Novel starch-tungsten (VI) oxide biocomposites: Preparation, characterization, and comparisons between experimental and theoretical photon attenuation coefficients.

This study synthesized biocomposites containing starch and WO3 at varying ratios of 10 %, 20 %, 30 %, 40 %, and 50 % and assessed their thermal and radiation-shielding properties. These biocomposites were characterized using Fourier-transform infrared spectroscopy, X-ray diffraction (XRD) analysis, particle-size distribution assessments, scanning electron microscopy-energy dispersive X-ray spectroscopy, and thermogravimetric analysis-differential thermogravimetry measurements. Furthermore, the linear attenuation coefficients of the biocomposites were experimentally measured using an NaI(Tl) gamma spectrometry system and theoretically computed using XCOM and GAMOS simulations for comparisons. The XRD and particle-size distribution profiles of the WO3.2H2O powder, respectively, demonstrated evident diffraction peaks and favorable pore-size distributions. Morphological characterizations revealed that the WO3 particles were homogeneously dispersed throughout the starch matrix without any agglomeration. Comparisons of the thermal degradation rates revealed that the pure starch and starch +50%WO3 biocomposite began decomposing at approximately 200°Cand 300 °C, respectively, indicating that increasing WO3 proportions enhanced thermal stability. Furthermore, the starch +50%WO3 biocomposite demonstrated the highest experimental linear attenuation coefficient, with a value of 0.2510 ± 0.0848 cm-1 at a gamma energy of 662 keV. Meanwhile, XCOM and GAMOS simulations revealed theoretical attenuation coefficients of 0.1229 and 0.1213 cm-1 for pure starch and 0.2202 cm-1 and 0.2178 cm-1 for the starch +50%WO3 biocomposite at 662 keV, respectively.

Quadriceps femoris muscle ultrasound in sarcoidosis: an observational case-control study.

BACKGROUND: Although loss of muscle mass may be associated with general weakness, intolerance to physical activity and fatigue, it is underestimated and poorly understood in patients with sarcoidosis. AIM: To compare the quadriceps femoris muscle (QFM) thickness measured by ultrasonography (US) between the female patients with sarcoidosis and controls, secondly to assess the correlation between the muscle strength, fatigue and QFM thickness. DESIGN: Observational, case-control study. SETTING: Physical Medicine and Rehabilitation Department of a University Hospital. POPULATION: Thirty-one women with sarcoidosis and 27 healthy volunteers were included in the study. METHODS: The participants were evaluated for the following outcomes: 1) handgrip strength; 2) QFM thickness measured using US; and 3) sonographic thigh adjustment ratio (STAR). The sarcoidosis group was also evaluated with the 30-second chair stand test (30s-CST) and Fatigue Severity Scale (FSS). RESULTS: The QFM thickness and STAR values of the patients with sarcoidosis were significantly lower than those of the controls (P=0.0001). However, no statistically significant difference was observed between the handgrip strengths of the groups (P=0.581). There was no statistically significant correlation between the STAR values and handgrip strength in the sarcoidosis group; however, there was a significant positive correlation between the STAR values and 30s-CST (r=0.467, P=0.008). CONCLUSIONS: Loss of muscle mass is one of the musculoskeletal conditions in patients with sarcoidosis that may be associated with nonspecific symptoms, such as general debility, intolerance to physical activity, and fatigue. In the present study, no difference was observed in hand grip strength between the groups, while we found that QFM thickness was affected in patients with sarcoidosis when compared to the controls. The ultrasonographic QFM evaluation seems to be an innovative tool which may be used at all stages of sarcoidosis patient follow-up. CLINICAL REHABILITATION IMPACT: The grip strength is a commonly used test to detect muscle weakness, but onset of a decrease in muscle mass in the lower extremities may occur earlier. Considering the increased burden of musculoskeletal problems in this population, performing 30s-CST and sonographic QFM thickness is practical methods to identify risky patients.

Does Mild Coronavirus Disease 2019 Pneumonia in Healthy Adults Cause Permanent Small Airway Injury?

