Diet and lifestyle behaviours simultaneously act on frailty: it is time to move the threshold of frailty prevention and control forward.

BACKGROUND: To analyse the association among the simultaneous effects of dietary intake, daily life behavioural factors, and frailty outcomes in older Chinese women, we predicted the probability of maintaining physical robustness under a combination of different variables. METHODS: The Fried frailty criterion was used to determine the three groups of "frailty", "pre-frailty", and "robust", and a national epidemiological survey was performed. The three-classification decision tree model was fitted, and the comprehensive performance of the model was evaluated to predict the probability of occurrence of different outcomes. RESULTS: Among the 1,044 participants, 15.9% were frailty and 50.29% were pre-frailty; the overall prevalence first increased and then decreased with age, reaching a peak at 70-74 years of age. Through univariate analysis, filtering, and embedded screening, eight significant variables were identified: staple food, spices, exercise (frequency, intensity, and time), work frequency, self-feeling, and family emotions. In the three-classification decision tree, the values of each evaluation index of Model 3 were relatively average; the accuracy, recall, specificity, precision, and F1 score range were between 75% and 84%, and the AUC was also greater than 0.800, indicating excellent performance and the best interpretability of the results. Model 3 takes exercise time as the root node and contains 6 variables and 10 types, suggesting the impact of the comprehensive effect of these variables on robust and non-robust populations (the predicted probability range is 6.67-93.33%). CONCLUSION: The combined effect of these factors (no exercise or less than 0.5 h of exercise per day, occasional exercise, exercise at low intensity, feeling more tired at work, and eating too many staple foods (> 450 g per day) are more detrimental to maintaining robustness.

Trends in Antibiotic Use in a Large Children's Hospital in London (United Kingdom): 5 Years of Point Prevalence Surveys.

Background: Antibiotics are commonly prescribed in paediatrics. As their excessive use contributes to adverse drug events, increased healthcare costs, and antimicrobial resistance, antimicrobial stewardship initiatives are essential to optimising medical care. These single-centre point prevalence surveys aimed to provide insights into antibiotic prescribing trends and identify targets for paediatric AMS activities. Methods: 14 point prevalence surveys were conducted from March 2016-April 2021, collecting data on antibiotic prescriptions, indication, adherence to guidelines, and route of administration. The UK adapted the World Health Organisation's AWaRe classification-guided antibiotic categorization. Results: 32.5% of all inpatients were on at least one antimicrobial; this remained stable during all surveys (range: 20-44%, p = 0.448). Of all prescriptions, 67.2% had an end- or review-date, and the majority was for agents in the Watch category (46.8-70.5%). Amoxicillin and clavulanate were the most frequently prescribed antibiotics (20.8%), followed by gentamicin (15.3%). Approximately 28.8% of all prescriptions were for prophylactic indications, while 7.6% of the prescriptions were not adherent to the hospital guidelines. Conclusions: This study highlights the importance of ongoing monitoring and robust AMS initiatives to ensure prudent antibiotic prescribing in paediatric healthcare. It underscores the need for tailored guidelines, educational efforts, and targeted interventions to enhance the quality of antibiotic usage, ultimately benefiting both individual patients and public health.

Technical specifications for a EU-wide baseline survey of antimicrobial resistance in bacteria from aquaculture animals.

The European Commission requested scientific and technical assistance in the preparation of a EU-wide baseline survey of antimicrobial resistance (AMR) in bacteria from aquaculture animals. It is recommended that the survey would aim at estimating the occurrence of AMR in Aeromonas spp. isolated from Atlantic Salmon (Salmo salar), European seabass (Dicentrarchus labrax) and trout (Salmo trutta, Salvelinus fontinalis, Oncorhynchus mykiss) intended to consumption, at harvesting (at farm/slaughter), at the EU level and in addition, at estimating the occurrence and diversity of AMR of Escherichia coli, Enterococcus faecium, Enterococcus faecalis, Vibrio parahaemolyticus and Vibrio alginolyticus in blue mussel (Mytilus edulis) and Mediterranean mussel (Mytilus galloprovincialis) from production areas and at dispatch centres at the EU level. These technical specifications define the target populations, the sample size for the survey, sample collection requirements, the analytical methods (for isolation, identification, phenotypic susceptibility testing and further genotypic analysis of some of the bacteria targeted) and the data reporting requirements. The data to be reported by the EU Member States to support this baseline survey are presented in three data models. The results of the survey should be reported using the EFSA reporting system.

Worldwide Anatomic Characteristics of the Mandibular Canine-A Multicenter Cross-Sectional Study with Meta-Analysis.

