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Introduction: Croatian National Cancer Registry of Croatian Institute for Public Health reported that in year 2020 lung cancer was the second most common cancer site diagnosed in men with 16% and the third most common in women with 10% incidence among all cancer sites. Unfortunatelly lung cancer has the highest mortality in both men and women. Haematological malignancies had 7% share in all malignancies in both male and female cances cases. In 2020 190 newly diagnosed cases of lymphatic leukemia in men and 128 cases in women were reporeted, meaning 1.5 and 1.2% of all malignancies, respectively. Chronic lymphatic leukemia (CLL) is an advanced age disease and incidence increases with age. Impaired immunity, T and B cell dysfunction in CLL, chromosomal aberations, long-term immunosuppressive therapy and genetic factors can all cause secondary malignancies. Co- occurence of solid tumors and CLL is very rare. Although patiens with CLL have an increased risk of developing second primary malignancies including lung carcinoma, the data about their clinical outcomes are lacking. Parekh et al. retrospectively analyzed patients with simultaneous CLL and lung carcinoma over a 20-year period, and they found that ~2% of patients with CLL actually developed lung carcinoma. The authors claimed that up to 38% of patients will also develop a third neoplasm more likely of the skin (melanoma and basal cell carcinoma), larynx (laryngeal carcinoma) or colon. Currently there are no specific guidelines for concurrent CLL and non-small cell lung carcinoma (NSCLC) treatment. Usually, when the tumors are diagnosed simultaneously, treatment is based to target the most aggressive malignancy, as the clinical outcomes depend on the response of the tumor with the poorest prognosis. For this reason, a multidisciplinary approach is mandatory. Case report: A patient with history of coronary heart disease, myocardial infarction and paroxysmal atrial fibrillation was diagnosed in 2019 (at the age of 71) with B chronic lymphocytic leukemia with bulky tumor (inguinal lymph nodes 8x5 cm), stage B according to Binet, intermediate risk. He was treated with 6 cycles of chemoimmunotherapy (rituximab/cyclofosfamid/fludarabine). In 10/2019 remission was confirmed, but MSCT described tumor in the posterior segment of upper right lung lobe measuring 20x17 mm and bilateral metastases up to 11 mm. Bronchoscopy and biopsy were performed, and EGFR neg, ALK neg, ROS 1 neg, PD-L1>50% adenocarcinoma was confirmed. He was referred to Clinical Hospital Center Osijek where monotherapy with pembrolizumab in a standard dose of 200 mg intravenously was started in 01/2020. Partial remission was confirmed in October 2020. Immunotherapy was discontinued due to development of pneumonitis, dysphagia and severe weight loss (20kg), but without radiologically confirmed disease progression. At that time he was referred to our hospital for further treatment. Gastroscopy has shown erosive gastritis with active duodenal ulcus, Forrest III. Supportive therapy and proton pump inhibitor were introduced. After complete regression of pneumonitis, improvement of general condition and resolution of dysphagia, no signs of lung cancer progression were found and pembrolizumab was reintroduced in 12/2021. Hypothyroidism was diagnosed in 01/2021 and levothyroxine replacement ther apy was started. In 03/2021 he underwent surgical removal of basal cell carcinoma of skin on the right temporal region with lobe reconstruction. From 02/2021, when pembrolizumab was reintroduced, regression in tumor size was continously confirmed with complete recovery of general condition. He was hospitalized for COVID 19 infection in 09/2021, and due to complications pembrolizumab was discontinued till 11/2021. Lung cancer immunotherapy proceeded till 11/2022, when Multidisciplinary team decided to finish pembrolizumab because of CLL relapse. CLL was in remission till August 2022 when due to B symptoms, lymphcytosis, anemia and generalized lymphadenopathy, hematological workup including biopsy of cervical lymph node was performed and CLL/SLL relapse was confirmed. Initially chlorambucil was introduced, but disease was refractory. Based on cytogenetic test results (IGHV unmutated, negative TP53) and due to cardiovascular comorbidity (contraindication for BTK inhibitors) venetoclax and rituximab were started in 01/2023. After just 1 cycle of treatment normal blood count as well as regression of B symptoms and peripheral lymphadenopathy occured, indicating the probability of complete disease remission. In our patient with metastatic lung adenocarcinoma excellent disease control is achieved during 41 month of treatment in first line setting. Furthermore, relapsed/refractory CLL/SLL is currently in confirmed remission. Conclusion(s): Successful treatment of patients with multiple primary malignancies is based on multidisciplinarity, early recognition and management of side effects, treatment of comorbidities with the aim of prolonging life, controlling symptoms of disease and preserving quality of life.