OBJECTIVES: Impulse oscillometry (IOS) is a type of oscillation technique that measures the input impedance (Z) of the respiratory system and can be used to detect pathological changes in the small airways at an early stage. Although coronavirus disease 2019 (COVID-19) affects the vascular and parenchymal structures in the lung, chronic postinfection coughs also may be attributed to small airway pathologies. Our research aimed to use IOS for the assessment of the presence of small airway resistance (R) in patients who have had COVID-19. METHODS: Thirty-eight patients with past COVID-19 infections and without any presence or medical treatment of an airway disease who presented to the post-COVID outpatient clinic with coughing symptoms were included in the study. The control group consisted of 17 patients with no past COVID-19 infection and without an airway disease. IOS and spirometry were performed twice in the case group, at 3 and 6 months after COVID-19. RESULTS: The mean age of the case group was 44.7 ± 12.3 years, whereas the mean age of the control group was 49.4 ± 11.8 years. The case group consisted of 38 patients, whereas 17 patients constituted the control group. No statistically significant difference was found between the two groups in the first and second test measurements, performed 3 months apart (P > 0.05). CONCLUSIONS: The fact that there was no difference between respiratory system impedance, airway resistance, and spirometry values between groups with and without past COVID-19 infections supported the hypothesis that small airways were not affected 3 months after COVID-19.

Treatment adherence and anxiety levels of bronchiectasis patients in the COVID-19 pandemic.

It has been reported that during the coronavirus disease-2019 (COVID-19) pandemic, bronchiectasis patients were adversely affected due to their limited respiratory functions and acute exacerbations which were triggered by viral infections. The increased concern in the population during the pandemic has affected the attitudes of people toward avoiding disease and patients' treatment compliance. It is unclear whether treatment adherence and anxiety levels of bronchiectasis patients have changed during the pandemic. We aimed to evaluate treatment adherence and anxiety levels in patients with bronchiectasis. A cross-sectional survey was conducted between May and November 2021. A total of 123 patients with bronchiectasis and 110 adults without chronic diseases were included in the control group. Patient demographic information, bronchiectasis follow-up data, and COVID-19 history were recorded. Then, patients filled out "MARS-5 Index" (Medical Adherence Report Scale-5), Beck Anxiety Scale and the Effect of Events Scale (IES-R). Responses of questionnaires were statistically analyzed. Our results showed that the majority of patients with bronchiectasis had high Medical Adherence Report Scale-5 index total scores during the COVID-19 pandemic (86.2%). The total scores on the Beck Anxiety Scale of bronchiectasis patients who did not have COVID-19 were significantly higher than those who had COVID-19 (P = .04). The total scores on the IES-R were found to be significantly higher in the control group (P < .001). No significant difference was found in the total scores on the Beck Anxiety Scale between the patients and the control group. The bronchiectasis patients had high adherence to their current treatment during the COVID-19 period and were less affected by the pandemic and its psychological effects compared to the healthy population. Furthermore, individuals diagnosed with bronchiectasis who were not infected with COVID-19 demonstrated increased levels of anxiety compared to those who were infected with COVID-19 which may be due to their concern about contracting the disease.

Humoral and Cellular Immunity to Severe Acute Respiratory Syndrome Coronavirus-2 Vaccination in Patients with Sarcoidosis

