Background & Aims: Reports of a rise in childhood cancer incidence in Australia and globally prompted the investigation of cancer incidence and survival in South Australia (SA) and the Northern Territory (NT) over a 28-year period, with emphasis on Indigenous peoples. Methods: This cross-sectional analysis of two prospective longitudinal databases, the SA and NT Cancer Registries (1990-2017), included all reported cases of childhood cancers. Poisson regression provided estimates of incidence rate ratios and survival was modelled using Cox proportional hazard models for children aged 0.05). With reference to the 1990-1999 era, overall survival improved in subsequent eras in SA (2000-2009: HR 0.53 [0.38-0.73]; 2010-2017: 0.44 [0.28-0.68]); however, remained unchanged in the NT (2000-2009: 0.78 [0.40-1.51]; 2010-2017: 0.50 [0.24-1.05]). In the NT, overall survival of Indigenous patients was significantly lower compared with the non-Indigenous cohort (3.42 [1.92-6.10]). While the survival of Indigenous children with cancer significantly improved in the last two eras (p0.05). Conclusions: The incidence of childhood cancers has remained unchanged over 28-years in SA and the NT. Encouragingly, improved survival rates over time were observed in SA and amongst Indigenous children of the NT. Nevertheless, survival rates in Indigenous children remain lower than non-Indigenous children.

Pregnant women are especially vulnerable to respiratory diseases. We aimed to study seroconversion rate during pregnancy in a cohort of consecutive pregnancies tested in the first and third trimesters and to compare maternal and obstetric complications between women who seroconverted in the first versus the third trimester. This is an observational, cohort study carried out at Hospital Universitario de Torrejón, in Madrid, Spain, during the first peak of the COVID-19 pandemic. All consecutive singleton pregnancies with a viable fetus attending their 11-13 weeks scan between January 1st and May 15th, 2020, were included and monthly follow up until delivery. Antibodies against SARS-CoV-2 (IgA and IgG) were analyzed on stored serum samples obtained from the first and third trimester routine antenatal bloods in 470 pregnant women. Antibodies against SARS-CoV-2 were detected in 31 (6.6%) women in the first trimester and in 66 (14.0%) in the third trimester, including 48 (10.2%) that were negative in the first trimester (seroconversion during pregnancy). Although the rate of infection was significantly higher in the third versus the first trimester (p = 0.003), no significant differences in maternal or obstetric complications were observed in women testing positive in the first versus the third trimester.

Diarrhea and fever are prevalent childhood illnesses with potentially severe consequences, especially when they co-occur. This study investigates the prevalence and determinants of diarrhea, fever, and their coexistence among children under-five in Bangladesh. Data from the 2017-18 Bangladesh Demography and Health Survey (BDHS) were analyzed using multivariable stepwise logistic regression with backward selection. This study found that 5.0% for diarrhea, 34.0% for fever, and 3.0% for the coexistence of both illnesses. Common factors associated with childhood diarrhea and fever included the mother's education, her attitude toward wife-beating, and the child’s age (12-23 months). Diarrhea was associated with households with improved water sources and children in the Barisal division, while fever was linked to underweight children and those from more affluent backgrounds. The coexistence of both was significantly linked to underweight children, higher birth orders, and children from the Rajshahi division. Notably, child illnesses were associated with parental education, higher socio-economic status, and access to improved drinking water sources. Diarrhea affects one in 20 children, fever affects one in three, and the coexistence of both conditions affects one in 35 children in Bangladesh. The findings need further research and policy reviews to develop effective interventions and improve child health in Bangladesh.

We investigate a new fundamental property of infectious diseases with natural adaptive immunity that weakens over time. Numerical experiments with a model of the Covid-19 epidemic in Moscow have demonstrated that when the reproduction number R0 is about 4, a qualitative change (bifurcation) occurs in the behavior of the virus-human system. Below this value, the long-term forecast tends to undamped oscillations; above it, the forecast shows damped oscillations: the amplitudes of epidemic waves decrease gradually, with a constant, very high background level of morbidity that keeps the natural immunity near 100%. To confirm this result analytically, we use an original modification of the Euler-Lotka renewal equation, which describes the dynamics of infected patients distributed by disease duration (time since infection) and accounts for immunity. To construct a bifurcation diagram, which illustrates the dependence of the equilibrium stability on the parameter R0, we linearize the equation in the vicinity of the equilibrium point and examine its numerical approximation (discrete form). This approximation can be interpreted as a Leslie model, with the matrix elements dependent on the parameter R0. By examining the roots of the corresponding Lotka polynomial, we can assess the stability of the equilibrium point. For the bifurcation diagram, we use the functions obtained from the simulation of the Covid-19 epidemic in Moscow. However, observations of the epidemic in other cities and countries support the primary finding of our study regarding the attenuation of epidemic waves.

Aims and objectives: The primary aim of our study was to evaluate morbidity and mortality following feeding jejunostomy in pancreaticoduodenectomy compared to the control group. We also evaluated individual complications like delayed gastric emptying; post operative pancreatic fistula, superficial and deep surgical site infection. Material and Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2.the random-effects model was used. Results: Four studies including Total of 1639 patients were included in the analysis. Total 843 patients were included in Feeding jejunostomy group and 796 patients included in control group without feeding jejunostomy. Over all morbidity was significantly higher in feeding jejunostomy group. (P = 0.001). There was no significant difference between both the groups. (P=0.07). Delayed gastric emptying was significantly higher in feeding jejunostomy group. [P=0.021]. There was no significant difference in development of pancreatic fistula between the two groups. Deep surgical site infection was significantly higher in feeding jejunostomy group. (P=0.013). Hospital stay was significantly more in feeding jejunostomy group (p<0.0001). There was no significant difference between readmission; TPN requirement and time to start oral feed. Conclusion: Feeding jejunostomy seems to be associated with increased morbidity and increased length of stay.