INTRODUCTION: This study aimed to examine the global prevalence of root and root canal morphologies in mandibular canines and analyze potential influences of region, ethnicity, sex, and age on the proportion of a second root and root canal configuration. METHODS: Observers from 44 countries screened 13,200 canines using cone-beam computed tomographic exams and gathered data on the percentages of 2 root canal morphologies and 2-rooted configurations (primary outcomes), as well as the root canal configurations (secondary outcome). Demographic factors (ethnicity, sex, and age) were collected for each participant. Primary outcomes were represented as odds ratios and untransformed proportions accompanied by 95% confidence interval (CI) forest plots. Meta-analysis compared subgroups and identified sources of heterogeneity. Intra- and inter-rater tests were conducted. Statistical significance was set at 5%. RESULTS: The worldwide prevalence of a second canal was 7.5% (95% CI, 6.3%-8.7%), ranging from 0.7% in Nigeria to 17.7% in Uruguay. The meta-analysis also revealed significant variations when comparing ethnicity, gender, and age (P < .05). The global prevalence of a second root was 1.9% (95% CI, 1.5%-2.3%), with the highest proportion observed in Spain (6.7%). Caucasian and Indian (south Asian) ethnic groups, females, and older patients exhibited higher proportions of 2 roots (P < .05). Meta-regression excluded side, voxel size, and field of view as sources of heterogeneity (P > .05). CONCLUSIONS: The prevalence of 2 root canals and 2-rooted configurations in the mandibular canine exhibited variations based on geographic location, ethnicity, sex, and age. The global prevalence of 2 root canals and 2-root configuration was 7.5% and 1.9%, respectively.

Pre-septal and Orbital Cellulitis: A Retrospective Analysis of Manifestations and Outcomes of a Tertiary Center in Kuwait.

Introduction Orbital cellulitis is an infectious condition that presents a gap in the literature in regard to its manifestations in the Middle East. A retrospective investigation was undertaken at one tertiary care facility in Kuwait, aiming to augment regional insights into the etiological factors and subsequent outcomes associated with this condition. Methods A retrospective review collected data from 92 patients in a tertiary care center in Kuwait for patients admitted with pre-septal and orbital cellulitis between January 2013 and June 2023. Primary outcomes assessed the resolution of symptoms, categorized as "completely resolved" and "resolved with complications". Secondary outcome measures included patients' ages, microbiology, laboratory, and radiological findings. Gender, predisposing conditions, surgical status, and orbital involvement were additionally extracted and analyzed descriptively. Results Data of n=92 (56 males and 36 females) were extracted. Ages ranged from 20 days to 18 years, the mean being seven years. Additionally, 52.2% (n=48) were diagnosed with orbital cellulitis, and 42.4% (n=39) were diagnosed with pre-septal cellulitis on admission. Cultures were available for n=60. Specifically, 52.1% (n=48) received CT scans; 6.5% (n=6) MRI scans; and 98.9% (n=91) received antibiotics (microbiology investigated: n=83). Ceftriaxone was used in 82.6% (n=76); 20.6% (n=19) received surgical interventions, and incision and drainage (I&D) were done on 15.2% (n=14). Visual acuity was assessed in 59.7% (n=55) patients. Five (5.43%) reported visual deterioration, and 87 (94.6%) of the outcomes were classified as "completely resolved". Conclusion Upper respiratory tract infections were the most common documented predisposing risk factor in the development of pre-septal and orbital cellulitis. Adverse outcomes in vision were documented in 5.43% of patients. A paucity of regional data highlights the importance of conducting further studies locally.

Population-based prevalence of congenital defects in a routine sentinel site-based surveillance system in the Western Cape, South Africa.

BACKGROUND: Lack of data on the burden and scope of congenital disorders (CDs) in South Africa undermines resource allocation and limits the ability to detect signals from potentially teratogenic pregnancy exposures. METHODS: We used routine electronic data in the Western Cape Pregnancy Exposure Registry (PER) to determine the overall and individual prevalence of CD identified on neonatal surface examination at birth in the Western Cape, South Africa, 2016-2022. CD was confirmed by record review. The contribution of late (≤24 months) and antenatal diagnoses was assessed. We compared demographic and obstetric characteristics between women with/without pregnancies affected by CD. RESULTS: Women with a viable pregnancy (>22 weeks gestation; birth weight ≥ 500 g) (n = 32,494) were included. Of 1106 potential CD identified, 56.1% were confirmed on folder review. When internal and minor CD were excluded the prevalence of major CD identified on surface examination at birth was 7.2/1000 births. When missed/late diagnoses on examination (16.8%) and ultrasound (6.8%) were included, the prevalence was 9.2/1000 births: 8.9/1000 livebirths and 21.5/1000 stillbirths. The PER did not detect 21.5% of major CD visible at birth. Older maternal age and diabetes mellitus were associated with an increased prevalence of CD. Women living with/without HIV (or the timing of antiretroviral therapy, before/after conception), hypertension or obesity did not significantly affect prevalence of CD. CONCLUSIONS: A surveillance system based on routine data successfully determined the prevalence of major CD identified on surface examination at birth at rates slightly higher than in equivalent studies. Overall rates, modeled at ~2%, are likely underestimated. Strengthening routine neonatal examination and clinical record-keeping could improve CD ascertainment.