Background: The coronavirus disease 2019 vaccine induces both antibody and T-cell immune responses and has been proven to be effective in preventing coronavirus disease 2019, including its severe disease form, in healthy individuals. However, the details of severe acute respiratory syndrome coronavirus-2 immunoglobulin-G antibody responses and severe acute respiratory syndrome coronavirus-2 specific T-cell responses in patients with sarcoidosis are unknown. Aim: To measure and compare antibody responses and T cell responses using enzyme-linked immunosorbent assays and interferon-gamma release assay in sarcoidosis patients infected with coronavirus disease 2019 and vaccinated with CoronaVac. Study Design: A prospective cohort study. Methods: A total of 28 coronavirus disease 2019 polymerase chain reaction test-positive sarcoidosis patients who were infected with severe acute respiratory syndrome coronavirus-2 in the past 6 months and did not have coronavirus disease 2019 vaccination and 28 sarcoidosis patients who were administered with 2 doses of CoronaVac and never had coronavirus disease 2019 were included in this study. The immune response levels of patients were determined by measuring the severe acute respiratory syndrome coronavirus-2 immunglobulinG and interferon-gamma levels in the blood of the patients by the enzyme-linked immunosorbent assays method and interferon-gamma release assay tests, respectively. Results: The mean age of the patients in the COVID-infected group was 48.1 ± 11.3, while the mean age of the patients in the vaccinated group was 55.6 ± 9.32. The mean time elapsed after infection was 97.32 ± 42.1 days, while 61.3 ± 28.7 days had passed since the second vaccination dose. In the COVID-infected group, immunoglobulin-G and interferon-gamma release tests were positive in 64.3% and 89.3% of the patients, respectively. In the vaccinated group, immunoglobulin-G was positive in 10.7% of the patients, and interferon-gamma release test was positive in 14.3%. Conclusion: Innate immune responses are better than adaptive immune responses in patients with sarcoidosis. The coronaVac vaccine is insufficient to generate humoral and cellular immunities in patients with sarcoidosis.

Bronchodilator reversibility testing in long-term cough and dyspnea after Covid-19 viral infection: a trigger for asthma?

Objective: This study aims to investigate the presence of underlying chronic airway disease in individuals with chronic cough and dyspnea lasting longer than eight weeks and who had previously Coronavirus disease 2019 (COVID-19) and had no known lung disease.Methods: A total of 151 patients admitted to the respiratory diseases outpatient room with the complaint of cough and/or dyspnea that persisted for at least eight weeks following COVID-19 infection were accrued to the study. Demographic characteristics, smoking history, the severity of lung involvement on chest computed tomography in the acute phase of Covid-19 infection, and bronchodilator reversibility test results were recorded. Smoking history and forced expiratory volume in the first second (FEV1) were compared.Results: FEV1 increase ≥ 200 ml was observed in 40 (26.5%) patients. In 24 (15.9%) patients, an increase in FEV1 was found to be 200 ml and above, and the percentage of FEV1 was 12% or more. While 14 (9.3%) patients were diagnosed with asthma, 13 (8.6%) patients were diagnosed with nonreversible airflow obstruction (NRAO), and 1 (0.7%) patient was diagnosed with chronic obstructive pulmonary disease (COPD).Conclusions: COVID-19 infection may play a vital role in initiating asthma pathogenesis. It should be kept in mind that viral infection-related asthma may be the underlying cause of prolonged cough and dyspnea after COVID-19 infection.

Association between presence of Bacillus Calmette-Guerin vaccine scar and coronavirus disease 2019.

Bacillus Calmette-Guerin vaccine is administered for protection against tuberculosis and may also have beneficial effects against some viral respiratory tract infections. In this study, it was aimed to investigate the relationship between Bacillus Calmette-Guerin vaccination which is confirmed by BCG scar, and the frequency and course of Coronavirus disease 2019 (COVID-19). Among 490 patients, 400 patients who accepted to participate in the study were included. After the consent of patients, age, gender, body mass index, comorbidities, smoking, history, and the progress of COVID-19 of these patients were investigated; the presence and number of Bacillus Calmette-Guerin scars were recorded by a physician. Data from groups with and without COVID-19 history were compared. There was no relation between presence and number of the BCG scar and COVID-19 related hospitalization and intensive care unit admission. When groups with and without COVID-19 history compared, no statistically significant difference was found with the presence and number of Bacillus Calmette-Guerin scars (P > 0,05). No association was found between the presence or number of BCG scars and the frequency and course of COVID-19 in individuals with Bacillus Calmette-Guerin vaccination history confirmed by the presence of Bacillus Calmette-Guerin vaccine scars. Currently, the most important protection against COVID-19 is the COVID-19 vaccine.

Induced sputum eosinophilia and pulmonary function tests in ex-smokers with asthma controlled with an inhaled steroid and long-acting beta-agonist therapy.