Multi-morbidity and polypharmacy are common in older people and pose a challenge for health and social care systems especially in context of global population ageing. They are complex and interrelated concepts in the care of older people that require early detection and patient centred decision making that are underpinned by the principles of multidisciplinary led comprehensive geriatric assessment (CGA). Personalised care plans need to remain responsive and adaptable to the needs of a patient, enabling an individual to maintain their independence.

Optimal breastfeeding practices among mothers have been proven to have health and economic benefits, but evidence on breastfeeding practices among adolescent mothers in Bangladesh is limited. Hence, this study aims to estimate breastfeeding indicators and factors associated with selected feeding practices. The sample included 2554 children aged 0-23 months of adolescent mothers aged 12-19 years from four Bangladesh Demographic and Health Surveys collected between 2004 and 2014. Breastfeeding indicators were estimated using World Health Organization indicators. Selected feeding indicators were examined against potential confounding factors using univariate and multivariate analyses. Only 42.2% of adolescent mothers initiated breastfeeding within the first hour of birth, 53% exclusively breastfed their infants, predominant breastfeeding was 17.3%, and 15.7% bottle-fed their children. Parity (2-3 children), older infants and adolescent mothers who made postnatal check-up after two days were associated with increased exclusive breastfeeding (EBF) rates. Adolescent mothers aged 12-18 years and who watched television were less likely to delay breastfeeding initiation within the first hour of birth. Adolescent mothers who delivered at home (adjusted OR=2.63, 95% CI:1.86, 3.74) and made postnatal check-up after two days (adjusted OR=1.67, 95% CI: 1.21, 2.30) were significantly more likely to delay initiation breastfeeding within the first hour of birth. Younger infants, adolescent mothers living in Barisal region and who listened to radio reported increased odds of predominant breastfeeding and increased odds for bottle-feeding included male infants, an infant aged 0-5 months, Adolescent mothers who had eight or more antenatal clinic visits and richest wealth quintiles. In order for Bangladesh to meet the Sustainable Development Goals (SDGs) 2 and 3 by 2030, breastfeeding promotion programmes should discourage bottle-feeding among adolescent mothers from richest households and promote early initiation of breastfeeding especially among adolescent mothers who delivered at home and had late postnatal check-up after delivery

Aims: Primary AIM of the study was to evaluate effect of prolonged hospital stay on Surgical site infections We also evaluated effect of prolonged hospital stay on overall morbidity in Gastrointestinal and Hepatobiliary Surgery as secondary outcome. Methods: We retrospectively analysed all the patients who underwent gastrointestinal and hepatobiliary surgery between April 2017 to March 2020. On our analysis we found mean hospital stay in patient who did not develop SSI and/or morbidity was 4 days (Total hospital stay) vs 6 days who developed morbidity (hospital stay before diagnosis of SSI or diagnosis or morbid event). Based on this to avoid selection bias, we did 1:1 propensity score analysis between patients who had 4 or less than hospital stay vs patients who had 5 or more hospital stay before diagnosis of surgical site infection and/or morbid event. We took all the preoperative and intraoperative factors like Age, sex, malignant disease, ASA score, CDC grade of surgery, open or laparoscopic surgery, HPB surgeries, colorectal surgeries, Upper Gastrointestinal surgeries and small intestinal surgeries as covariates. We used nearest neighbor matching protocol with a calipher of 0.2. Cases were not reusable after matching. Statistical analysis was done using SPSS version 23. Results: We included 348 patients operated between April 2017 and March 2020 in our analysis. After 1:1 propensity score matching 58 patients included in study arm (prevent hospital stay more than 4 days) and 56 patients in control arm. Both groups were comparable with regard to Age, Sex, Surgery for malignant disease, ASA score, CDC grade of surgery, HPB surgeries, Small intestinal surgeries, Colorectal surgeries, upper gastrointestinal surgeries, intraoperative blood product requirement, intraoperative hypotension or any other event, operative time. Prolonged hospital stay (> 4 days) was significantly associated with surgical site infections (p<0.0001), morbidity (p=0.001). Open surgeries were associated with prolonged hospital stay. (p=0.032). Conclusion: Prolonged Hospital stay is associated with increase surgical site infection and morbidity in Gastrointestinal and Hepatobiliary Surgery.

Recent policy and service provision recommends a woman-centered approach to maternity care and encourages the development of personalized models of clinical assistance. As ethnicity has been recognized as determinant in the risk calculation of some obstetric complication, our aim was to assess costs for birth assistance according to the maternal ethnicities. In a five-year period (2012-16) all women admitted for delivery at the Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Rome, Italy were investigated. Economic evaluations were performed by using the ‘diagnosis-related group’ (DRG) approach. Cost analysis was completed by including maternal ethnicity, delivery mode and perinatal complications. A total of 18,093 patients were involved in the analysis. An overall care expense of €42.663.481 was calculated. Caucasian was the main ethnicity (90.7%), leaving the minority groups to 9.3%. Vaginal delivery (VD) was the most common mode of delivery in all ethnic clusters, with a global rate of 59.6%. Not including Asiatic women, increased CS rates were recorded in all minority ethnic groups (Maghreb (51.5%) and Afro-Caribbean (47.8%)). A double incidence of complicated VD was observed in the minority groups, primarily among Afro-Caribbean (69.9%), followed by Asiatic (64.1%), Maghreb (63.2%) and Latin-America (62.7%) patients. By logistic regression, Afro-Caribbean delivering women had a significant increased risk of complicated CS among all subgroups. Minority groups (Afro-Caribbean, in particular) increase the health care cost for birth assistance due to higher incidence of adverse perinatal outcomes.