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BackgroundThe COVID-19 pandemic has led to changes in dietary and lifestyle habits among children and adolescents. This study investigated the prevalence and factors associated with unhealthy dietary habits among 1,475 primary and secondary school students from 2021 to 2022.MethodsA cross-sectional study was conducted in randomly selected primary and secondary schools participating in a project promoting online health education and promotion named GoSmart using self-administered questionnaires. Logistic regression analyses were conducted to investigate the demographic and lifestyle habits associated with various unhealthy dietary habits. This study was approved by Survey and Behavioural Research Ethics (SBRE) [Reference No.: SBRE-21-0052] and funded by Quality Education Fund (QEF#2019/0883).ResultsThe prevalence of inadequate consumption of vegetables and fruits was high among both primary (81.5%) and secondary school students (89.5%) and associated with physical inactivity in both primary (aOR=3.35, 95%CI: 1.41-7.97, p=0.006) and secondary students (aOR=4.30, 95%CI: 1.51-12.25, p=0.006). A substantial prevalence of breakfast skipping was observed among primary students (22.9%) who spent two or more hours on video games or social media (aORs=1.84-2.27);and among secondary students (23.7%) who consumed two or more hours on social media, alcohol consumption, and consumption of unhealthy food (aORs=1.42-2.79). Consumption of unhealthy food was reported by 43.9% and 48.2% for primary and secondary students respectively, with primary and secondary students who spent two or more hours on video games or social media (aORs=1.62-2.27) and secondary students who perceived themselves as underweight (aOR=1.79, 95%CI: 1.13-2.83, p=0.012) having a higher frequency of consumption.ConclusionsThere was a high prevalence of unhealthy dietary habits among schoolchildren in Hong Kong. Alarming results were observed with physical inactivity being associated with a higher risk of unhealthy dietary habits among primary and secondary students, which may increase the risk of obesity. Moreover, the apparent interrelationship between unhealthy habits highlights the need for a comprehensive approach to promoting healthy habits through education in this population.
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Background and aim: Malnutrition is a major public health problem, especially in developing countries. The aim of this study was to analyze the trend in malnutrition among children under 5 years of age in Iran over recent decades and to estimate malnutrition status for 2020. Methods: This study took the form of a secondary analysis of the reports and data from three cross-sectional national surveys on children's nutritional status conducted between 1998 and 2017. Anthropometric indices, including markers of underweight, wasting, stunting, overweight, and obesity, were used as indicators of the nutritional status of children under 5 years. Malnutrition indicators are reported separately based on regional food security status. Linear mixed-effects modeling was used to predict the status of malnutrition indicators for 2020. Results: The results of this study indicated a downward trend in the prevalence of stunting, underweight, and wasting, from 15.4 to 4.8%, 10.9 to 4.3%, and 4.9 to 4.3%, respectively, between 1998 and 2017. The proportion of children at risk of overweight and prevalence of childhood overweight/obesity showed a downward trend between 2010 and 2017, from 3.73 to 3.02% and from 12.1 to 10.3%, respectively. However, the trend varied between different provinces. Estimates of the prevalence of malnutrition in 2020 also indicated a decrease in the prevalence of all indicators among children. Conclusion: Despite the decreasing trend in malnutrition over the past three decades, the prevalence of stunting, underweight, and wasting is still high in food-insecure provinces. Moreover, following the COVID-19 pandemic and its economic consequences, an increase in the prevalence of malnutrition, especially in food-insecure provinces, is plausible.
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Background/Aims We report the features of chronic chilblain-like digital lesions newly presenting since the start of the covid-19 pandemic. Comparison with primary perniosis and acrocyanosis, reveals a unique phenotype which appears to be a long-covid phenomenon. Methods The case records of 26 patients with new onset persistent chilblain-like lesions presenting to the Rheumatology service of St George's University Hospital, London between Autumn 2020 and Spring 2022 were reviewed. Demographic and clinical features, serology, imaging, treatment response and outcome up to Summer 2022 were collated retrospectively. Results Chilblain-like lesions first occurred between September and March;2019/ 2020 6 cases, 2020/2021 18 cases and 2021/2022 2 cases. Mean age 35.4 (17-60) years, 88% female, 85% white, all non-smokers. Median body mass index (BMI) 20.2, range 17.0 - 33.2. BMI underweight (<18.5) in 27%. All cases reported new red-purple-blue colour changes of the fingers, some with pain, swelling and pruritis, affecting both hands in 12, one hand in 6, and both hands and feet in 8 cases. There was a past history of cold sensitivity or primary Raynaud's in 54%. Covid was confirmed in 3 cases, 2 - 8 months prior to onset of chilblain-like symptoms. Possible covid, unconfirmed, was suspected in 5 cases, 1 - 11 months earlier. Affected digits appeared diffusely erythro-cyanotic in 81%, with blotchy discrete maculo-papular erythematous lesions in 42%, some with both features. Involvement was asymmetric in 54%, thumbs spared in 69%. Complement was low in 50% (8/16), ANA positive in 26% (6/23). MRI of hands showed phalangeal bone marrow oedema in keeping with osteitis in 4 of 7 cases. More severe signs and symptoms were associated with low BMI, low C3/4 and a past history of cold sensitivity or Raynauds. Cold avoidance strategies were sufficient for 58%. Pain prompted a trial of NSAIDs, aspirin, nitrates, calcium channel blockers, hydroxychloroquine, oral or topical corticosteroid or topical tacrolimus in 42%. In general, these were minimally effective or not tolerated. 4 severe cases received sildenafil or tadalafil, effective in 2. In 27% complete remission occurred during the first summer season after symptoms commenced, median duration 6 (range 2 - 10) months. In the remaining 19 cases, chilblain-like symptoms returned or worsened in the subsequent second winter period, with 6 of 19 entering remission the following summer. For the remaining 13 persistent cases the total duration of symptoms spans more than a year, and in four cases more than 2 years. Conclusion This series illustrates a distinct chronic chilblain-like condition. Features similar to primary perniosis include female predominance, middle age, pruritic painful blotchy lesions, asymmetry and low BMI. Features in keeping with acrocyanosis include chronicity, extensive diffuse erythro-cyanotic discoloration, relative improvement in warm weather and lack of association with smoking.