Introduction: This study aims to investigate the relationship between induced sputum eosinophilia and pulmonary functions in ex-smoker asthma patients controlled with an ICS/LABA therapy. Materials and Methods: Asthma patients who are known to use ICS/LABA regularly for at least three months, without an attack in the last month, quit smoking (5-20 pack-years) and have asthma under control (ACT> 20), and concurrent with induced sputum cytology who had spirometry and lung volume measurements were included in the study. Cytology results, induced sputum eosinophil and neutrophil counts, FEV1 (L), FEV1 (%), FVC (L), FVC (%), RV (L), RV (%) and RV/TLC (%) values of all patients were recorded. The relationship between sputum neutrophil and eosinophil count and pulmonary function test parameters was evaluated. Result: Seventeen (68%) of the patients were female, eight (32%) were male, and the mean age was 49.7 ± 13.6 years. The mean sputum eosinophil percentage was 9.4 ± 16.7, and the neutrophil percentage was 71.4 ± 20.5. A positive correlation was found between induced sputum eosinophil percentage values and FEV1 (L) (r= +0.472; p= 0.01) and FVC (L) (r= +0.502; p= 0.01). No correlation was found between the FEV1/FVC%, FEV1%, FVC%, RV (L), RV%, and RV/TLC% values and the percentage of induced sputum eosinophils (p> 0.05). Conclusions: It was observed that controlled asthmatic patients with induced sputum eosinophilia treated with ICS/LABA and who quit smoking had high FVC (L) and FEV1 (L) levels.

Diagnosis of pleuroparenchymal fibroelastosis: A review.

Pleuroparenchymal fibroelastosis (PPFE) is a rare lung disease with unprecedented features characterized by fibroelastotic changes in the subpleural lung parenchyma affecting the upper lobes. PPFE is usually idiopathic, but it can be caused by infection, autoimmunity, bone marrow or lung transplantation, or a genetic predisposition. Histopathologic examination of lung biopsy samples reveals homogenous subpleural fibrosis and abundant elastic fibers, allowing for a definitive diagnosis. As PPFE mimics many interstitial lung diseases, clinicians face significant difficulties in making a definitive final diagnosis. Since most disease-related comorbid conditions manifest at an advanced stage, invasive tissue sampling for histopathologic evaluation is consistently impossible. Such a patient presentation highlights the importance of an analysis based solely on clinical findings, which would provide a definitive diagnosis without the need for a biopsy. Because of its exceptional and inconceivable presentation, PPFE creates a diagnostic dilemma. In light of our two cases and the literature data, we present a diagnostic assessment score assay that relies solely on clinical manifestations without histopathological tissue verification to shed light on the diagnosis of PPFE. This review focuses on PPFE identification through the use of a diagnostic assessment analysis to improve early disease recognition without the use of invasive diagnostic interventions to obtain biopsy samples for histopathologic evaluation. This analytic approach, while not diagnostic in and of itself, may provide a useful pathway for differential diagnosis and may preclude redundant initiatives.

SARS-CoV-2 antibody research in patients with unprovoked pulmonary embolism in COVID-19 pandemic period.

OBJECTIVE: Due to the coronavirus disease 2019 (COVID-19) pandemic, a significant increase has been observed in patients diagnosed with pulmonary embolism (PE) in our clinic. In addition to COVID-19-related PE, the increase in the number of patients with unprovoked or idiopathic PE was also noteworthy. Although it is not surprising that PE due to immobilization was observed in elderly patients and patients with comorbidities at risk for PE during the pandemic, it is important to investigate the increase in the number of unprovoked PE. Thus, we aimed to show that a previous COVID-19 infection may be a risk factor in these patients by examining the presence of severe acute respiratory syndrome-causing coronavirus (SARS-CoV-2) antibodies in patients diagnosed with unprovoked PE. MATERIALS AND METHODS: The participants of the study consisted of 45 consecutive patients who were diagnosed with PE in our clinic, had no risk factors for PE, were considered unprovoked (idiopathic) PE, and had no history of COVID-19. SARS-CoV-2 antibody titers were measured in the serum samples of the patients for detecting immunity as a result of encountering COVID-19. RESULTS: Of the 45 patients diagnosed with PE, 24 (53.3%) patients were diagnosed with computed tomography pulmonary angiogram (CTPA), and 21 (46.7%) patients were diagnosed with perfusion single-photon emission computed tomography (Q-SPECT/CT). Immunity acquired after encountering COVID-19 was checked with the NCP kit, which revealed positive results in 9 (20%) patients. CONCLUSION: It should be kept in mind that some of the patients diagnosed with idiopathic PE during the pandemic may have embolism due to asymptomatic COVID-19. In addition, it is now known that COVID-19 also creates a tendency toward thrombosis in asymptomatic patients.