Background/Objectives: The use of post-operative drains in gynaecologic oncology procedures is controversial with evidence both supporting and questioning their efficacy. Proponents argue that such drains help detect complications early, reduce abscess formation, and also alleviate post-operative pain. On the other hand, drains are associated with increased risks of incisional hernia, infection, prolonged hospitalization, and postoperative pain. Methods: We conducted a research in the PubMed database and supplemented it with a manual search to retrieve addition-al papers eligible for inclusion. Results: Their use is not always found to improve outcomes, no-tably in surgeries such as a radical hysterectomy with pelvic lymphadenectomy, where they may actually enhance lymphocyst formation and other complications. In cytoreductive surgery for ovarian cancer, negative pressure wound therapy showed some potential benefits, but evidence remained inconclusive due to limited studies. The international guidelines presented in this re-view, suggest avoiding the routine use of drains and promote early removal when their use is necessary. Conclusions: This review aims to present an update on the current knowledge re-garding the role of drainage in gynaecologic oncology and while further good-quality research is required, particularly in high-risk surgical procedures, numerous prospective trials have exten-sively addressed the topic, trying to provide clear suggestions.

Pregnancy-related morbidity and mortality remains high across the United States and the majority of deaths are preventable. Misdiagnosis and delay in diagnosis are thought to be contributors to preventable harm. These diagnostic errors in obstetrics are understudied. We present selected research methods to ascertain rates of and harm associated with diagnostic errors, the challenges in investigating them, and present future steps toward achieving diagnostic excellence in obstetrics.

Background: The aim of this audit is to evaluate the characteristics of dental infections requiring hospitalisations, which may help improve preventative and management policies. Methods: This study retrospectively evaluated the patients’ records admitted to a public hospital due to dental infections between 2018 and 2019. Results: A total of 102 patients, mostly in thirties with equal gender distribution were admitted with dental infections, presenting with pain (100%), swelling (99%), Trismus (40.2%), dysphagia (27.4%), fever (21%) >37°C, Tachycardia (24.75%) and Tachypnoea (9.3%). Most patients presented (68%) on weekends, outside regular working hours and public holidays. 54 (52.5%) patients had taken prior antibiotics. Dental Caries, smoking, mental health issues and illicit drug use were featured strongly. The majority of patients (56.4%) underwent treatment under local anaesthesia. The total length of hospital stay was 271 days (mean 2.66). Augmentin was the most prescribed antibiotics. Complications were reported in 8.8% patients, primarily related to airway compromise. Conclusion: Dental infections leading to hospitalizations continue to be a burden on the healthcare system. A notable finding was the presentations primarily on weekends, outside regular hours and public holidays and the majority requiring dental intervention under local anaesthesia. Provision of on call emergency dental services may reduce length of hospital stay and admissions.

Background and Objectives: The current study aimed to determine the impact of fasciotomy on mortality and morbidity in children and adults with crush-related AKI following the 2023 Kahramanmaraş earthquakes. Materials and Methods: The study included individuals who had suffered crush injuries after the 2023 Kahramanmaraş earthquakes and were identified as having acute kidney injury (AKI). Patients with AKI were divided into two groups based on age: those under 18 years and those over 18 years. A comparative analysis was conducted between the mortality and morbidity rates of patients who underwent fasciotomy and those who did not. Disseminated intravascular coagulopathy (DIC), sepsis, and adult respiratory distress syndrome (ARDS) have all been identified as contributors to morbidity. Results: The study was conducted with a total of 40 patients (21 males and 19 females) aged between four and 83 years. A total of 21 patients underwent fasciotomy and the patients underwent varying numbers of fasciotomy, ranging from zero to 11. The mortality rate was 12.5%, corresponding to five adult patients. No instances of mortality were reported in the paediatric cohort. The application of fasciotomy in instances of crush-induced AKI did not result in elevated levels of mortality in either the paediatric or adult demographic. Within the adult population, a substantial difference in the duration of dialysis was observed between individuals who underwent fasciotomy and those who did not. A statistically significant increase in the number of fasciotomy incisions was observed in patients diagnosed with sepsis compared with those without sepsis. The study found a significant positive correlation between the number of fasciotomy incisions and dialysis days. Conclusions: Neither adult nor paediatric patients with crush-induced AKI showed an increased risk of death after fasciotomy. The number of fasciotomy incisions significantly correlated with the development of sepsis. Despite experiencing delays in hospital admission for paediatric patients, the incidence of both crush syndrome and mortality rates among children remained relatively low.

The classic Body Mass Index, (BMI), developed in the 19^th century by the Belgian mathematician Adolphe Quetelet [1] is an important indicator of the risk of death, of obesity, of negative health consequences, body fat percentage and of the shape of the body. While he BMI is assumed to indicate obesity in sedentary people and in people who do not practice sports, it is undisputed and a consensus among researchers [2][3][4][5][9][25] that Body Mass Index (BMI) is not a good indicator for obesity in people who developed their body through heavy physical work or sport but also in other segments of population such as those who appear to have a normal weight but in fact have a high body fat percentage and obese methabolism. The BMI also does not include all the variables essential for a health predictor. The BMI is not always a good predictor of metabolic disease, people who appear of healthy weight according to BMI have in some cases an obese metabolic syndrome. The BMI was developed as a law of natural sciences and “social physics” [1], as it was called then, before the middle of the 19^th century, and it had been used from the 70s for medical purposes, to detect obesity and the risk of mortality [6][7]. The BMI has a huge importance for modern society, affected by an obesity epidemic [8]. BMI has applications in medicine, sport medicine, sport, fitness, bodybuilding, insurance, nutrition, pharmacology. The main limitation of the BMI is that it does not account for body composition including non fat body mass such as muscles, joints, body frame and makes no difference between fat and non fat components of the body weight. The body composition and the proportion of fat and muscles make a difference in health outcomes [12][13][14][25][26][27][35][36][37] [38][39][40][41][42][43][44]…[100]. Body composition makes a difference also in the level of sport performance for athletes of every level. In nearly two centuries since the Body Mass Index was developed, no formula had been successfully developed to account for body composition and make the difference between muscle and fat in a consistent way. This can be considered a longstanding open problem of major importance for society. The objective of this analysis is to develop new formulae taking into account the health implication of body composition measured through indirect, simple indicators and making the difference between muscles and fat, healthy and non healthy metabolism. The formulae developed in this article are the only formula to successfully generalize BMI and make this difference. I develop a direct generalization of BMI, in the mathematical and physiological sense to account for fat and fat free mass and muscles, small and large body frames. It is the first such generalization because the classic BMI can be determined as a particular case of my formulae in the strict mathematical and practical physiologic sense. No other formula generalized the BMI to make the difference between fat and a large frame and muscles has ever been published in nearly two centuries since the BMI formula had been developed. The formulae I developed explain and generalize the conclusions of a large number of highly cited empirical experiments cited in the reference section. [35][36][37][38][38][39] [40][42][43][44]..[100] Most of the experimental proof I bring in support of my formulae and bodyweight quantification theory comes from many highly cited experimental research publications in medicine, sports medicine, sport science and physiology. My formulae explain also performance in decades of competitive sports and athletics