Worldwide Assessment of the Root and Root Canal Characteristics of Maxillary Premolars - A Multi-center Cone-beam Computed Tomography Cross-sectional Study With Meta-analysis.

INTRODUCTION: This worldwide study examined the root and root canal characteristics of maxillary premolars and explored how demographic factors impact the outcomes. METHODS: Observers from 44 countries assessed 26,400 maxillary premolars using cone-beam computed tomography and employed a standardized screening method to gather data on multiple canal morphology and 3-rooted configuration (primary outcomes), as well as secondary outcomes related to root and root canal anatomies. Demographic factors such as ethnicity, sex, and age were collected for each participant. The intra- and inter-observer tests ensured observer reliability. Primary outcomes were represented as odds ratios and untransformed proportions accompanied by 95% confidence interval (CI) forest plots. Meta-analysis compared sub-groups and identified sources of heterogeneity (α = 5%). RESULTS: The overall prevalence of multiple canal morphology in the first premolar was 93.5% (95% CI, 93.3%-94.7%), while in the second premolar, it was 49.7% (95% CI, 44.9%-54.6%). The proportion of 3-rooted configuration was 1.8% (95% CI, 1.4%-2.1%) in the first premolar and 0.4% (95% CI, 0.3%-0.5%) in the second. Asian countries generally displayed fewer roots and root canals, while European nations showed higher counts (P < .05). Males exhibited higher percentages and odds ratios for both outcomes in both premolars. Younger patients demonstrated lower percentages of multiple root canal morphologies (P < .05). Factors such as tooth side, voxel size and field-of-view did not influence the outcomes (P > .05). CONCLUSIONS: The worldwide assessment of root and root canal characteristics of maxillary premolars has revealed a discernible influence of various factors such as tooth type, geographical region, ethnicity, sex, and age.

Investigating the Prevalence and Predictors of Uncontrolled Hypertension: A Cross-Sectional Study in Gujarat, India.

BACKGROUND: Uncontrolled hypertension is a major public health concern that contributes significantly to cardiovascular morbidity and mortality. Treatment of hypertension prevents and reduces cardiovascular morbidity, notably a 40% reduction in risk of stroke and a 15% reduction in risk of myocardial infarction. Understanding the prevalence and predictors of uncontrolled hypertension is crucial for developing targeted interventions. OBJECTIVE: This study aimed to determine the prevalence of uncontrolled hypertension and identify potential predictors among patients attending the Non-Communicable Disease (NCD) clinic of a tertiary care center in Gujarat, India. METHODS: A cross-sectional study involving 732 adult patients with hypertension was conducted. Sociodemographic data, lifestyle factors, anthropometric measurements, and comorbidities were assessed. Blood pressure was measured using standardized protocols, and uncontrolled hypertension was defined as a systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Univariate and multivariate logistic regression analyses were performed to identify predictors of uncontrolled hypertension. RESULTS: The prevalence of uncontrolled hypertension was 60.2% (95% CI: 56.7%-63.7%). In the multivariate analysis, increasing age (adjusted OR: 1.21, 95% CI: 1.05-1.39), increased body mass index (adjusted OR: 1.49, 95% CI: 1.27-1.75), diabetes (adjusted OR: 1.68, 95% CI: 1.20-2.35), chronic kidney disease (adjusted OR: 2.11, 95% CI: 1.22-3.65), and current smoking status (adjusted OR: 1.83, 95% CI: 1.14-2.93) were identified as independent predictors of uncontrolled hypertension. CONCLUSION: This study revealed a high prevalence of uncontrolled hypertension in this tertiary care setting. Age, obesity, diabetes, chronic kidney disease, and smoking were identified as significant predictors. Targeted interventions addressing these modifiable risk factors and comorbidities are crucial for improving blood pressure control and reducing the burden of hypertension-related complications.

Worldwide Prevalence of Single-rooted with a Single Root Canal and Four-rooted Configurations in Maxillary Molars: A Multi-center Cross-sectional Study with Meta-analysis.