Investigating the Differences in Polysomnography Results Evaluated According to the Recommended and Alternative Hypopnea Criteria Utilized in the Evaluation of Polysomnography.

OBJECTIVE: The criteria of hypopnea recommended by the American Academy of Sleep Medicine until 2012 was 3% desaturation and 50% decline in the signal amplitude. The recommended and alternative criteria for hypopnea were determined as 3% desaturation accompanied by a 30% decline in the signal amplitude and 4% desaturation accompanied by a 30% decline in the amplitude by the 2013 update of the guideline was published by the American Academy of Sleep Medicine in 2012. The objective of our study was to investigate to what degree scoring of hypopneas has great importance in the diagnosis and severity grading of obstructive sleep apnea syndrome according to different criteria. MATERIAL AND METHODS: The present study was designed as a retrospective study in which the results of the polysomnography of 62 patients were recorded after evaluation according to 3 different hypopnea criteria. Criteria 1, criteria 2, and criteria 3 were accepted as a 3% drop in SaO2 accompanied by a 30% decline in the amplitude, as a 4% drop in SaO2 accompanied by a 30% decline in the amplitude, and as a 3% drop in SaO2 accompanied with a 50% decline in the amplitude, respectively. RESULTS: Statistically significant differences were determined between criteria 1 and criteria 2, criteria 1 and criteria 3, and criteria 2 and criteria 3 regarding the numbers of hypopneas. CONCLUSION: For the same polysomnography, evaluations with different accepted hypopnea criteria cause different polysomnography results.

Investigation of the ongoing pulmonary defects with perfusion-single photon emission computed tomography/computed tomography in patients under anticoagulant therapy for coronavirus disease 2019-induced pulmonary embolism.

OBJECTIVE: It was aimed to reveal the continuing perfusion defect rates in patients with a diagnosis of pulmonary embolism (PE) due to COVID-19 who have completed the third month of anticoagulant therapy but whose symptoms or laboratory elevations continue. METHODS: Patients with COVID-19 who were diagnosed with PE by Q-SPECT-CT between 1 September 2020 and 1 November 2021, who underwent control Q-SPECT/CT were included in the study. Demographic characteristics, laboratory findings, and first and second Q-SPECT/CT evaluation results of the patients were recorded. RESULTS: It was observed that the pulmonary defect continued in Q-SPECT/CT in the third month of anticoagulant treatment in 58.3% of the patients diagnosed with PE due to COVID-19, and new defects developed in 6.3%. The persistence rate of segment defects was higher than that of subsegment defects. It was observed that the defects persisted more frequently in patients with a history of hospitalization due to COVID-19. CONCLUSION: Perfusion defects may still be present in patients diagnosed with PE due to COVID-19 in the presence of persistent dyspnea/chest pain/D-dimer elevation after 3 months of treatment. Perfusion defect persistence rates are higher in defects more proximal to the subsegment level and in people with severe COVID-19, and extended treatment should be considered in these patients.

Coronavirus Disease 2019 in Patients with Asthma: Case Study from a Tertiary Center Regarding Their Phenotypes and Their Adherence to Asthma Treatment by Telemedicine.

