases of multidrug-resistant tuberculosis were mainly in young people, Afrodescendants, and males. Of the clinical conditions, comorbidities such as malnutrition, diabetes, and HIV, presence of at least one factor, such as drug dependence, taking immunosuppressive medications, belonging to the black race, afro, and living in an area of high disease burden were risk factors. Conclusion. In addition to the diagnosis and timely provision of MDR-TB treatment, it is necessary that public health programs at the local level pay special attention to patients with the identified risk factors.

Introducción. La tuberculosis multirresistente-resistente a la rifampicina (TB-MDR/RR) es difícil de controlar, tiene una alta morbilidad y mortalidad y exige una intervención prioritaria en salud pública. En Colombia, la TB-MDR/RR se ha ido extendiendo cada año. Antes de la pandemia de COVID-19, en un periodo de 8 años, el número de casos de TB-MDR/RR en Colombia se acercaba a los mil. La identificación oportuna de los diferentes factores de riesgo de TB-MDR/RR contribuirá de manera fundamental al manejo sistemático de la enfermedad. Objetivo. Determinar los factores de riesgo que se asociaron a la presentación de la TB- MDR/RR en Colombia entre 2013 y 2018. Materiales y métodos. Se realizó un estudio retrospectivo de casos y controles, para el cual se utilizaron los datos de la vigilancia rutinaria de eventos de TB MDR/RR en el país. Resultados. Los casos de TB MDR se presentaron principalmente en jóvenes, afrodescendientes y varones. De las condiciones clínicas, fueron factores de riesgo las comorbilidades como la desnutrición, la diabetes y el VIH, y la presencia de, al menos, un factor como la farmacodependencia, el consumo de medicamentos inmunosupresores, el ser de raza negra o afro y el vivir en una zona del país de alta carga de tuberculosis. Conclusiones. Además del diagnóstico y la provisión oportuna del tratamiento de la TB MDR, es necesario que los programas de salud pública a nivel local presten especial atención a los pacientes con los factores de riesgo identificados.

The understanding of epidemiology and study designs

The goal of health care systems is to keep patients healthy by monitoring, diagnosing, and treating their illnesses. These complex systems have many objectives, such as improving the quality of health care, making healthcare accessible to all people who are in need, extending people’s life span, preventing illnesses, etc. Promoting healthy lifestyles along with the prevention of illnesses to improve people’s health is also a fundamental principle of public health, and now it also become a fundamental principle of health care and integrating into health and social care strategies across the world. Epidemiology is the system of ultimate reasoning focused on creating and examining theories in systematic fields such as biology, physics, behavioral sciences. Epidemiology rationalize the health-associated states and events and provide the justification for further suitable real-world public health measures. While working in the field, I observed that allied healthcare professionals lacked basic knowledge about epidemiology and related study designs. The input from this healthcare professional not only assists in building meaningful research studies but also demonstrates its powerful impact on patients’ healthcare through preventive measures and study results. The goal of this article is to provide basic knowledge of epidemiology and its various study designs in a simplistic language to allied healthcare professionals working in the field. In this article, I have described a general overview of epidemiology and various study designs, along with examples. I hope this information could be beneficial for a better understanding of epidemiology to healthcare professionals working in the field.

Association of modifiable risk factors among stroke patients attending a tertiary care hospital at Durg district of Chhattisgarh: a case-control study

Background: Non-communicable diseases (NCDs) are medical conditions or illnesses that are not caused by infectious agents. Modifiable behavioural risk factors, such as tobacco use, physical inactivity, unhealthy diet, stress and the harmful use of alcohol and metabolic risk factors, such as hypertension, diabetes, dyslipidemia, obesity, increase the risk of stroke. Strokes in Asian patients account for more than two-thirds of the overall stroke incidence worldwide. Methods: The Hospital based case-control study was carried out on 88 hospitalized patients with history of first time stroke and Controls were selected from hospital with no history of stroke. For each case gender, age (+5 years) matched control was selected in 1:1 ratio. A predesigned pretested questionnaire was used to collect data. Data were compared between case and control groups using chi-squared test, Students t-tests as appropriate and Uni-variate odds ratio (ORs) for these risks factors were calculated. Results: We recruited 88 cases of stroke and 88 controls for this study. In the current study Hypertension was found to be significantly associated with stroke. The stroke cases had significantly higher proportion of diabetes mellitus and the risk of developing stroke with diabetes mellitus was high and significant. Similarly, stroke was associated with alcohol, family history of stroke and obesity. Risk of developing stroke was not associated with cardiac disease. Conclusions: Hypertension, alcohol, obesity are the biggest risk factors for stroke. This could be helpful in early identification of subjects at risk of stroke and formulation of public health strategy. Additional studies of large patient cohorts will be essential to validate these findings.