INTRODUCTION: To evaluate the prevalence of single root with a single root canal and four-root configurations in the maxillary first and second molars, and analyze how geographic region, ethnicity, sex, and age impact these outcomes. METHODS: Researchers from 44 nations examined 26,400 maxillary molars using cone-beam computed tomography scans to gather data on the proportions of single roots with single canals and four-root configurations. All observers underwent prior calibration regarding the step-by-step assessment protocol and anatomical concepts to ensure consistent evaluations across all assessed locations. Tests were conducted to evaluate the intraobserver and interobserver reliability. Demographic data including ethnicity, gender, and age were collected for each participant. The potential impact of imaging voxel size and field-of-view on bias was also assessed. The primary results were depicted as odds ratios and untransformed proportion forest plots with 95% confidence intervals. Additionally, a meta-analysis was performed to compare various subgroups and identify sources of variation among them. Statistical significance was set at 5%. RESULTS: The prevalence of single-rooted with a single canal and four-rooted configurations in the maxillary first molar was 0.16% and 0.28%, respectively, while in the maxillary second molar, it was 2.56% and 0.83%. Males tended to exhibit lower percentages of single roots with a single canal (P < .05) and higher percentages of four-rooted configurations (P > .05) in the second molar, whereas the African subgroup displayed lower proportions for both configurations. Additionally, in both teeth, single roots with a single canal were more prevalent among older patients. Voxel size and field-of-view did not significantly influence the results (P > .05). CONCLUSIONS: The proportions of single-rooted with a single canal and four-rooted configurations were low, and demographic factors such as geographic region, ethnicity, sex, and age may have influenced the outcomes for the maxillary second molar.

Exploring the association between dietary Inflammatory Index and chronic pain in US adults using NHANES 1999-2004.

Chronic pain, a substantial public health issue, may be influenced by dietary patterns through systemic inflammation. This cross-sectional study explored the association between Dietary Inflammatory Index (DII) and chronic pain among 2581 American adults from NHANES data. The DII, ranging from - 4.98 to 4.69, reflects the inflammatory potential of the diet, with higher scores indicating greater pro-inflammatory capacity. Our findings showed no significant association between the continuous DII score and chronic pain prevalence. However, a nonlinear relationship emerged. When the DII was categorized, a significant association between higher DII scores (DII ≥ 2.5) and chronic pain prevalence was observed. The analysis uncovered a U-shaped pattern, with an inflection point at a DII score of - 0.9, indicating an association between both low and high levels of dietary inflammation are associated with higher pain prevalence. This nuanced interaction between dietary inflammation and chronic pain indicates the possibility of incorporating dietary modification into pain management strategies and underscores the need for further research into the long-term effects of diet on chronic pain.

Cone beam computed tomography evaluation of c-shaped canal morphology in mandibular premolar teeth.

Purpose: The aim of this study was to evaluate the prevalence and the morphology of c-shaped root canal(s) in mandibular premolars using cone beam computed tomography (CBCT) images. Materials and methods: CBCT images of 1095 mandibular premolars were examined at coronal, middle, and apical levels of the root canals. The type, the level, and the position (buccal or lingual) of the c-shaped anatomy were recorded. Absolute counts and percentages of different groups and subgroups of C-shape morphologies were calculated. The Chi-square test was used to compare the prevalence of C-shaped morphology between mandibular first and second premolars. The Z-test for proportions in independent groups was used to analyze the differences in mandibular C-shaped premolar proportions between location (left and right side) and tooth (first or second premolars) (p=0.05). Results: C-shaped root canal morphology was present in 44 teeth. The percentage of c-shaped morphologies was 6.9% and 1.6% in mandibular first and second premolars, respectively. Comparison of the first and the second premolars showed that C1 type (p=0.008) and C4b type (p=0.013) configurations are more common in the first premolars at the coronal level. In contrast, the C2 type configuration showed significantly higher prevalence in the second premolars (p=0.009). Additionally, the C4c type configuration was significantly frequent on the right premolars at the coronal level (p=0.038). Conclusion: C-shape canal morphology is a rare but complex anatomic feature in mandibular premolars. Therefore, clinicians should be aware of this complex root canal anatomy for the success of endodontic treatment in mandibular premolar teeth.

Prevalence, Attributes, and Risk Factors of QT-Interval-Prolonging Drugs and Potential Drug-Drug Interactions in Cancer Patients: A Prospective Study in a Tertiary Care Hospital.