OBJECTIVE: The aim of this study was to determine the prevalence and the characteristics of coronavirus disease 2019 (COVID-19) in a tertiary outpatient clinic of asthma patients, find the predisposing asthma phenotype to COVID-19, and to see their adherence to asthma treatment. MATERIAL AND METHODS: A retrospective, cross-sectional, real life study was conducted via phone interviews with the patients being followed in the asthma outpatient clinic. From the files of the patient information was obtained about their demographics, asthma phenotype, co-morbidity, prick tests, spirometry test results and their medications at the last visit before the COVID-19 pandemic. Information's about asthma exacerbations, ACT, asthma treatment adherence and history of COVID-19 were obtained via telephone interviews. RESULTS: Of the 573 patients with asthma, 13 (2.26%) had COVID-19 history. The mean age of patients with asthma and COVID-19 was 51.84±14.92 year. Two patients were on mepolizumab and one was on omalizumab treatment. Mean ACT was 19.84±2.73. Lack of adherence was reported in 8% of all patients with asthma compared to 23% in the patients who had COVID-19. Asthma exacerbation was seen during the course of SARS-CoV2 infection in 3 of 13 patients with asthma. Asthma exacerbations were reported during the period of one month following COVID-19 in 2 patients. CONCLUSION: The most common asthma phenotype in the cases of COVID-19 was obese phenotype. Rates of using biological agents and non-adherence to the treatment were found to be higher. Asthma exacerbation may be seen during course of COVID-19 albeit being less common.

Investigation of perfusion defects by Q-SPECT/CT in patients with mild-to-moderate course of COVID-19 and low clinical probability for pulmonary embolism.

OBJECTIVE: Pulmonary embolism is a severe source of mortality and morbidity in patients with severe and critical coronavirus disease 2019. It is not yet clear whether the tendency to thrombosis is increased in the mild-to-moderate course of COVID-19. Our research aims to show the clinical benefit of Q-SPECT/CT in diagnosing PD in outpatients treated with mild-to-moderate course of COVID-19 and to determine the frequency of perfusion defects in these patients having relatively lower risk. METHODS: All patients who underwent Q-SPECT/CT with suspicion of embolism were examined retrospectively. Only patients with low clinical probability and mild-to-moderate course of COVID-19 for PE were included in the study. The patients were evaluated comparatively as those with and without perfusion defects. Patients were divided into laboratory suspicion, clinical suspicion, or clinical and laboratory suspicion. RESULTS: In outpatients with mild-to-moderate COVID-19 with low clinical probability for PE, PD without CT abnormality was detected with a rate of 36.6% with Q-SPECT/CT performed for complaints of high D-dimer and/or dyspnea. None of the patients had PD at more proximal level than the segment level. PD with no concomitant CT abnormality was observed with a rate of 56.5% in patients with both clinical and laboratory suspicion. For D-dimer = 0.5 mg/dL cut-off sensitivity is 85%, for D-dimer = 1.5 mg/dL cut-off specificity 81%. CONCLUSION: Thrombosis tendency is also present in outpatients with mild-to-moderate COVID-19, and these patients should also be offered anticoagulant prophylaxis during the COVID-19 period.

Assessment score for the diagnosis of a case with pleuroparenchymal fibroelastosis.

Idiopathic pleuropulmonary fibroelastosis is an extremely rare lung disease characterized by the combination of fibrosis of the visceral pleura and the fibroelastotic changes transcending in the subpleural lung parenchyma that predominantly affects the upper lobes with accompanying volume loss. It is mostly idiopathic while infection, autoimmunity, bone marrow or lung transplantation and genetic predisposition may be associated with the development of PPFE. The disease is exceptionally rare as approximately ninety cases have been reported in the literature currently. A 35-year-old female presented with exertional dyspnea, dry cough and weight loss. Physical examination demonstrated platythorax, suprasternal notch deepening and fine rales over the upper lobes. Blood count, serum biochemistry, autoimmunity and serologic markers for collagen vascular diseases were within normal limits. Arterial blood gases demonstrated a low pO2 (48 mm Hg) and a high pCO2 (54 mm Hg) values. Chest x-ray showed bilateral parenchymal fibrotic lesions, left pneumothorax, bronchiectasis in the middle and pleural thickening in the upper lung zones while HRCT revealed bilateral apical pleural thickening, traction bronchiectasis, subpleural reticulations, ground-glass opacities and honeycombing in the upper lobes. Bronchoscopy, BAL cytology, smear and culture did not reveal any pathologic findings. Relevant with the clinical, laboratory, radiologic manifestations and the differential diagnosis with other interstitial lung diseases, PPFE was the final diagnosis. The aim of this case report was to present the clinical manifestations of our case. The second crucial objective was to establish a diagnostic scoring system relevant with the literature and the clinical manifestations of the patient.