Health differences across socioeconomic strata have always pointed out that poorer and minorities have higher mortality and morbidity than richer and majorities. This difference is exacerbated for particular populations such as the victims of ongoing armed conflicts, who are also much harder to quantify due to the conflict itself. This study applies network analysis to a combination of three large administrative records for the health system and mortality records in the province of Risaralda (Colombia) between 2011 and 2016. It produces the most common causes of morbi-mortality for both victims of violence and the poorest inhabitants of Risaralda, defined as those who qualify as recipients of subsidies from the Colombian welfare program called SISBEN in the categories of highest need. Both populations show high morbidity frequencies for non-communicable diseases such as Type II diabetes, hypertension, and hyperglyceridaemia, mostly associated with exposure to unhealthy lifestyles. Additionally, the mortality outcomes reflect the different lifestyles and medical treatments of both subpopulations. While the poorest replicate the same causes identified for morbidity, the victims of armed conflict die of additional causes including Type II diabetes, which reflects the even worse conditions they face.

Background: Maternal near-miss refers to a situation where a woman who nearly died but survived from severe life-threatening obstetric complications that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy. It has been estimated that up to 9 million women survive obstetric complications every year. According to studies done around the world most mothers suffer from Near Miss due to the factors which includes, low socioeconomic status, patient related, health provider related, and health related and health institution related issues. Objectives: The objective of the study was to determine the proportion of maternal near misses and its associated factors in Selected Public Health Institutions of Keffa, Bench-Maji and Sheka Zones of South Nations Nationalities and Peoples Regional state, South West Ethiopia, 2017. Methodology: Hospital based cross-sectional study design was employed and simple random sampling techniques (Lottery Method) was used to select the study institution and Systematic sampling technique was used to select 845 study participants every 5^th interval. Information was collected by using pre-tested and structured interviewer administered questioner. Using SPSS version 21 software, descriptive statistics and bivariate logistic regression analysis was done and variables with p-value <0.2 were transferred to multivariate analysis and during Multivariate logistic regression analysis Variables with P-value < 0.05 were considered as statistically significant and AOR with 95% CI were used to control for possible confounders and to interpret the result. The results were summarized by tables, graphs and charts. Result: There were 5530 Live Births, 227 Sever Acute Maternal Morbidity cases of this 210 were Maternal Near-Misses cases and 17 were maternal deaths, 364 Maternal Near-Misses Events. The overall Maternal Near-Misses Proportion is 24.85%. The maternal Near-Misses outcome ratio was 41 cases/1,000 live births (LB); mortality ratio was 12.35cases/1 maternal death and 74.8/1000LB of mortality index. Parity, residence, distance of living place from hospital, ANC Follow up, duration of labor, and administrative related problems were found to have statistically significant associations. Conclusion: The proportion of Maternal Near-Misses is relatively high when compared to other regional studies and efforts should be done to lower the near-misses.

Extreme heat is a climate hazard that has been linked with high morbidity and mortality. The way extreme heat events are felt in the population varies depending on a variety of factors, such as age, employment status, living conditions, air-conditioning, housing conditions, habits, behaviors, and other socio-demographic parameters. To quantify and locate vulnerabilities of populations to extreme heat, we analyze socio-economic data at the NUTS3 level for the national case study of Greece and at the census tract level for the local case study of the city of Athens. The target variable for this study is defined as the average daily mortality during heatwaves per 100,000 individuals and a methodology is developed for constructing this variable, based on socio-economic data available in public databases. Independent variables were selected based on their contribution to socioeconomic vulnerability; they include the percentage of elderly, retired, unemployed, renting, living alone, residing in smaller houses, living in older houses, and immigrants from developing countries. An ensemble gradient boosted tree model was employed for this study to obtain feature importance metrics that was used to construct a composite index of socioeconomic heat vulnerability. The socioeconomic heat vulnerability index (SHVI) was calculated for each prefecture in Greece and for each census tract in the city of Athens, Greece. The unique feature of this SHVI is that it can be applied to any geographical resolution using the same methodology and produces a result that is not only quantifiable, but also allows comparison between vulnerability scores of different regions. This application aimed to map the SHVI of both prefecture and city, to examine the significance of scale, to identify vulnerability hotspots, and rank the most vulnerable areas, which are prioritized by authorities for interventions that protect public health.