Introduction Cancer chemotherapy regimens include multiple classes of adjuvant drugs as supportive therapy. Because of the concurrent intake of other drugs (like antiemetics, antidepressants, analgesics, and antimicrobials), there is a heightened risk for possible QT interval prolongation. There is a dearth of evidence in the literature regarding the usage of QT-prolonging anticancer drugs and associated risk factors that have the propensity to prolong QT interval. The purpose was to explore the extent of the use of QT-interval-prolonging drugs and potential QT-prolonging drug-drug interactions (QT-DDIs) in cancer patients attending OPD in a tertiary-care hospital. Methods This was a hospital-based, cross-sectional, observational study. Risk stratification of QT-prolonging drugs for torsades de pointes (TdP) was done by the Arizona Center for Education and Research on Therapeutics (AzCERT)/CredibleMeds-lists, and potential QT-DDIs were determined with four online DDI-checker-software. Results In 1331 cancer patients, the overall prevalence of potential QT-prolonging drug utilization was 97.3%. Ondansetron, pantoprazole, domperidone, and olanzapine were the most frequent QT-prolonging drugs in cancer patients. The top six antineoplastics with potential QT-prolonging and torsadogenic actions were capecitabine, oxaliplatin, imatinib, bortezomib, 5-fluorouracil, and bendamustine. Evidence-based pragmatic QTc interval prolongation risk assessment tools are imperative for cancer patients. Conclusion This study revealed a high prevalence of QT-prolonging drugs and QT-DDIs among cancer patients who are treated with anticancer and non-anticancer drugs. As a result, it's critical to take precautions, stay vigilant, and avoid QT-prolonging in clinical situations. Evidence-based pragmatic QTc interval prolongation risk assessment tools are needed for cancer patients.

Oral Cancer Risk and Screening Prevalence Among Hospitalized Women.

Background Oral cancer screenings are often on the back burner in the face of other cancer screenings. In high-risk individuals, early detection of oral cancer has a better prognosis and survival. Hospitalization may offer an opportunity to target high-risk populations. This study evaluates the prevalence of women at high risk for oral cancer among hospitalized women and their preference for oral cancer screening. Design and participants Five hundred and ten cancer-free women admitted to the hospital under the internal medicine service at an academic center were enrolled to participate in the study. Three hundred and seventy women were at high risk for developing oral cancer, defined by smoking status, alcohol use, or both. High-risk women received bedside smoking cessation counseling and oral cancer informational handouts and were offered oral screening examinations during hospitalization. Six months after discharge, study participants received a follow-up phone call to determine if these women discussed oral cancer screening with their primary care physicians at the follow-up visit. Results Seventy-three percent of the hospitalized women were at high risk for developing oral cancer. Fifty-seven percent of high-risk women reported having no primary dentist. High-risk women were more likely to be younger, reported a disability, and had a lower comorbidity burden than the average-risk group. Only 41% of high-risk hospitalized women received oral cancer screening examinations during the hospital stay. Post-hospitalization, 66% of high-risk patients discussed oral cancer screening with their primary care. Conclusion Almost three-fourths of hospitalized women are at high risk for developing oral cancer. Hospitalization provides an opportunity to educate and screen high-risk populations.

Healthcare-associated infections and antimicrobial use at a major referral hospital in Papua New Guinea: a point prevalence survey.

Background: Healthcare-associated infections (HAI) and antimicrobial use (AMU) are drivers for antimicrobial resistance, and robust data are required to inform interventions and track changes. We aimed to estimate the prevalence of HAI and AMU at Port Moresby General Hospital (PMGH), the largest hospital in Papua New Guinea. Methods: We did a point prevalence survey (PPS) on HAI and AMU at PMGH in May 2023 using the European Centre for Disease Prevention and Control (ECDC) PPS protocol. We included all critical care patients and randomly sampled half of the patients in other acute-care wards. We calculated weighted HAI and AMU prevalence estimates to account for this sampling strategy. Weighted HAI estimates were also calculated for an expanded definition that included physician diagnosis. Findings: Of 361 patients surveyed in 18 wards, the ECDC protocol identified 28 HAIs in 26 patients, resulting in a weighted HAI prevalence of 6.7% (95% CI: 4.6, 9.8). Surgical site infections (9/28, 32%) were the most common HAI. When adding physician diagnosis to the ECDC definitions, more skin and soft tissue, respiratory, and bloodstream HAIs were detected, and the weighted HAI prevalence was 12.4% (95% CI: 9.4, 16.3). The prevalence of AMU was 66.5% (95%CI: 61.3, 71.2), and 73.2% (263/359) of antibiotics were from the World Health Organization Access group. Interpretation: This is the first reported hospital PPS of HAI and AMU in Papua New Guinea. These results can be used to prioritise interventions, and as a baseline against which future point prevalence surveys can be compared. Funding: Australian Government Department of Foreign Affairs and Trade and Therapeutic Guidelines Limited Australia.