Validation of an Algorithm to Ascertain Late Breast Cancer Recurrence Using Danish Medical Registries.

PURPOSE: About 70% of women with breast cancer survive at least 10 years after diagnosis. We constructed an algorithm to ascertain late breast cancer recurrence-which we define as breast cancer that recurs 10 years or more after primary diagnosis (excluding contralateral breast cancers)-using Danish nationwide medical registries. We used clinical information recorded in medical records as a reference standard. METHODS: Using the Danish Breast Cancer Group clinical database, we ascertained data on 21,134 women who survived recurrence-free 10 years or more after incident stage I-III breast cancer diagnosed in 1987-2004. We used a combination of Danish registries to construct the algorithm-the Danish National Patient Registry for information on diagnostic, therapeutic and procedural codes; and cancer diagnoses from the Danish Pathology Registry, the Danish Cancer Registry and the Contralateral Breast Cancer database. To estimate the positive predictive value (PPV), we selected 105 patients who, according to our algorithm, had late recurrence diagnosed at Aarhus University Hospital. To estimate the sensitivity, specificity and negative predictive value (NPV), we selected 114 patients diagnosed with primary breast cancer at Aalborg University Hospital. We abstracted clinical information on late recurrence for patients with medical record-confirmed late recurrence at Aarhus University Hospital. RESULTS: Our algorithm had a PPV of late recurrence of 85.7% (95% CI: 77.5-91.3%), a sensitivity of 100.0% (95% CI, 39.8-100.0%), a specificity of 97.3 (95% CI, 92.2-99.4) and a NPV of 100% (95% CI, 96.6-100.0%). CONCLUSION: Our algorithm for late recurrence showed a moderate to high PPV and high sensitivity, specificity and negative predictive value. The algorithm could be an important tool for future studies of late breast cancer recurrence.

Association of Neighborhood Disadvantage With Cardiovascular Risk Factors and Events Among Refugees in Denmark.

Importance: Refugees are among the most disadvantaged individuals in society, and they often have elevated risks of cardiovascular risk factors and events. Evidence is limited regarding factors that may worsen cardiovascular health among this vulnerable group. Objective: To test the hypothesis that refugee placement in socioeconomically disadvantaged neighborhoods is associated with increased cardiovascular risk. Design, Setting, and Participants: The study population of this quasi-experimental, registry-based cohort study included 49 305 adults 18 years and older who came to Denmark as refugees from other countries during the years of Denmark's refugee dispersal policy from 1986 to 1998. Refugees were dispersed to neighborhoods with varying degrees of socioeconomic disadvantage in an arbitrary manner conditional on observed characteristics. The association of neighborhood disadvantage on arrival with several cardiovascular outcomes in subsequent decades was evaluated using regression models that adjusted for individual, family, and municipal characteristics. Health outcomes were abstracted from the inpatient register, outpatient specialty clinic register, and prescription drug register through 2016. Data analysis was conducted from May 2018 to July 2019. Exposures: A composite index of neighborhood disadvantage was constructed using 8 neighborhood-level socioeconomic characteristics derived from Danish population register data. Main Outcomes and Measures: Primary study outcomes included hypertension, hyperlipidemia, type 2 diabetes, myocardial infarction, and stroke. Before data analysis commenced, it was hypothesized that higher levels of neighborhood disadvantage were associated with an increased risk of cardiovascular risk factors and events. Results: A total of 49 305 participants were included (median [interquartile range] age, 30.5 [24.9-39.8] years; 43.3% women). Participant region of origin included 6318 from Africa (12.8%), 7253 from Asia (14.7%), 3446 from Eastern Europe (7.0%), 5416 from Iraq (11.0%), 6206 from Iran (12.6%), 5558 from Palestine (via Lebanon, Israel, Occupied Palestinian Territories; 11.3%), and 15 108 from Yugoslavia (30.6%). Adjusted models revealed an association between placement in disadvantaged neighborhoods and increased risk of hypertension (0.71 [95% CI, 0.30-1.13] percentage points per unit of disadvantage index; P < .01), hyperlipidemia (0.44 [95% CI, 0.06-0.83] percentage points; P = .01), diabetes (0.45 [95% CI, 0.09-0.81] percentage points; P = .01), and myocardial infarction (0.14 [95% CI, 0.03-0.25] percentage points; P = .01). No association was found for stroke. Individuals who arrived in Denmark before age 35 years had an increased risk of hyperlipidemia (1.16 [95% CI, 0.41-1.92] percentage points; P < .01), and there were no differences by sex. Conclusions and Relevance: In this quasi-experimental cohort study, neighborhood disadvantage was associated with increased cardiovascular risk in a relatively young population of refugees. Neighborhood characteristics may be an important consideration when refugees are placed by resettlement agencies and host countries. Future work should examine additional health outcomes as well as potential mediating pathways to target future interventions (eg, neighborhood ease of walking, employment opportunities).

