Factors Affecting Adenoma Risk Level in Patients with Intestinal Polyp and Association Analysis

Objective. To explore the factors affecting the adenoma risk level in patients with intestinal polyp and association. Methods. The clinical data of 3,911 patients with intestinal polyp treated in our hospital from January 2018 to January 2021 were retrospectively analyzed, all patients accepted the histopathological examination, their risk of suffering from adenoma was evaluated according to the results of pathological diagnosis, and relevant hazard factors affecting adenoma risk level in them were analyzed by multifactor logistic regression analysis. Results. The results of multifactor logistic analysis showed that male gender, age ≥60 years, number of polyps >3, diameter ≥2 cm, onset at colon, and physiologically tubulovillous adenoma were the hazard factors causing high-grade adenoma risk in patients with intestinal polyp. Conclusion. There are many risk factors causing high-grade adenoma in patients with intestinal polyp, and therefore, the screening for high-risk population shall be enhanced to reduce the potential of carcinomatous change in such patients.

Treatment of Locally Advanced Merkel Cell Carcinoma—A Multi-Center Study

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a high risk of recurrence and poor prognosis. The treatment of locally advanced disease involves surgery and radiotherapy. To analyze real-life treatment patterns and clinical outcomes, we conducted a retrospective analysis of data from 161 MCC patients treated with curative intent in four oncological centers in Poland. The median age at diagnosis was 72 years (30–94); 49.7% were male. Lymph node (LN) involvement at diagnosis was found in 26.9% of patients. Sentinel lymph node biopsy (SLNB) was performed in 36.5% of patients (positive in 10.5%), and 51.9% of patients received perioperative treatment. The relapse rate was 38.3%. With the median follow-up of 2.3 years, the median disease-free survival (DFS) was not reached, and the 1-year rate was 65%. The negative independent risk factors for DFS were male gender, metastases in LN at diagnosis, no SLNB in patients without clinical nodal metastases, and no perioperative radiotherapy. The estimated median overall survival (OS) was 6.9 years (95%CI 4.64–9.15). The negative independent risk factors for OS were male gender, age above 70, metastases in LN at diagnosis, and no SLNB in patients without clinical nodal metastases. Our results confirm that the MCC treatment should be conducted in an experienced multidisciplinary team; however, the outcomes are still unsatisfactory.

HCV Genotype Has No Influence on the Incidence of Diabetes—EpiTer Multicentre Study

HCV infection is one of the main reasons for liver cirrhosis and hepatocellular carcinoma. In recent years, one finds more and more extrahepatic manifestations of HCV infection, including its possible influence on the development of diabetes. In the presented work, one finds the frequency analysis of the incidence of diabetes among 2898 HCV infected patients treated in Poland, and the assessment of their relevance to the HCV genotype and the progression of fibrosis. The results indicate that the hepatitis C infection seems to be a risk factor for diabetes in persons with more advanced liver fibrosis, for older people, and for the male gender. Thus, one found no differences regarding the frequency of its incidence depending on HCV genotype, including genotype 3.

Student-, Study- and COVID-19-Related Predictors of Students’ Smoking, Binge Drinking and Cannabis Use before and during the Initial COVID-19 Lockdown in The Netherlands

Tobacco, alcohol and cannabis are commonly used among university students. However, student lives and their substance use have changed dramatically since the start of the COVID-19 pandemic. This study investigated the impact of COVID-19 on (trends in) weekly smoking, weekly binge drinking and weekly cannabis use in Dutch university students and investigated associated student-, study- and COVID-19-related characteristics. Between April and June 2020, several Dutch higher educational institutes invited their students to participate in an online survey. Data of 9967 students (Mage = 22.0 (SD = 2.6); Nfemale = 7008 (70.3%)) were available for analyses. Overall, weekly smoking remained stable (±11.5%), weekly binge drinking decreased (from 27.8% to 13.9%) and weekly cannabis use increased (from 6.7% to 8.6%). Male gender, not living with parents, being a bachelor student, having less financial resources and less adherence to the COVID-19 measures were found to increase the risk of substance use (before/during the first COVID-19 lockdown). Additionally, male gender, not living with parents, being a bachelor student, not being born in the Netherlands and having a student loan contributed to the likelihood of increased substance use during COVID-19. Patterns of characteristics contributing to the likelihood of decreased weekly substance use during COVID-19 were less clear. The risk factors male gender, not living with parents and being a bachelor student do not only contribute to the likelihood of using substances but also contribute to the likelihood of increased use during a lockdown. Prevention and intervention programs should especially target these risk groups.