Prevalence of Strongyloides stercoralis and other helminths in four districts of Madagascar.

BACKGROUND: Estimation of prevalence of Strongyloides stercoralis infection is required in endemic areas, in order to identify areas in need of control programmes. Data on prevalence of strongyloidiasis in Madagascar are scant. Aim of this work was to estimate prevalence of S. stercoralis in four districts of Madagascar. METHODS: Fecal and serum samples collected in the context of a previous study on schistosomiasis were tested with S. stercoralis real-time PCR and serology, respectively. A multiplex real-time PCR for Ascaris lumbricoides, Ancylostoma duodenalis, Necator americanus, and Trichuris trichiura was done on fecal samples collected in the areas demonstrating higher prevalence of strongyloidiasis. Comparisons between proportions were made using Fisher exact test, with false discovery rate correction used for post-hoc comparisons. A multivariable Firth logistic regression model was used to assess potential risk factors for S. stercoralis infection. RESULTS: Overall, 1775 serum samples were tested, of which 102 of 487 (20.9%) and 104 of 296 (35.2%) were serological-positive in Marovoay and in Vatomandry districts (both coastal areas), respectively, compared to 28 of 496 (5.6%) and 30 of 496 (6.1%) in Tsiroanomandidy and in Ambositra districts (both highlands), respectively (adj. p < 0.001). PCR for S. stercoralis was positive in 15 of 210 (7.1%) and in 11 of 296 (3.7%) samples from Marovoay from Vatomandry, respectively, while was negative for all samples tested in the other two districts. High prevalence of A. lumbricoides (45.9%), hookworm (44.6%) and T. trichiura (32.1%) was found in Vatomandry. In the multivariable analysis, strongyloidiasis was associated with hookworm infection. Hookworm infection was also associated with male sex and lower education level. CONCLUSIONS: S. stercoralis prevalence proved higher in coastal areas compared to highlands. Different climatic conditions may explain this distribution, along with previous rounds of anthelminthics distributed in the country, which may have reduced the parasite load in the population. The high prevalence of the other soil-transmitted helminths (STH) in Vatomandry was unexpected, given the good coverage with benzimidazole in control campaigns. Further studies are needed to explore the risk factors for STH and S. stercoralis infections in Madagascar, in order to align with the WHO recommendations.

Structural and functional abnormalities of the tongue: An epidemiological study from a tertiary care center in India.

Background: The tongue is a prominent muscular organ of the oral cavity and the integrity of the tongue mucosa frequently can reflect the overall health of an individual. Many notable structural and functional alterations can affect the tongue. These changes may be symptomatic or asymptomatic. Hence, the aim of the study was to determine the prevalence of structural and functional abnormalities of the tongue in a population reporting to a tertiary care center. We also assessed the prevalence of the normal variants and evaluated the normal tongue protrusion measurement in the study population. Methods: The cross-sectional study included 1,143 dental outpatients above 18 years of age who visited the Department of Oral Medicine and Radiology between October 2021 to February 2022. Demographic details of the patients were noted. Participants were asked questions regarding any symptoms or abnormalities noticed on the tongue. The tongue was examined thoroughly for any structural/ functional abnormalities. The maximal tongue protrusion for each participant was measured by asking them to extend their tongue out. Medical history, drug history, and social history were recorded. Results: The study included 564 male and 579 female participants; tongue lesions were positive in 66.5% of the study population. Coated tongue (26.2%) was the most frequent structural abnormality that was noted in the present study. Taste dysfunction (4.6%) was the most frequent functional abnormality. The lesions were mostly in the anterior two-thirds (4.2%) of the tongue. Functional abnormalities of the tongue were noted in 8.7% of the study participants. Conclusions: The results of the present study showed that structural and functional abnormalities of the tongue were present in 66.5% of the population. Careful and detailed evaluation of the tongue examination is mandated in routine dental checkups. This shall help in the prompt identification of various etiological factors causing structural and functional abnormalities of the tongue.

Prevalence of antimicrobial-resistant organisms in smaller Canadian hospitals: Community, Rural, and Northern Acute Care Point Prevalence (CNAPP-19) Survey, 2019.