In utero opioid exposure and risk of infections in childhood: A multinational Nordic cohort study.

PURPOSE: There is an increasing number of children with in utero exposure to opioids. Knowledge about opioid safety in pregnancy, particularly for outcomes later in childhood is scarce. It has been suggested that opioids can modulate immune system and increase the risk of infections. Our goal was to study the impact of in utero opioid exposure on the immune system and the risk of infections in childhood. METHODS: This population-based cohort study used nationwide registers from Denmark, Norway, and Sweden. Among pregnant women we identified users of opioids for two different indications, opioids used in opioid maintenance therapy (OMT) and opioids used for treatment of pain. We followed the exposed children and studied susceptibility for infections measured as number of antibiotic prescriptions expressed as Incidence rate ratios (IRRs) and diagnoses in specialist health care expressed as hazard ratios (HRs). RESULTS: After adjustment we did not observe increased risk for filling antibiotic prescriptions in children exposed to OMT opioids compared with OMT discontinuers (IRR, 1.08; 95% CI 0.81-1.44 in Norway and Sweden, and IRR, 0.74; 95% CI 0.63-0.88 in Denmark), or for diagnosis of infection in specialist health care (HR 0.83; 95% CI 0.55-1.26 in Norway and Sweden, and 0.82; 95% CI 0.62-1.10 in Denmark). CONCLUSIONS: In this population-based cohort study, we did not observe increased risk of infections among children prenatally exposed to OMT opioids when compared to OMT discontinuers, nor long-term analgesic opioids exposed when compared to short-term analgesic opioids exposed.

Hospital Records of Pain, Fatigue, or Circulatory Symptoms in Girls Exposed to Human Papillomavirus Vaccination: Cohort, Self-Controlled Case Series, and Population Time Trend Studies.

Human papillomavirus (HPV) vaccination has been associated with subsequent diffuse symptoms in girls, reducing public confidence in the vaccine. We examined whether girls have nonspecific outcomes of HPV vaccination, using triangulation from cohort, self-controlled case series (SCCS), and population time trend analyses carried out in Denmark between 2000 and 2014. The study population consisted of 314,017 HPV-vaccinated girls and 314,017 age-matched HPV-unvaccinated girls (cohort analyses); 11,817 girls with hospital records (SCCS analyses); and 1,465,049 girls and boys (population time trend analyses). The main outcome measures were hospital records of pain, fatigue, or circulatory symptoms. The cohort study revealed no increased risk among HPV vaccine-exposed girls, with incidence rate ratios close to 1.0 for abdominal pain, nonspecific pain, headache, hypotension/syncope, tachycardia (including postural orthostatic tachycardia syndrome), and malaise/fatigue (including chronic fatigue syndrome). In the SCCS analyses, we observed no association between HPV vaccination and subsequent symptoms. In time trend analyses, we observed a steady increase in these hospital records in both girls and (HPV-unvaccinated) boys, with no relationship to the 2009 introduction of HPV vaccine to Denmark's vaccination program. This study, which had nationwide coverage, showed no evidence of a causal link between HPV vaccination and diffuse autonomic symptoms leading to hospital contact.