A comparative investigation of clients' attitudes toward breaking bad news to patients with cancer

Background: Truth disclosure is one of the major challenges for physicians with cancer patients. The attitude toward breaking news adopted by individuals depends on their cultural background. The present study was conducted at Ardabil University of Medical sciences, Ardabil, Iran, to investigate the attitudes of Turkish-speaking patients with cancer and their families to the disclosure of bad news. Materials and Methods: The present descriptive cross-sectional study used convenience sampling to select 62 patients, 76 family members of young and 58 children. The mean age of the patients was 37.29 years, and their majorities were 32-42 years old. The data were collected using the questionnaire proposed by Managheb et al., which included six dimensions, i.e., suitability of the person, suitability of the time, the place, factors affecting the delivery of bad news, amount of disclosed information, and acceptance. Results: Despite the insignificant differences in the total score of attitude between the groups (P=0.23), significant differences were found in terms of suitability of the time (P=0.017) and affecting factors (P=0.007) between children's families. Also, in parents of children, employment made truth acceptance better (p=0.04). The acuteness of the disease increased the total attitude score in all the participants (P=0.047). Significant relationships were also observed between age and accepting truth (P=0.045), male gender and place of disclosing the truth (P=0.004), male gender and amount of disclosed information (P=0.043), as well as owning a house and accepting truth (P=0.002). Moreover, education was negatively related to the person for truth disclosing (P=0.036) and factors affecting the truth disclosing (P=0.015). Conclusion: There are different circumstances and economic impacts in children's families on their tolerance. Given the difficulty of disclosing the truth to the employee and highly-educated individuals, it is recommended that health workers consider individual conditions in these circumstances.

Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study

Objective: To study the differences in clinical characteristics, risk factors, and complications across age-groups among the inpatients with the coronavirus disease 2019 (COVID-19).Methods: In this population-based retrospective study, we included all the positive hospitalized patients with COVID-19 at Wuhan City from December 29, 2019 to April 15, 2020, during the first pandemic wave. Multivariate logistic regression analyses were used to explore the risk factors for death from COVID-19. Canonical correlation analysis (CCA) was performed to study the associations between comorbidities and complications.Results: There are 36,358 patients in the final cohort, of whom 2,492 (6.85%) died. Greater age (odds ration [OR] = 1.061 [95% CI 1.057–1.065], p < 0.001), male gender (OR = 1.726 [95% CI 1.582–1.885], p < 0.001), alcohol consumption (OR = 1.558 [95% CI 1.355–1.786], p < 0.001), smoking (OR = 1.326 [95% CI 1.055–1.652], p = 0.014), hypertension (OR = 1.175 [95% CI 1.067–1.293], p = 0.001), diabetes (OR = 1.258 [95% CI 1.118–1.413], p < 0.001), cancer (OR = 1.86 [95% CI 1.507–2.279], p < 0.001), chronic kidney disease (CKD) (OR = 1.745 [95% CI 1.427–2.12], p < 0.001), and intracerebral hemorrhage (ICH) (OR = 1.96 [95% CI 1.323–2.846], p = 0.001) were independent risk factors for death from COVID-19. Patients aged 40–80 years make up the majority of the whole patients, and them had similar risk factors with the whole patients. For patients aged <40 years, only cancer (OR = 17.112 [95% CI 6.264–39.73], p < 0.001) and ICH (OR = 31.538 [95% CI 5.213–158.787], p < 0.001) were significantly associated with higher odds of death. For patients aged >80 years, only age (OR = 1.033 [95% CI 1.008–1.059], p = 0.01) and male gender (OR = 1.585 [95% CI 1.301–1.933], p < 0.001) were associated with higher odds of death. The incidence of most complications increases with age, but arrhythmias, gastrointestinal bleeding, and sepsis were more common in younger deceased patients with COVID-19, with only arrhythmia reaching statistical difference (p = 0.039). We found a relatively poor correlation between preexisting risk factors and complications.Conclusions: Coronavirus disease 2019 are disproportionally affected by age for its clinical manifestations, risk factors, complications, and outcomes. Prior complications have little effect on the incidence of extrapulmonary complications.