Background: The availability of national data on the prevalence of antimicrobial resistant infections in smaller, community, northern and rural acute care hospitals is limited. The objective of this article is to determine the prevalence of infections caused by selected antimicrobial-resistant organisms (AROs) in these smaller hospitals. Methods: A point prevalence survey was conducted by 55 hospitals between February and May 2019 and included representation from all 10 Canadian provinces. Eligible hospitals were those with 350 or fewer beds. Data were collected on hospital characteristics. De-identified patient data were collected on selected infections (pneumonia, urinary tract infections, bloodstream infections, skin/soft tissue infections, surgical site infections, and Clostridioides difficile infections) for selected AROs (methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, extended-spectrum ß-lactamase-producing organisms and carbapenemase-producing organisms). Data on antimicrobial prescribing and infection prevention and control precautions were also collected. Results: A total of 3,640 patients were included in the survey. Median patient age was 73 years, and 52.8% (n=1,925) were female. Selected infections were reported in 14.4% (n=524) of patients, of which 6.9% (n=36) were associated with an ARO infection. Infection prevention and control additional precautions were in place for 13.7% (n=500) of patients, of which half (51.0%, n=255) were due to an ARO. Approximately one third (35.2%, n=1,281) of patients had at least one antimicrobial prescribed. Conclusion: Antimicrobial-resistant organisms remain a serious threat to public health in Canada. The results of this survey warrant further investigation into AROs in smaller Canadian hospitals as a potential reservoir of antimicrobial resistance.

Iodine deficiency in women of childbearing age in Brazil: systematic review and meta-analysis / Deficiencia de yodo en mujeres en edad fabricante en Brasil: revisión sistemática y metanálisis

Background: Despite current policies of salt iodination, iodine deficiency is still a global public health problem, especially in women. So far, conflicting evidence has been suggested for the prevalence of iodine deficiency in Brazil. Objective: To estimate the prevalence of iodine deficiency and associated factors in women of childbearing age in Brazil. Methods: A systematic review was conducted using databases (PubMed, LILACS, WHO, Scopus, and Capes' dissertation and thesis), from inception to May 2020. Meta-analyses of proportions were performed using the variance inverse for the fixed model. Reporting and methodological quality were assessed using the Joanna Briggs Institute tool to prevalence studies. Results: Our review identified seven studies published between 2002 e 2017, including 1354 participants, especially pregnant women. All studies presented at least one quality limitation, mainly regarding the sampling method (i.e., convenience) and small sample size. The prevalence of iodine deficiency ranged among studies from 16% to 62%. In contrast, the meta-analysis identified a mean prevalence of 40% (95% confidence interval, CI 37%-43%) for pregnant women and 13% (95% CI 4%-24%) for non-pregnant women. Cumulative meta-analysis suggests a tendency of higher iodine deficiency prevalence from 2018 in pregnant women. Conclusions: Although this systematic review identified studies with poor methodological and reporting quality, a high prevalence of iodine deficiency was identified in pregnant women, reinforcing the importance of national nutritional policies for monitoring iodine status in this population. Future studies should consider random probabilistic sampling, appropriate sample size, and pre-defined subgroup analysis to adequately inform the prevalence of iodine deficiency and associated factors in women of childbearing age and support health policies

Antecedentes: A pesar de las políticas actuales de yodación de la sal, la deficiencia de yodo sigue siendo un problema de salud pública mundial, especialmente en las mujeres. Hasta ahora, se han sugerido pruebas contradictorias sobre la prevalencia de la deficiencia de yodo en Brasil. Objetivo: Estimar la prevalencia de deficiencia de yodo y factores asociados en mujeres en edad fértil, en Brasil. Métodos: Se realizó una revisión sistemática, buscando en PubMed, LILACS, OMS, Scopus y la base de datos de disertaciones y tesis de Capes desde el inicio hasta mayo de 2020. Se realizaron metanálisis de proporciones utilizando la variancia inversa para el modelo fijo. La calidad de información y metodológica se evaluó utilizando la herramienta del Institute Joanna Briggs para estudios de prevalencia. Resultados: Nuestra revisión identificó siete estudios publicados entre 2002 y 2017, incluyendo 1354 participantes, especialmente mujeres embarazadas. Todos los estudios presentaron al menos una limitación de calidad, principalmente con respecto al método de muestreo (es decir, la conveniencia) y el pequeño tamaño de la muestra. La prevalencia de la deficiencia de yodo varió entre los estudios del 16% y el 62%, mientras que el metanálisis identificó una prevalencia media del 40% (intervalo de confianza del 95%, IC 37%-43%) para las mujeres embarazadas y del 13% (IC del 95% 4%-24%) para mujeres no embarazadas. El metanálisis acumulativo sugiere una tendencia a una mayor prevalencia de deficiencia de yodo a partir de 2018 en mujeres embarazadas. Conclusiones: Si bien esta revisión sistemática identificó estudios con mala calidad metodológica y de reporte, se identificó una alta prevalencia de deficiencia de yodo en mujeres embarazadas, lo que refuerza la importancia de las políticas nutricionales nacionales para monitorear el estado de yodo en esta población. Los estudios futuros deben considerar el muestreo probabilístico aleatorio, el tamaño de muestra apropiado y el análisis de subgrupos predefinidos para informar adecuadamente la prevalencia de la deficiencia de yodo y los factores asociados en mujeres en edad fértil y para respaldar las políticas de salud