SARS-CoV-2 is the Coronavirus responsible for the COVID-19 pandemic. Even though we are no more in a pandemic situation, people are getting infected some of them needing hospitalization, and a few of them die. Methods: We did a retrospective study including 445 patients who accessed the Emergency Section of Policlinico Umberto I, Rome, Italy, where they had routine blood exams. In this study, we concentrated on the complete blood count, creatinine, and azotemia. The data was analyzed using ANOVA, Spearman correlation, and ROC analysis. They were divided into four groups based on their outcome: (1) the emergency group (patients with mild forms who were quickly discharged); (2) the hospital ward group (patients who after admission to the emergency section were hospitalized in a COVID-19 ward); (3) the intensive care unit (ICU) group (patients that after the admission in the emergency section required intensive assistance); (4) the deceased group (patients that after the admission in the emergency section had a fatal outcome). Results: We found significant changes for creatinine, azotemia, hematocrit, mean corpuscular hemoglobin concentration, basophils, monocytes, red blood cell distribution width, hemoglobin, hematocrit, and red blood cell numbers by ANOVA according to their outcomes, particularly for the deceased group. Also, we found outcome correlations for eosinophils, hemoglobin, hematocrit, mean corpuscular hemoglobin concentration, lymphocyte, neutrophil, platelet, and red blood cell number and red blood cell distribution width. Conclusions: This study discloses an association between “classical” routine blood biomarkers and the severity of outcomes in Omicron patients.

The implications of the adult congenital heart disease anatomic and physiological classification (AP-ACHD) for risk assessment have not been adequately studied. A retrospective cohort study was conducted using data from an ongoing national, multicentre registry of patients with ACHD and atrial arrhythmias (AA) receiving apixaban (PROTECT-AR study, NCT03854149). At enrollment, patients were stratified according to Anatomic class (AnatC, range I to III) and physiological stage (PhyS, range B to D). Follow-up was conducted between May 2019 and September 2021. The primary outcome was a composite of death from any cause, any major thromboembolic event, major or clinically relevant non-major bleeding, or hospitalization. Cox proportional-hazards regression modeling was used to evaluate the risks for the outcome among AP-ACHD classes. Over a median 20-month follow-up period, 47 of 157 (29.9%) ACHD patients with AA experienced the composite outcome. Adjusted hazard ratios (aHR) with 95% confidence intervals [CI] for the outcome in PhyS C and PhyS D were 1.84 (95% CI 0.73 to 4.61) and 7.88 (95% CI 1.54 to 40.41) respectively, as compared with PhyS B. The corresponding aHRs in AnatC II and AnatC III were 1.10 (95% CI 0.39 to 3.06) and 0.99 (95% CI 0.24 to 4.10) respectively, as compared with AnatC I. In conclusion, the PhyS component of the AP-ACHD classification was an independent predictor of net adverse clinical events among ACHD patients with AA receiving apixaban.

Within the past several decades, the emergence of new viral diseases with more severe health complications and mortality, primarily in older adults with comorbidities, is evidence of an age-dependent, compromised bodily response to abrupt stress with concomitant reduced immunity. The emergence of new infectious coronaviruses such as SARS-CoV-2 has resulted in the coronavirus disease 2019 (COVID-19). The result is increased morbidity and mortality in persons with underlying chronic diseases and among those with compromised defense mechanisms, regardless of age and among older adults who are more likely to fit these categories. COVID-19 appears to be primarily an upper respiratory disease. While SARS-CoV-2 is highly virulent, there is variability in the severity of the disease and its complications in humans. Severe pneumonia, acute respiratory distress syndrome (ARDS), lung fibrosis, cardiac t complication, acute kidney injury, hospitalization, and high mortality have been reported in older adults with COVID-19, that result from pathogen-host interactions. Here, we review potential interactions of the coronavirus and host cellular responses in relation to hallmarks of aging including genomic instability, telomere attrition, impaired autophagy, mitochondrial dysfunction, innate immunosenescence, inflammation and inflammasomes, adaptive immunosenescence, and epigenetic alterations, that likely contribute to the increased pathophysiological responses to SARS-CoV-2 among older adults.

Frailty syndrome, a significant contributor to morbidity and mortality in older adults, has traditionally been addressed through aerobic exercises. However, recent research has highlighted the importance of anaerobic and strength training activities in mitigating frailty. This article explores the shift from aerobic to anaerobic/strength training exercises, emphasizing the benefits of the latter in improving muscle strength, balance, and overall physical function. The discussion includes the physiological mechanisms underlying this shift, the evidence supporting strength training, and practical recommendations for implementation.

Background: Parkinson's disease (PD) is a neurodegenerative disorder that affects both patients and their caregivers, particularly parents who often become informal caregivers. Caring for someone with PD is linked to increased psychiatric morbidity and persistent anxiety-depressive distress. Methods: This study investigates the burden on caregivers of PD patients using multi-dimensional scales and identifies the personological and environmental factors contributing to this burden. Results: 20.6% of participants reported a severe burden according to the Caregiver Burden Inventory (CBI), while 13.8% had a moderate to severe burden according to the Zarit Caregiver Burden Inventory (ZBI). The Family Strain Questionnaire Short Form (FSQ-SF) high-lighted a minority of caregivers needing psychological support, with some cases requiring ur-gent attention, particularly in stress-related symptoms (SR) and urgent support (U). The Depres-sion Anxiety Stress Scales Short Version (DASS-21) results showed a higher prevalence of stress-related symptoms compared to anxiety and depression. Retired caregivers reported higher ZBI scores and lower life satisfaction levels compared to working caregivers. Additionally, years of schooling negatively correlated with the ZBI score. T-test analysis indicated that caregivers of patients with cognitive impairment were at greater risk compared to caregivers of patients with-out cognitive impairment. Conclusions: The results underscore the need for early recognition of risky situations and adequate support for caregivers.

Evidence regarding the role of oral antibiotics (oA) alone or combined with mechanical bowel preparation (MoABP) for elective colorectal surgery remains controversial. A prospective database of 8,359 colorectal resections gathered over a 32-month period in 78 Italian surgical units (the iCral 2 and 3 studies), reporting patient-, disease-, and procedure-related variables together with 60-day adverse events, was re-analyzed to identify a subgroup of 1,013 cases (12.1%) that received either oA or MoABP. This dataset was analyzed using a 1:1 propensity score-matching model including 20 covariates. Two well-balanced groups of 243 patients each were obtained: group A (oA), and group B (MoABP). The primary endpoints were anastomotic leakage (AL) and surgical site infections (SSIs) rates. Group A vs. group B showed a significantly higher AL risk [14 (5.8%) vs 6 (2.5%) events; OR 3.77; 95%CI 1.22-11.67; p = .021], while no significant difference was recorded between the two groups regarding SSIs. These results strongly support the use of MoABP for elective colorectal resections.