Gender- and age-based differences in outcomes of mechanically ventilated ICU patients: a Chinese multicentre retrospective study

Background Previous studies have suggested that the gender and/or age of a patient may influence the clinical outcomes of critically ill patients. Our aim was to determine whether there are gender- and age-based differences in clinical outcomes for mechanically ventilated patients in intensive care units (ICUs). Methods We performed a multicentre retrospective study involving adult patients who were admitted to the ICU and received at least 24 h of mechanical ventilation (MV). The patients were divided into two groups based on gender and, subsequently, further grouped based on gender and age < or ≥ 65 years. The primary outcome measure was hospital mortality. Results A total of 853 mechanically ventilated patients were evaluated. Of these patients, 63.2% were men and 61.5% were ≥ 65 years of age. The hospital mortality rate for men was significantly higher than that for women in the overall study population (P = 0.042), and this difference was most pronounced among elderly patients (age ≥ 65 years; P = 0.006). The durations of MV, ICU lengths of stay (LOS), and hospital LOS were significantly longer for men than for women among younger patients (P ≤ 0.013) but not among elderly patients. Multivariate logistic regression analysis revealed that male gender was independently associated with hospital mortality among elderly patients but not among younger patients. Conclusions There were important gender- and age-based differences in the outcomes among mechanically ventilated ICU patients. The combination of male gender and advanced age is strongly associated with hospital mortality.

Predicting Hospital Readmission for Campylobacteriosis from Electronic Health Records: A Machine Learning and Text Mining Perspective

(1) Background: This study investigates influential risk factors for predicting 30-day readmission to hospital for Campylobacter infections (CI). (2) Methods: We linked general practitioner and hospital admission records of 13,006 patients with CI in Wales (1990–2015). An approach called TF-zR (term frequency-zRelevance) technique was presented to evaluates how relevant a clinical term is to a patient in a cohort characterized by coded health records. The zR is a supervised term-weighting metric to assign weight to a term based on relative frequencies of the term across different classes. Cost-sensitive classifier with swarm optimization and weighted subset learning was integrated to identify influential clinical signals as predictors and optimal model for readmission prediction. (3) Results: From a pool of up to 17,506 variables, 33 most predictive factors were identified, including age, gender, Townsend deprivation quintiles, comorbidities, medications, and procedures. The predictive model predicted readmission with 73% sensitivity and 54% specificity. Variables associated with readmission included male gender, recurrent tonsillitis, non-healing open wounds, operation for in-gown toenails. Cystitis, paracetamol/codeine use, age (21–25), and heliclear triple pack use, were associated with a lower risk of readmission. (4) Conclusions: This study gives a profile of clustered variables that are predictive of readmission associated with campylobacteriosis.

HIGH SALT INTAKE IMPLICATIONS AS RISK FACTOR FOR HYPERTENSION AND COMPARISON OF THREE SALT ESTIMATION METHODS- FINDINGS FROM ISLAMABAD, PAKISTAN

Objectives: The study was designed to estimate daily salt intake, its discretionary use in healthy individuals and to validate three common methods for salt estimation in Pakistani population. Methodology: Information on demography and discretionary salt use was collected from healthy adults (>18 years) along with a blood sample, spot and 24 hour urine samples. Sodium, chloride, potassium levels and serum creatinine were measured using standard methods. For daily salt estimation, three common methods i.e. INTERSALT, Tanaka and Kawasaki were validated for their applicability in local settings. Results: Overall 24 h sodium excretion was 158 mmol/l indicating intake of 8.64 (±4.43) grams salt per day which was significantly associated with male gender (p. <0.004) and adding salt during cooking (p. <0.0001). Most (73%) of the participants know about hazardous effects of high salt intake, however, only 25% consider important to lower salt intake. None of three methods i.e. INTERSALT (bias: -19.64; CCC -0.79), Tanaka (bias: 167.35; CCC -0.37) and Kawasaki (bias: -42.49, CCC -0.79) showed any agreement between measured and estimated 24 hour sodium. Conclusion: Daily intake of salt was high which increases the risk for hypertension. Comparison of methods for estimation revealed that none of the three methods could be used for estimating daily intake of salt in local settings of Pakistan.