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Background: The continuous evolution of SARS-CoV-2 in the diverse immune landscape (natural, vaccine, hybrid) is giving rise to novel immune escape mutations. So far, the resulting new variants (BA.1, BA.2, BA.2.12.1) were observed to cause mild infections, however, BA.5 infections are associated with an increased risk of hospitalization.1 Therefore it is essential to investigate the pathogenesis of BA.5. Method(s): Here we compared the pathogenicity of Pre-Omicron (B.1.351) and Omicron (BA.1, BA.2.12.1, and BA.5) variants in wild-type C57BL/6J mice and K18-hACE2 mice. The virus replication kinetics was also studied in human Calu3, pulmonary alveolar type 2 (AT2) cells, and airway organoids (HAO). Cell-to-cell spread of virus was measured by syncytia formation assay and immunohistochemistry (IHC) of infected lungs. Result(s): In the results, infection in C57BL/6J mice showed severe weight loss ( >15%) for B.1.351 infected mice and moderate ( >5%) for BA.5 infected. C57BL/6J mice showed higher virus replication of B.1.351 followed by BA.5, BA.1, and BA.2.12.1. At the peak of virus replication (2 days) plaque-forming units from lung extract of BA.5 infected mice were two, and three logs higher compared to BA.1 and BA.2.12.1 respectively. BA.5 infection was lethal to 80% of infected K18-hACE2 mice, whereas the mice looked normal after infection with BA.1 and BA.2.12.1. BA.5 infected mice showed high virus replication in brain tissue. Surprisingly the syncytia formation assay and IHC for BA.5 was comparable to that of B.1.351, indicating the higher cell-to-cell spread of BA.5 and B.1.351 compared to BA.1 and BA.2.12.1, which is one of the measures of pathogenicity. Calu3 and HAO showed the same trend of virus replication as was observed in-vivo experiments however AT2 cells were found to be resistant to BA.5 replication. Conclusion(s): These results suggest that the BA.5 variant (lineage) of Omicron has the potential to regain the pathogenicity as it shows increased virulence compared to other Omicron sub-variants. Lethal infection of BA.5 in K18-hACE2 mice may be attributed to catastrophic encephalitis and increased cell-to-cell spread.
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Background: Recent studies describe increasing rates of cannabis use among pregnant women. Gestational cannabis use has been associated with adverse neonatal outcomes and maternal reports of domestic violence. Domestic violence reportedly increased in Australia during the COVID-19 pandemic. We examined trends and outcomes of gestational cannabis use before and during the COVID-19 pandemic and sought associations with domestic violence. Method(s): The study population comprised women who attended the antenatal clinic and childbirth between 1 January 2019 and 31 December 2021 at an Australian tertiary hospital. Maternal socio-demographic, pregnancy progress and neonatal outcomes were recorded from the clinical records. We sought associations between maternal cannabis use and self-reported domestic violence during the study period, and the relationship with pregnancy outcomes. Result(s): Cannabis use was reported by 165/10,263 (1.6%) pregnant women. Cannabis use remained consistent during the study period, but reports of domestic violence increased from 2.9% pre-COVID to 6.7% during the COVID-19 pandemic. During the pandemic, women with gestational cannabis use were more likely to be young (40% <25 years vs. 11.8% .25 years), underweight (3.5% vs. 2.4%) and reported more domestic violence (33.0% vs. 6.3%), compared with non-users. The most common co-consumed substances by cannabis-users were tobacco (63.5%), alcohol (13.9%) and amphetamines (9.6%). Gestational cannabis use was associated with smaller neonates (median birth weight 2900 vs. 3330 g), higher preterm births (33% vs. 8.6%) and increased stillbirths (1.7% vs. 0.4%) Conclusion(s): Although domestic violence increased, gestational cannabis use remained constant during the COVID-19 pandemic and was associated with worse neonatal outcomes.
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For centuries, the Hijra enjoyed a special respect in the Hindu and Islamic cultures however, over the time, stigmatization took its toll and today the community is pushed to live on extreme societal margin. The present study was undertaken to assess the nutritional status of 304 transgender (Male to Female) residing in and around Mumbai using a mixed method approach. Participants were selected using a purposive sampling technique with the help of three Community Based Organisations (CBOs) working in close association with transgender. Data related to their nutritional status was collected before the pandemic using Food Frequency Questionnaire, 24-hr Recall and anthropometric measurements. Data related to impact of COVID-19 pandemic on food habits of transgender was collected from eight key informants working with CBOs using in-depth telephonic interviews. Results indicated that consumption of calorie dense junk foods was high and that of immunity building micronutrient dense foods such as fruits, vegetables and milk was notably low. Mean intake of macronutrients was adequate but that of micronutrients was lower for the majority. BMI assessment showed that 13 and 49% were underweight and overweight /obese respectively. COVID-19 pandemic further worsened nutritional status. The findings of the study may serve as basis for formulation of effective nutrition intervention programmes for transgender community.