Background: Non-surgical organ preservation protocols have known a large diffusion worldwide in the last decades. Their oncological and functional effectiveness in a real-world setting has been recently ques-tioned, also because of the high morbidity of salvage procedures. The aim of this study is to review the outcomes of post irradiation salvage total laryngectomy (STL) and reconstruction with pectoralis major flap. Methods: This retrospective observational study included 37 cases of STL in the period going from January 2015 to December 2021. Data for each patient were extracted from the hospital information system and reviewed. Results: The 3-year overall and disease specific survival are respectively 28% and 51%. All patients with recurrences died from the disease. Only 7 recurrences and 7 consequent deaths for cancer were rec-orded. The other 14 deaths derived from comorbidities, being diabetes the most significant predictive parameter for overall survival. Also low-er postoperative albumin levels were associated with a higher risk of death. Conclusions: Overall survival after STL and reconstruction with PMMF is low but most deaths are due to comorbidities and not to cancer progression or recurrence.

Background: The COVID infection became the source of serious disagreements between scientists, doctors, politicians and private citizens, directly after it’s detection in the population in January 2020. The pandemic had some very unusual properties as well as the people’s reaction to it. It was feared, that the virus might be used, intentionally or accidentally, to interfere with the usual, democratic way of the upcoming election. Objective: Re-search the original COVID statistic and metadata to obtain better understanding of the pandemic including the biological (viral) as well as the social (human) aspects of it. Provide a professional, independent, non-biased view of the pandemic, that is not polluted by political and media suggestions. Methods: Publicly available data – covering the first 5 months of the COVID pandemic, 2020 Jan-May - were collected and analyzed with the usual, common statistical methods, like student’s t-test and regression analyses.The political attitude of the states were characterized by a ratio (D/R) of the number of left, democrat (D) and right, republican (R) oriented citizens in the respective states, as determined by opinion research. Results: De novo statistical analyzes of publicly available data (covering the initial five months of the pandemic) suggests that the negative medical consequences of COVID pandemic were significantly more expressed in “democrat-dominated” (D) states than in “republican-dominated”, (R) states. The proportion of COVID test positive persons was higher in D-states (6.831 +/- 1605, n=14 and 1,165 +/- 323, n=13 respectively, p<0.001). The difference in mortality was even more striking, 8-times more person/million population died in COVID related conditions in solid D states than in solid R states (438 +/- 128, and 59 +/- 13; p<0.001, respectively). The COVID associated mortality increased two fold from right to left on the political scale of the states (2.7% +/- 0.3 vs. 5.3% +/- 0.5, p<0.001). The correlation between COVID deaths (mortality) and the age/pre-existing medical condition(s) of the diseased is very strong (R2= 0.98) and the overwhelming majority of COVID “victims” are persons who were close to death even independently of the epidemic. Conclusions: Alarming signals regarding the dangerousness of COVID infection seems to have originated in a few states with predominantly left oriented citizens (high D/R ratio). The COVID mortality statistic seems to be seen and analyzed with little or no respect for the context of mortality caused by other well-known diseases or even by the natural, age related deaths. We conclude that it is absolutely necessary to pay serious attention to the correct analyses and interpretation of the epidemic data to avoid being misled or manipulated by false circumstances.

Abstract: Background: Our goal was to evaluate whether wearing personal protective equipment (PPE) such as an N95, or a surgical mask during the (COVID-19) pandemic had really reduced the cases of influenza in the state of Wisconsin. Methods: Respiratory Virus Surveillance Reports from the Wisconsin Department of Health Services (DHS) and the Centers for Disease Control and Prevention (CDC) were used to compare the rates of Influenza during the seasons of 2018-2019 and 2020-2021. Results: The number of cases, hospitalizations, and mortality rates with Influenza had significantly decreased in the 2020-2021 season compared to the Influenza season of 2018-2019. Discussion: Reducing the burden of influenza illnesses, hospitalizations, and deaths on the health care system is imperative. Wearing masks should be addressed for the most vulnerable.

The current COVID-19 pandemic is one of the most devastating events in recent history. The virus causes relatively minor damage to young, healthy populations, imposing life-threatening danger to the elderly and people with diseases of chronic inflammation. Therefore, if we could reduce the risk for vulnerable populations, it would make the COVID-19 pandemic more similar to other typical outbreaks. Children don’t suffer from COVID-19 as much as their grandparents and have a much higher melatonin level. Bats are nocturnal animals possessing high levels of melatonin, which may contribute to their high anti-viral resistance. Viruses induce an explosion of inflammatory cytokines and reactive oxygen species, and melatonin is the best natural antioxidant that is lost with age. The programmed cell death coronaviruses cause, which can result in significant lung damage, is also inhibited by melatonin. Coronavirus causes inflammation in the lungs which requires inflammasome activity. Melatonin blocks these inflammasomes. General immunity is impaired by anxiety and sleep deprivation. Melatonin improves sleep habits, reduces anxiety and stimulates immunity. Fibrosis may be the most dangerous complication after COVID-19. Melatonin is known to prevent fibrosis. Mechanical ventilation may be necessary but yet imposes risks due to oxidative stress, which can be reduced by melatonin. Thus, by using the safe over-the-counter drug melatonin, we may be immediately able to prevent the development of severe disease symptoms in coronavirus patients, reduce the severity of their symptoms, and/or reduce the immuno-pathology of coronavirus infection on patients’ health after the active phase of the infection is over.