Determinants of tuberculosis in Central Region of Eritrea: a matched case-control study

Background: The WHO has recommended the need for holistic approach towards TB, including addressing the underlying socio-economic determinants in conjunction with direct observed treatment short-course (DOTS). However, there is lack of epidemiological data in Eritrea regarding factors that are associated with TB and this study aimed to assess such factors. Methods: A matched case-control study was used to assess factors that are associated with TB in the Central Region of Eritrea. A structured questionnaire was used to collect data about socio-demographic characteristics, living status, housing conditions, and medical history of the study participants. All TB patients in the eight DOTS treatment centers and two age-and-sex-matched controls for each case were included. Bivariate and multivariable conditional logistic regression models were used to identify the main risk factors of TB. Results: The study recruited 67 cases and 134 controls. Bivariate analyses indicated that BCG vaccination scar, past alcohol drinking habit, history of hospital admission, previous history of TB, and family history of TB were found to be factors associated with TB. Moreover, results of multivariable analysis showed that, absence of BCG vaccination scar, family history of TB, past drinking habit, and history of hospital admission were found to be factors associated with TB among the study participants. Conclusions: This is the first study in the Central Region of Eritrea that assessed the determinant of tuberculosis. Absence of BCG vaccination scar, family history of TB, past alcohol consumption and history of hospital admission were found to be independent risk factors for TB.c

Association of drugs, reproductive and lifestyle factors with carcinoma breast among women in a tertiary care center - a case–control study

Background: Breast Cancer is the most common cancer in the world and a leading cause of cancer deaths. The incidence and mortality vary widely. Multiple factors are found to be associated with the development of breast cancer. Aims and Objectives: To study the role of drugs and other selected factors in the development of carcinoma breast. Materials and Methods: A case–control study was done at Government Medical College Thrissur. Selected 125 cases and 250 controls. Data were collected by interview using a semi-structured proforma. The role of drugs, Body Mass Index (BMI), lifestyle, and reproductive factors were studied. Results: The cases and controls were matching in their sociodemographic characteristics. The mean age of cases was 53 years (SD = 11.5) and that of controls was 51.74 years (SD = 11.5). Hysterectomy was found to be a risk factor of breast cancer, Odds Ratio 2.3 (1.05–5.05). Heavy work, with an Odds Ratio 0.89 (0.12–0.66), and milk consumption with an odds ratio 0.46 (0.27–0.78) were found to be protective factors. contraceptive pill, hormone replacement therapy, prolonged drug intake, BMI, age of menarche, parity, abortion, or infertility were not found to have significant association. Conclusion: The history of drug intake is not having a role in the development of breast cancer. Hysterectomy is a risk factor while heavy work and milk consumption are protective factors in breast cancer development.

Fatores de risco para óbito perinatal em gestantes de alto risco de um hospital terciário de Curitiba-PR, Brasil: estudo caso-controle / Risk factors for perinatal death in high-risk pregnant women at a tertiary hospital in Curitiba-PR, Brazil: a case-control study

Resumo Estudo caso-controle com o objetivo de estimar os fatores de risco da mortalidade perinatal em um hospital de referência para gestações de alto risco em Curitiba-PR. Os dados de características sociodemográficas, maternas, da gestação e do concepto foram obtidos dos prontuários hospitalares de 316 casos e 316 controles do período de 2013 a 2017. Foi realizada análise de regressão logística múltipla hierarquizada, permanecendo no modelo final variáveis com p < 0,05. Os resultados mostram aumento do risco de óbito perinatal em mães com tipo sanguíneo B (OR = 2,82; IC95%: 1,07-7,43), que não realizaram pré-natal (OR = 30,78; IC95%: 4,23-224,29), conceptos com malformações congênitas (OR = 63,90; IC95%: 27,32-149,48), nascidos com menos de 28 (OR = 24,21; IC95%: 1,10-531,81) e entre 28-31 semanas de gestação (OR = 6,03; IC95%: 1,34-27,17) e peso ao nascer abaixo de 1.000g (OR = 51,94; IC95%: 4,31-626,46), entre 1.000-1.499g (OR = 11,17; IC95%: 2,29-54,41) e entre 1.500-2.499g (OR = 2,75; IC95%: 1,25-6,06). Conceptos de gestações com desfecho prematuro, baixo peso ao nascer e presença de malformações congênitas são os principais fatores de risco para o óbito perinatal. Em contrapartida, a assistência pré-natal adequada é importante fator de proteção.

Abstract A case-control study was carried out to estimate risk factors for perinatal mortality in a referral hospital for high-risk pregnancies in Curitiba-PR. Sociodemographic, maternal, pregnancy and concept characteristics data were obtained from the hospital records of 316 cases and 316 controls from 2013 to 2017. A hierarchical multiple logistic regression analysis was performed, remaining in the final model variables with p < 0.05. The results show an increased risk of perinatal death in mothers with blood type B (OR = 2.82; 95%CI: 1.07-7.43), who did not undergo prenatal care (OR = 30.78; 95%CI: 4.23-224.29), fetuses with congenital malformations (OR = 63.90; 95%CI: 27.32-149.48), born under 28 (OR = 24.21; 95%CI: 1, 10-531.81) and between 28-31 weeks of gestation (OR = 6.03; 95%CI: 1.34-27.17) and birth weight below 1,000g (OR = 51.94; 95%CI: 4.31-626.46), between 1,000-1,499g (OR = 11.17; 95%CI: 2.29-54.41) and between 1,500-2,499g (OR = 2.75; 25-6.06). Concepts of pregnancies with premature outcome, low birth weight and the presence of congenital malformations are the main risk factors for perinatal death. On the other hand, adequate prenatal care is an important protective factor.