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Introduction: It seems that Multiple sclerosis (MS) patients are at the higher risk for COVID-19 implications due to the use of immunomodulatory or immunosuppressive treatments. Obesity as a risk factor may lead to more adverse consequences. Relationship between obesity and COVID-19 risk and outcome in Iranian MS patients still remains unclear. We aimed to investigate the impact of BMI as a modifiable risk factors on the risk and outcomes of COVID-19 in Iranian patients with MS. Material(s) and Method(s): A cross-sectional study was conducted in the Sina hospital, Tehran, Iran. MS patients were asked to complete an online questionnaire in the google form format. Demographic information, clinical data consisting of MS disease-related factors, COVID-19-related factors, and anthropometric information were collected. In total, 492 patients were filled the questionnaire. BMI was categorized considering WHO's standard classification as underweight (BMI<18.5), normal weight (BMI>=18.5 and <25), overweight (BMI>=25 and <30), obesity type I (BMI>=30 and <35), and obesity type II (BMI>=35) (3). Result(s): The mean age was 36.7+/-8.2 and 395(80.3%) of them were women. 350(71.1%) of participants were suffered from RRMS. The most received MS drugs was Rituximab (36.0%). The mean BMI was 24.3+/-4.5 kg/m2. 234(47.6%) participants reported COVID-19 infection during the pandemic. 465(94.5%) of them were two doses vaccinated and 15(3%) of them were one-dose vaccinated. The odds ratio of COVID-19 infection was significantly 4.41 times more than the normal group in the type 2 obesity category (OR:5.41;95%CI:1.00-29.09) in the fully adjusted regression model. COVID-19 severity was significantly different in BMI groups (P:0.02), So that 11(8.6%) patients in normal weight group and 4(50%) of patients in type II obesity group were hospitalized due to COVID-19 infection. Respiratory symptoms (P:0.05) and gastrointestinal symptoms (P<0.01) were more prevalent among types I and II of obesity. On the other hand, no one in the obesity type I and II reported COVID-19 infection without any symptoms (P:0.04). Conclusion(s): The results of current study support that obesity could play a key role in susceptibility to COVID-19 infection and symptoms severity in MS patients. One of the issues that emerge from these findings is recommended that neurologists pay more attention on patients' BMI during this pandemic.Copyright © 2022
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Low Back Pain (LBP) is a health problem that affects performance in working. Indonesia is a country affected by the COVID-19 pandemic, so a study from the home policy has been issued. This study aimed to determine the association between the factors that affect LBP in Medical Students at the Faculty of Medicine, University of Mataram during the study from home. This study is an observational analytic study design with the cross-sectional approach. The population of this study is Medical Students, Faculty of Medicine, University of Mataram with total sample of 185 people. Collecting data using questionnaires and analyzed using univariate, bivariate, and multivariate analysis. According to univariate analysis, amount of LBP complaints (53 people). Based on bivariate analysis, the p-value of gender factor (0.000);body mass index factor (0.840);social-economy status factor (0.499);sitting position factors (sitting position while studying factor (0.008), sitting location while studying factor (0.046), chair shape while studying factor (0.286), body position while studying factor (0.037), legs position while studying factor (0.339), back support use while studying factor (0.455), table use while studying factor (0.010), elbows position while studying factor (0.627), stretching between study time factor (0.372), duration in each stretch factor (0.389), time range between stretch factor (0.311)), and sitting duration factor (0.011). Based on multivariate analysis, the strength of the association (OR) to LBP are sitting position factor (sitting position while studying factor) (8.232), sitting duration factor (1.956), and gender factor (0.187). The dominant factors to LBP are gender factor, sitting position factor (sitting position while studying factor), and sitting duration factor. The factor that has the strongest association with LBP is sitting position factor (sitting position while studying factor).Copyright Published by Oriental Scientific Publishing Company © 2023.