Preventing childhood obesity and associated comorbidities is often hampered by disproportionate disparity in healthcare provision in minority ethnic populations. This study contextualised lifestyle factors influencing childhood obesity and related comorbidity from the perspectives and experiences of parents of ethnic minority children with obesity comorbidity. Families of Black, Asian and Minority Ethnicities (BAME) in the Northeast of England (n=180) were contacted, and families with a child diagnosed with obesity and comorbidity (non-alcoholic fatty liver disease, musculoskeletal problems, respiratory disorder, or polycystic ovarian disease) were interviewed (n=11). Semi-structured interviews and qualitative thematic analysis included parents’ perspective and experience on how their children were impacted by obesity and comorbidities, healthcare preventative interventions including lifestyle physical activity and nutrition, and views on tackling obesity. Parents’ perspectives and experience revealed eleven themes centred around living with a child with obesity, risks and impact of obesity diseases; access to lifestyle nutritional and physical activity, and ethnicity specific barriers. Parents revealed social disadvantage, fear of victimisation by social services, perceptions on their cultural and religious traditions when dealing with nutrition and exercise, and child’s weight racial stigmatisation. Parents reported closer bonding with their children than health authorities to protect from obesity consequences. Work pressure, time, and lack of professionals’ guidance were seen as barriers to healthy lifestyle, while support from friends and family bond in adopting healthy lifestyle behaviours were facilitators. Parents reported no awareness of health service provision of nutritional and physical activity obesity prevention programmes. Minority ethnic communities’ perspective on childhood obesity prevention does not match the healthcare system preventative offerings. Community and family-oriented obesity preventative approaches, especially lifestyle nutrition and physical activity interventions are needed beyond those administered by the primary healthcare system.

The incidence and mortality of cervical cancer are high in Romania compared to other European countries, particularly for locally advanced cervical cancer cases, which are predominant at the time of diagnosis. Widely accepted therapeutic guidelines indicate that the treatment for locally advanced cervical cancer consists of concurrent chemoradiotherapy (total dose 85-90Gy at point A), with surgery not being necessary as it does not lead to improved survival and results in significant additional morbidity. In Romania, the treatment for locally advanced cervical cancer differs, involving lower-dose chemotherapy (total dose 60-65Gy at point A), followed by surgery which, under these circumstances, ensures better local control. In this regard, we attempted to evaluate the role and necessity of surgery in Romania, considering that in our study, residual lesions were found in 55.84% of cases on resected specimens, especially in cases with unfavorable histology (adenocarcinoma and adenosquamous carcinoma). This type of surgery was associated with significant morbidity (28.22%) in our study. The recurrence rate was 24.21% for operated patients compared to 62% for non-operated patients receiving suboptimal concurrent chemotherapy alone. In conclusion, In Romania, surgery will continue to play a predominant role until radiotherapy achieves the desired effectiveness for local control.

Our objective was to evaluate whether pregnancy is prolonged by use of a proteomics-based maternal serum screening test followed by treatment interventions. This is a secondary analysis of the PREVENT-PTB randomized trial comparing screening with the PreTRM test versus no screening. The primary trial analysis found no significant between-group difference in preterm birth rate. Rather than considering a dichotomous outcome (preterm vs term), we treated gestational age at birth as a continuous variable using survival analysis. We also evaluated between-group difference in NICU length of stay and duration of respiratory support. Results indicated that pregnancy was significantly prolonged in subjects screened with PreTRM test compared to controls (adjusted hazard ratio 0.53, 95% confidence interval 0.36-0.78, P &lt;0.01). Newborns of screened subjects had significantly shorter NICU stay but no significant decrease in duration of respiratory support. In the PreTRM screen-positive group, interventions that were associated with pregnancy prolongation included care management and low-dose aspirin but not 17-hydroxyprogesterone caproate. We concluded that screening with the PreTRM test followed by interventions for screen-positive pregnancies can prolong pregnancy and reduce NICU-LOS.

(1) Background: This work aimed to conduct the first comparative study providing long-term data about patient reported outcome measures as well as donor-site scar assessment and aesthetic evaluation of the reconstructed breasts in patients with DIEP versus PAP flap breast reconstruction. (2) Methods: This prospective, single-center, matched cohort study included a total of 36 patients after DIEP and PAP flap breast reconstruction. Evaluation was done using the Breast-Q and POSAS questionnaire as well as the Breast Aesthetic Scale for cosmetic analysis by four plastic surgeons. (3) Results: Post-operative Breast-Q evaluation revealed no significant differences between both patient groups for the categories physical well-being donor-site, physical well-being breast and satisfaction with the breast. Scar evaluation of the donor-site region showed equivalent results for the thigh and the abdomen concerning the overall opinion of patients and observers. There was no significant difference between both methods of reconstruction for all aspects of breast aesthetics. (4) Conclusions: Similar results of donor-site morbidity, scar quality and aesthetic outcome of the breast in both the DIEP and PAP patient group have been demonstrated. Hence, in cases suitable for both types of reconstruction, the decision can be based on factors such as patients’ lifestyle, leisure activities and preferences.