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The human body is inhabited by trillions of diverse microorganisms collectively called "microbiome" or "microbiota". Microbiota consists of bacteria, viruses, fungi, protozoa, and archaea. Microbiome demonstrates multi-faceted effects on human physical and mental health. Per evidence there is a multi-functional interplay between the whole-body microbiome composition on the epithelial surfaces including skin, nasal and oral cavities, airway, gastro-intestinal and urogenital tracts on one hand and on the other hand, the individual health status. Microbiota composition as well as an option to modulate it - together create a highly attractive operation area for the translational bio/medical research with multi-professional expertise and healthcare-relevant output in the framework of predictive, preventive and personalised medicine (PPPM/3 PM). Advanced PPPM strategies implemented in the microbiome area are expected to significantly improve individual outcomes and overall cost-efficacy of healthcare. According to the accumulated research data, corresponding diagnostic and treatment approaches are applicable to primary care (health risk assessment in individuals with sub-optimal health conditions and prevention of a disease development), secondary care (personalised treatment of clinically manifested disorders preventing a disease progression) and tertiary care (making palliation to an optimal management of non-curable diseases). In the current book, we do highlight the implementation potential of the microbiome-relevant research in the framework of predictive diagnostics, targeted prevention and treatments tailored to the individualised patient profile.Copyright © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Introduction/Background: Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss Syndrome, is a rare, small to medium vessel ANCA associated vasculitis. Hallmarks of EGPA include asthma, chronic rhinosinusitis, and peripheral neuropathy. EGPA is characterized by a prodrome of asthma and allergic rhinitis, followed by peripheral blood hyper-eosinophilia and accumulation of extravascular eosinophils, and finally systemic vasculitis. Extrapulmonary involvement is common, sometimes with fatal outcomes. The onset of EPGA is typically between 25-50 years;however, EGPA also occurs during childhood and has a significant morbidity and mortality. Description/Method: Our patient presented to the emergency department with a 2-week history of lethargy, wheeze and left sided neck swelling. After testing COVID-19 positive eight months prior to this, she developed wheezy episodes and was subsequently diagnosed with asthma which was managed with bronchodilators as required. She was reviewed by an allergist who confirmed a dust mite allergy and prescribed Montelukast. She remained well during the summer months however during winter she had 3 distinctive episodes of wheeze and cough which were managed by antibiotics and prednisolone. In the emergency department, an echocardiogram was performed which showed a cardiac tamponade. She was transferred to CICU where she had a pericardial drain inserted. The fluid was abundant with inflammatory cells. Multiple investigations were performed as follows: Hb: 135g/L, wbc: 20.30 x 10 9/L, Eosinophils: 12.77 x 10 9/L, CRP: 51 mg/L, ESR: 75 mm/hr, LDH: 1188 IU/L, IgE: 8000 UI/ml, ANA, ANCA: negative. CT chest showed mediastinal lymphadenopathy and patchy bilateral infiltrate and cardiac MRI showed myopericarditis and LV fibrosis. BMA showed no malignant cells and sinusitis was confirmed by CT. On examination, she was underweight. Her nasal mucosa looked inflamed. Otherwise systemic examination was unremarkable. In the context of poor ejection fraction (20%) with LV fibrosis, urgent MDT was arranged and concluded that our working diagnosis was EGPA. The decision was made to start IV methylprednisolone 10mg/kg/day for 3 days and Ivermectin. That night our patient had a VF arrest which required a single shock conversion 4J/kg. There was 7-minute downtime. Treatment was escalated to include cyclophosphamide, rituximab and plasmapheresis. The patient made a remarkable recovery, extubated and transferred to a normal ward. Her eosinophils count and inflammatory markers improved dramatically following treatment. However, she developed severe neuropathic left leg pain and NCS confirmed peripheral neuropathy Discussion/Results: EGPA is a very rare disease and diagnosis can be challenging especially with the absence of histopathology diagnosis. Early empirical treatment especially in a very ill child in intensive care unit can save lives and divert the progress of the disease. This patient has fulfilled the American College of Rheumatology criteria to diagnose EGPA including asthma, eosinophil count > 10% of upper normal, peripheral neuropathy, pulmonary infiltrates on CT thorax and paranasal sinuses abnormalities. Cardiac biopsy of the fibrotic mass may be a useful tool for diagnosis;however, this invasive procedure may expose this patient with high risk of fatal arrhythmias. Since other causes of eosinophilia were ruled out including parasitic infections, lymphoproliferative disorders, and rare primary immunodeficiency syndromes (hyper-IgE syndrome due to STAT3 or DOCK8 deficiency and Omenn syndrome) and the patient responded well to treatment, the diagnosis of EGPA was supported. Key learning points/Conclusion: Asthma not responding to bronchodilator could be another diagnosis Eosinophilia should be interpreted with caution. Defer the need for histopathology diagnosis in critically ill children Cardiac involvement is a life-threatening marker Early diagnosis prevents life threatening complications.
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The COVID-19 pandemic has forced the public health authorities to impose a lockdown as an epidemiological containment strategy. Due to COVID-19, the world is facing an unprecedented challenge that has changed people's lifestyles. This study aimed to evaluate how the COVID-19 pandemic lockdown affected students in Tamilnadu in terms of changes to their eating habits, sleeping patterns, and level of physical activity. A cross-sectional study was conducted using a random representative sample of 263 undergraduate students (mean age 19.63+ 1.86 years, males 33.46%) from Tamilnadu voluntarily filling out an online questionnaire. The Pittsburgh Sleep Quality Index (PSQI) and The International Physical Activity Questionnaires, Eating Attitude Test (EAT-26) were used to assess sleep quality, Physical Activity, and Eating Attitude disorder, respectively. The prevalence of poor sleep quality among participants was 43.3% (males: 44.32% and females: 42.86%). The mean score of the participants' EAT-26 score was found to be 10.92 +/- 8.63. Students' high body weight and BMI risk factors for eating disorders (chi(2)=9.68 p=0.02, chi(2)=9.59 p=0.02). 46% of students did not do any physical activity. There is no significant correlation between sleep and Eating attitude scores (p=0.21). 66.16% of participants experienced Psychological stress due to lock down. Findings from this study indicate that a lockdown period due to COVID-19 negatively impacted young undergraduate adults' physical activity levels and sleep quality. Finally, body weight, BMI, monthly family income, and poor physical activity with excess eating during the COVID 19 lockdown were the common exposures that are significantly associated with a higher risk of developing sleep disturbances and eating disorders. Several efficient strategies, programs, and coordinated efforts must be rigorously executed to encourage a seamless transition between school and daily life.