Background: Shortly after the detection of the COVID virus in January 2020 the US Government introduced and enforced a series of restrictions to protect the elderly from a “deadly virus” and the “pandemic of the century”. Persons who disagreed were silenced and punished. Objective: In the 15^th month of COVID epidemic (April 2021), we have access to sufficient statistical data and methods to better understand the nature, origin of the COVID pandemic. It is now possible to reliably evaluate the effectiveness of the restrictions and the human factors / driving forces behind this drastic limitations of our natural freedom in this country. Methods: Publicly available epidemiological and population parameters were collected and analyzed using the ‘political score’ and ‘restriction ranking’ of 50 states and evaluated by simple and usual statistical methods, mainly correlation analyses. The Political Score of the States (D/R) is the ratio of the number of citizens who self-identified as democrats (D) or republicans (R). The political scores of the 50 states altogether defined a wide, continuous scale, the political scale, that could be used to measure (and statistically evaluate) the effect of politics of a state on the numerical parameters of that state, including population and epidemiologic parameters. The COVID Restriction Score of the States were created to rank the states from 1-50, there 1 is the lowest number of restrictions and 50 is the highest number of restrictions applied by the States. It was based on 13 different key metrics. ResultsThis study revealed, that 1) restrictions reduced the number of viral infections, but 2) they totally failed to reduce the number of supposedly COVID related deaths, expressed as mortality, 3) they increased (SIC!) the lethality of coronavirus. The grade of restrictions were/are strongly associated to the 4) left/right political ratio of the States, there States with more democrat citizens practiced more restrictions. It was found that race, religion and Medicare/healthcare spending have significant influence on politic as well as on the grade of restriction orders. Factors moving States toward the political left and harder COVID restrictions have 5) larger ‘non-white’ population, 6) larger number of ‘non-protestant’ believers, 7) larger Jewish population, and 8) more generous Medicare/healthcare spending. It was not possible to see any influence of the size of the 9) senior (65+) population [i.e. those who are allegedly the most vulnerable and are mostly in need of protective restrictions] neither on the States politic nor on the restrictions. Conclusions: The degree of restrictions enforced by different states ware not primarily determined by biological or epidemiological factors (like number of elderly, say 65+ in the state) but by social, political influences instead. Political (a), religious (b) ethnic (c) and economic (d) forces represented the decisive forces on the state’s restrictive orders and not the convincing evidence of the potentially harmful effects of the COVID infection and the well-founded adequacy of the defense against it.

Background: Short after the detection of the COVID virus in January 2020 the US Government introduced and enforced a series of restrictions to protect the elderly from a “deadly virus” and the “pandemic of the century”. Persons who disagreed were silenced and punished. Objective: In the 15^th month of COVID epidemic (April 2021), we have access to sufficient statistical data and methods to better understand the nature, origin of the COVID pandemic. It is now possible to reliably evaluate the effectiveness of the restrictions and the human factors / driving forces behind this drastic limitations of our natural freedom in this country. Methods: Publicly available epidemiological and population parameters were collected and analyzed using the ‘political score’ and ‘restriction ranking’ of 50 states and evaluated by simple and usual statistical methods, mainly correlation analyses. Results: This study revealed, that 1) restrictions reduced the number of viral infections, but 2) they totally failed to reduce the number of supposedly COVID related deaths, 3) they increased (SIC!) the mortality of coronavirus. The grade of restrictions were/are strongly associated to the 4) left/right political ratio of the States, there States with more democrat citizens practiced more restrictions. It was found that race, religion and Medicare spending have significant influence on politic as well as on the grade of restriction orders. Factors moving States toward the political left and harder COVID restrictions have 5) larger ‘non-white’ population, 6) larger number of ‘non-protestant’ believers, 7) larger Jewish population, and 8) more generous Medicare spending. It was not possible to see any influence of the size of the 9) senior (65+) population [i.e. those who are allegedly the most vulnerable and are mostly in need of protective restrictions] neither on the States politic nor on the restrictions Conclusions: The conclusion is that COVID restrictions are primarily politically motivated, they are ineffective to reduce COVID related mortality and they provide no extra health benefit for the so called “vulnerable” minority (elderly).

Background: Despite tremendous efforts to reduce neonatal mortality worldwide and in 24 Ethiopia, there is the country is one of the countries with highest neonatal morbidity and health 25 losses. Never the less, the past three decades’ national trend and subnational distribution of 26 neonatal morbidity and mortality and its health loss in Ethiopia, was not well documented. 27 Hence, this study had aimed to analyze the trend and distributions as well as health losses 28 resulting from neonatal morbidity in the past three decades in Ethiopia, 2019. 29 Objective: To assess the national trend and sub national distributions of neonatal morbidity and 30 neonatal mortality in the previous three decades by using Global Burden of Diseases, 2019 data. 31 Methods: The data sources were primary and secondary data related to risk factors, morbidity, 32 disability, deaths, Disability Adjusted Life Years, Years Lived with Disability and Years Life Lost 33 were collected form case studies and case series, household surveys, socio-demographic surveys 34 and surveillances, health facilities surveys, Health facility observations and interviews and 35 published and unpublished literatures. The prevalence, deaths and health losses were calculated 36 by using embedded model. The study period covered from 1990 to 2019. Results were presented 37 buy using texts, tables and graphs. 38 Results: Seventy percent of neonatal disorders had occurred among early neonates aged 0 to 6 39 days. Between 1990 and 2019, the national prevalence of neonatal disorders had increased by 40 47% in to 28,319 (95% UI, 25646-30,361). Bet Similarly, the highest number of neonatal deaths 41 caused by neonatal sepsis had shifted from Southern Nations Nationalities and Peoples region to 42 Oromia region while Harari remains to bear the lowest burden in the last three decades. The 43 highest and the lowest YLL as a result of neonatal disorders had occurred in Oromia 44 [(2,753,038,95% UI, 2,184,142-3,497-926) and Amhara 1,360,847 [(95% UI, 95% UI, 45 1,062,660-1,762,028)] regions respectively. Unlike other regions, Addis Ababa had the highest 46 (52%) prevalence of preterm birth in 2019 47 Conclusion and Recommendation: About seven in ten of neonatal death had occurred among 48 early neonates indicating narrowed occurrence of the event. The highest and the lowest number 49 of neonatal death and health loss had occurred in Oromia and Harari regions respectively. The 50 main causes of death were neonatal sepsis and other infections, neonatal preterm, hemolytic 51 disease and other jaundice and neonatal encephalopathy and trauma. Hence, Contextualized, 52 locally accepted innovative early neonatal care is crucial to avert the event.