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Background: COVID-19 is a pandemic disease caused by droplet infection from SARS-CoV-2. Due to its rapid transmission and high case fatality rate, the identification of risk factors and prognostic factors is important. Obesity is a risk factor for poor outcomes in COVID-19. It is associated with chronic inflammation, disorders of the immune system. Obesity can be determined based on BMI. Chest X-Ray is supported in establishing the diagnosis and prognosis of COVID-19 patients. Assessment of the severity index of Chest X-Ray radiographs can use the Modified Chest X-Ray Scoring System of RSUP Dr. Soetomo. This study was conducted to analyze the relationship between BMI and chest radiography severity index in hospitalized COVID-19 patients at dr. Mohammad Hoesin Palembang in 2021. Methods: This research used a cross-sectional analytic observational design. Sampling was done using a consecutive sampling technique with 70 samples and obtained from the patient's medical record. The data were analyzed by univariate and bivariate (Chi-Square) using IBM SPSS Statistics 26 software. Results: Patients with BMI Overweight-Obesity had more in Moderate-Severe (18.6%) radiographic severity index scores (18.6%) than Normal-Mild (15.7%). Chi-Square bivariate analysis, BMI (p=0.033;p-value <0.05) had a significant relationship with the chest radiographic severity index with Odds Ratio 3,00, 95% CI (1,073–8,386). Conclusion: There is a significant relationship between body mass index and chest radiography severity index in COVID-19 patients. Overweight-Obesity BMI patients have a 3-fold chance of having a Moderate-Severe category of radiographic severity index compared to Underweight-Normal BMI patients.
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Background: In March 2020, World Health Organization declared COVID-19 outbreak a pandemic, with children forced to be away from structured school settings making them experience circumstances that could accelerate weight gain, including increased stress, irregular mealtimes, increased screen time, and lesss physical activity. Recent studies showed increased body mass index (BMI) trends in children during COVID-19 pandemic and recommended replicating this result with other population. Our study aims to measure the BMI trends before and after the COVID-19 pandemic lockdown in children 2-19 years of age presented to ambulatory clinics at a local community with the majority of black race. Method(s): A retrospective study on children aged 2-19 years who presented to ambulatory clinics affiliated with Brookdale Hospital, New York from 10/1/2018 to 10/31/2021. We included subjects with at least two BMI readings before COVID-19 lock down in March 2020, and at least one reading afterwards. Children who were underweight at baseline (BMI percentile < 5) or with medical conditions that may cause impact on weight such as endocrinological conditions (e.g. diabetes mellitus or hypothyroidism), genetic (e.g. Prader Willi syndrome), gastrointestinal diseases (e.g. inflammatory bowel disease or celiac disease), psychiatric diagnoses (e.g. eating disorders), as well as children who received systemic steroids > 2 weeks, were excluded from the study. Two baseline BMI readings were taken for all subjects during the pre-COVID period from October 2018 until March 2020 (one during the first 9 months, baseline-1;and second during the following 9 months, baseline-2). In the post-COVID period, the latest BMI measurement for the same cohort, at least 9 months from COVID-19 lockdown, was retrieved for comparison. Data was analyzed using SPSS software. The percentage of overweight and obese children was compared between different timelines using Chi-squared test. Change of BMI percentiles over time was tested for significance using the Wilcoxon Signed Ranks test. Result(s): After implementing the exclusion criteria, final number of studied patients was 3713. Children < 5 years old were 905 (24.4%), 5-12 years old were 1707 (46%), and > 12 years old were 1101 (29.7%). The median age (IQR) was 9 (5-12) years, with 1844 (49.6%) males. Black race accounted for 1777 (47.9%) while Hispanics or Latinos were 470 (12.7%), with other ethnicities being 1466 (39.4%). There was no difference in the percentage of obese children from baseline-1 (806/3713=21.7%) to baseline-2 (829/3713=22.3%), p-value=0.795, but this increased significantly in the post-COVID period (1136/3713= 30.6%), p-value <0.001 (figure 1). There was no significant change in the percentage of overweight children between the three timelines. The BMI percentile median (IQR) did not change between baseline-1 = 70 (36-93) and baseline-2 = 71 (35- 93), however, this increased significantly to 81 (36-93) in the post-COVID period, p-value<0.001 compared to both baseline-1 and baseline-2. Comparing the change in BMI percentiles from baseline 2 to post-COVID in the different age groups, it was more evident in the <5 years age group (median increment of 4.3 percentile) and 5-12 years age group (median increment of 3.9 percentile) compared to the >12 years age group (median increment of 0.7 percentile), p-value<0.001 (table 1). Conclusion(s): In our local community, COVID-19 lockdown resulted in a higher prevalence of obesity and an overall increase in BMI percentiles among children aged 2-19 years. The increase in BMI percentiles was more evident in children less than 12 years of age.
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Background: To control the spread of COVID-19 in NYC, a stay-at-home order was issued for March 22, 2020-June 13, 2020 followed by ongoing restrictions and only partial school reopening. The health impacts of these unprecedented restrictions on children are not yet known. Our objective was to examine whether BMI change during the COVID-19 period differed from the prior year among healthy children. Methods: This is a multicenter retrospective observational study of children aged five to eighteen years who received care within the NYC public hospital system between 2018 and 2020 encompassing all the five boroughs of the city. Using the system's electronic medical records, we identified patients who had a well-child visit between June 13, 2020 and December 31, 2020. Patients were included if they had annual well-child visits in the two previous years with anthropometric data recorded at all three visits. Patients with diagnoses that may affect adiposity (e.g. hypothyroidism) were excluded. We collected sociodemographic and anthropometric data for each year and calculated a modified body mass index z-score (mBMIz), which is a measure of relative BMI adjusted for age and sex. We compared change in mBMIz/month between the 2019 and 2020 visits (which included the pandemic) with the change in mBMIz/month between the 2018 and 2019 visits using generalized estimating equations (GEE). We examined whether the mBMIz/month change differed between the two periods and whether 2018 BMI category (underweight (5%), normal (5-85%), overweight (85-95%), obese (95-99%), extremely obese(>99%))modified this effect. Analyses were conducted using STATA software. Results: Of 23,458 patients seen between June 13, 2020 and December 31, 2020, 7,575 (32.3%) met our inclusion and exclusion criteria. The mean mBMIz was 0.68 in 2018, 0.69 in 2019 and 0.90 in 2020. (Table 1). In GEE analysis, the change in mBMIz/month was statistically significantly higher in 2019-2020 than in 2018-2019 (mean difference in mBMIz/month change=0.0152, p < 0.0001). While the change in mBMIz/month in 2019-2020 was lowest in patients in the extremely obese category, the difference in mBMIz/month between the two periods was greatest in this group (interaction effect of period and 2018 baseline category p < 0.0001). (Table 2). Conclusion: Our study suggests that the activity restrictions due to the COVID-19 outbreak are associated with greater excess weight gain in a diverse NYC population of healthy children as measured by mBMIz relative to the year prior to the outbreak. These findings correspond to the mean BMI percentile of our population changing from approximately 75th to the 82nd. These findings require further monitoring to better understand the specific reasons for the observed patterns across children in different BMI categories, assessment of longer-term health impact on this population and interventions to modify or reverse these worrisome trends. (Table Presented).
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Objectives: It is the objective of the study to assess the impact of nutrition on the clinical outcome of Covid-19 infection and its correlation with mortality. Materials and Methods: Among patients who were admitted for Covid 19 infection, nutritional parameters were evaluated at baseline and correlated with severity of Covid 19 infection and clinical outcome. This is a retrospective correlational study conducted in Fatima University Medical Center from March 2020 to October 2021 in adult patients admitted due to COVID-19 infection. Results: Among the two hundred and one patient were evaluated, 137 patients were malnourished (68%) with about 11 (8%) underweight, 33 (24%) overweight, Obese I 69 (50%) and Obese II 24 (18%). Among patients with abnormal BMI, hospital stay is significantly longer (14 days) than those with normal weight 11 days. Patients with abnormal BMI progressed to severe and critical cases (p-value 0.00010), while normal BMI are more likely to have mild cases. Mortality is significantly higher among those with abnormal BMI (29.2% vs 12.5%) p value of 0.0002. Conclusion: Patients with abnormal baseline weight showed a more progressive Covid 19 infection with direct correlation with hospital stay and mortality. Baseline nutrition is thus a predictor factor for mortality and suggest that prompt nutrition care or intervention and monitoring be performed.
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CASE: A 23-year-old female presented to resident clinic for 7 months of right shoulder pain. She received her second COVID-19 mRNA vaccine just prior to onset of pain. She noted vaccine administration was “traumatic” with significant bleeding and bruising. She started noticing pain with overhead activities several days later. She is very active with cardiovascular exercises. She lifts weights but none requiring overhead motions. The pain was worst at the front of the shoulder but radiated to the lateral aspect. She had not tried, ice, heat, medications or physical therapy. Because of her injury, she was hesitant to receive her COVID-19 booster. BMI was low at 16.65. Exam showed thin build and overall low muscle bulk. Right shoulder showed no signs of muscle atrophy. There was tenderness of subacromial and coracoid areas. No pain along biceps tendon or AC joint. She had full ROM with shoulder abduction, internal and external rotation. She had full strength of supraspinatus, infraspinatus, teres minor, and subscapularis muscles. She noted pain with abduction, internal rotation and lift-off maneuver. Her Hawkins and Neer's maneuvers were positive. No pain with Yergason's and Speed's maneuvers. The patient was diagnosed with right shoulder subacromial bursitis and impingement syndrome. IMPACT/DISCUSSION: Mild shoulder pain is expected after vaccine administration and typically resolves in days. However, SIRVA is an increasingly recognized complication of improper vaccine administration particularly in the occupational setting. SIRVA results from vaccine being delivered inadvertently within the subdeltoid bursa or joint space. It is thought to result from an immune mediated reaction to the vaccine components as injury tends to be greater than expected from a needle injury. We were able to find 5 cases of reported SIRVA related to the COVID vaccine. All included some form of subacromial, subdeltoid, or subcoracoid bursitis. One case noted a supraspinatus tear. Ultrasound has demonstrated the subacromial bursa can extend distal to the acromion by up to 6 cm, so administration to bursa is possible in the superior deltoid. Appropriate injection technique can reduce the risk of injury;administrators should use landmarks of the acromion and distal insertion point of deltoid mid-humerus. Proper needle length is important. It has been suggested a smaller deltoid fat pat and smaller deltoid muscle bulk are risk factors for SIRVA. Women tend to have a higher incidence. CONCLUSION: We presented the case of a slender female who developed shoulder bursitis and impingement following administration of COVID-19 mRNA vaccine. She was referred to PT for rotator cuff strengthening, instructed to refrain from aggravating activities, and provided NSAIDs for pain relief. She reports pain relief. Another option for a more severe case would be a subacromial bursa steroid injection. It is important for providers to be aware of this pathology to provide appropriate treatment and decrease vaccine hesitancy.
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Child malnutrition is the leading public health problem in Sub-Saharan Africa, resulting in poor health and economic losses. Ethiopia has one of the highest child undernutrition rates in the world that occurs to multifaceted factors, including food insecurity. Thus, we performed a cross-sectional study to assess the prevalence and risk factors for child undernutrition in largely food insecure areas of Ethiopia. Data were collected from 354 mother-child pairs from the Siraro district. Both bivariate and multivariate logistic regression was used for statistical analysis. Variables with a P-value of <0â 05 in multivariate analysis were used to detect statistical significance at a 95 % confidence level. About 67 % of households are food insecure. The prevalence of stunting wasting and underweight were 42â 7, 9â 9 and 27â 7 %, respectively. Female gender, higher age of the child (12-23 months v. 6-11 months), living in a household with five or more siblings, not getting therapeutic zinc supplement at least once, inadequate diet diversity, lack of growth monitoring service, and maternal own income increases the likelihood of child undernutrition. It can be concluded that child undernutrition is a severe public health problem in the study area. Improving primary healthcare services related to zinc supplementation, growth monitoring and promotion, and improving infant and child feeding practices can be considered as a strategy to address the problem.
Subject(s)
Child Nutrition Disorders , Malnutrition , Child Nutrition Disorders/complications , Child Nutrition Disorders/epidemiology , Child, Preschool , Cross-Sectional Studies , Ethiopia/epidemiology , Female , Food Insecurity , Humans , Infant , Malnutrition/epidemiology , ZincABSTRACT
Background: Depending on the level of care and the availability of pediatric intensive care unit (PICU) facilities, the mortality rate of acutely ill children varies in PICUs. Referral of patients from other medical centers, admission during working or off-work hours, and nosocomial infections are the most important risk factors for the high mortality rates in PICUs. Objectives: The present study aimed to investigate the characteristics and factors related to the risk of mortality in pediatric patients admitted to the PICU of a pediatric hospital in Qazvin, Iran. Methods: This cross-sectional study was performed on children admitted to the PICU of a pediatric hospital in Qazvin, Iran, between June 2017 and June 2020. During this period, a total of 1504 children, aged one month to 13 years, were admitted to the PICU, and 106 cases expired. The patients’ clinical data (ie, demographic characteristics, underlying disease, cause of death, and length of hospital stay) was extracted from their medical records. A prolonged length of stay was defined as more than 28 days of PICU admission. Results: A total of 106 children, with a mean age of 3.89 ± 3.23 years, expired during the study, with 41 (38.7%) cases being male. Among the investigated cases, 61 (57%) were < 2 years, 18 (17%) were 2 - 5 years old, and 27 (26%) were ≥ 6 years. In these patients, sepsis (13/82, 15.85%) and pneumonia (10/82, 12.19%) were the main causes of death. Other mortalities (14/106) were due to infectious diseases (gastroenteritis, influenza, and coronavirus disease) and non-infectious diseases (aspiration, anaphylaxis, and electrocution). The majority of children with a prolonged length of stay were < 2 years (17/23, 74%). The length of PICU stay was shorter in children with a lower weight percentile (P = 0.016). Conclusions: Following infectious diseases, congenital abnormalities and genetic disorders were the most common causes of pediatric mortality. Chronically ill children were more likely to be underweight and develop nutritional disorders, leading to the deterioration of their condition.
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OBJECTIVES: It is likely that the number of older adults who eat alone has increased during the COVID-19 pandemic. Older adults who eat alone tend to experience weight fluctuations. Weight loss and underweight in older adults cause health problems. The study objective was to longitudinally investigate the association between changes in eating alone or with others and body weight status in older adults. METHODS: This longitudinal cohort study was conducted in March and October 2020 in Minokamo City, Gifu Prefecture, Japan. Questionnaire data for 1071 community-dwelling older adults were analyzed. Multinomial logistic regression analysis was performed using changes in eating alone or with others as the independent variable and body weight status as the dependent variable. The analysis was adjusted for age, sex, living arrangements, educational level, diseases receiving medical treatment, cognitive status, depression, and instrumental activities of daily living. Missing data were imputed using multiple imputation. RESULTS: The average age of participants was 81.1 y (SD, 4.9 y). Individuals who reported eating alone in both surveys were more likely to report weight loss than those who reported eating with others in both surveys (adjusted model: odds ratio, 2.25; 95% confidence interval, 1.06-4.78; P = 0.04). CONCLUSIONS: These findings suggest that measures to prevent weight loss in older adults who eat alone are particularly important during the COVID-19 pandemic.