Spontaneous and induced abortion trends and determinants in the Northeast semiarid region of Brazil: a transversal series / Tendência de abortos espontâneos e induzidos na região semiárida do Nordeste do Brasil: uma série transversal

Abstract Objectives: this study intends to estimate the rates, associated factors and trends of selfreported abortion rates in the northeast of Brazil. Methods: series of population-based surveys realized in Ceará, northeast of Brazil, one of the poorest states in the country. A sample of about 27,000 women of reproductive age was used. Abortion was assessed according to women´s information and rates were calculated using official population estimates. The trends and the association among socioeconomic and reproductive factors were studied using regressive models. Results: a trend for reduction in rates was identified. For induced abortion, the determinants were: not having a partner, condom in the last sexual intercourse, first child up to 25years old (AOR= 5.21; ACI: 2.9 - 9.34) and having less than 13years old at first sexual intercourse (AOR= 5.88; ACI: 3.29 - 10.51). For spontaneous abortion were: having studied less than 8 years, knowledge and use of morning-after pill (AOR= 26.44; ACI: 17.9 - 39.05) and not having any children (AOR= 3.43). Conclusions: rates may have been low due to self-reporting. Young age and knowledge about contraceptive methods were associated to both kinds of abortion, while education level along with spontaneous and marital status with induced. Programs to reduce abortion rates should focus on single younger women with low education.

Resumo Objetivos: este estudo objetiva estimar as taxas, fatores associados e tendência das taxas de aborto no Nordeste do Brasil. Métodos: série de estudos transversais realizada no Ceará, um dos estados mais pobres do país. Uma amostra de cerca de 27000 mulheres em idade reprodutiva foi utilizada. A ocorrência de aborto foi aferida através de informação dada pela participante e taxas foram calculadas usando estimativas populacionais oficiais. As tendências e associações entre fatores socioeconômicos e reprodutivos foram estudadas através de modelos regressivos. Resultados: foi identificada tendência de redução nas taxas de abortamento. Para aborto induzido, os determinantes foram não ter um parceiro fixo, ter utilizado camisinha na última relação sexual, ter tido o primeiro filho com menos de 25 anos (AOR= 5,21; ACI: 2,9 - 9,34), e ter tido a primeira relação com menos de 13 anos (AOR= 5,88; ACI: 3,29 - 10,51). Para o espontâneo, ter estudado menos de oito anos, conhecimento sobre a pílula do dia seguinte (AOR= 26,44; ACI: 17,9 - 39,05), e não ter filhos (AOR= 3,43). Conclusões: as taxas podem ser subestimadas por serem auto relatadas. Estar na adolescência e ter conhecimento sobre métodos contraceptivos foram associados aos dois tipos de aborto, enquanto nível educacional com o espontâneo e estado conjugal com induzido. Programas para reduzir taxas de abortamento deveriam focar em mulheres solteiras e com baixa educação.

Lipohipertrofias en niños con diabetes mellitus tipo 1 / Lipohypertrophy in child with type 1 diabetes mellitus

ntroducción: La diabetes mellitus tipo 1 (DM1) es la enfermedad crónica más frecuente en la edad pediátrica. La educación del niño con DM1 es fundamental para un adecuado control de la enfermedad. Las lipohipertrofias son una de las complicaciones más frecuentes que se producen por el tratamiento con insulina. Estas son consideradas problemas de colaboración y, por lo tanto, es labor de la enfermera controlar su aparición e intervenir para minimizar sus consecuencias. Objetivo: Determinar las características de las lipohipertrofias en niños diagnosticados con diabetes mellitus tipo 1. Métodos: Estudio descriptivo transversal mediante muestreo por conveniencia. Se evaluó la presencia, localización y tamaño de las lipohipertrofias y la relación de la persona que administra la insulina con el régimen de tratamiento. Se estudiaron pacientes de edades comprendidas entre 2 y 18 años que tuviesen, al menos, 3 meses de tratamiento insulínico. Se calculó el tamaño de la muestra mediante estimación de la proporción. Resultados: La prevalencia de lipohipertrofias fue del 44,5 por ciento. Sin embargo, entre los niños estudiados que se encontraban en tratamiento con múltiples dosis de insulina, el porcentaje se elevó a 53,8 por ciento. Los análogos de acción rápida eran inyectados principalmente en abdomen y brazo, los de acción lenta en glúteo y muslo. Los lugares con más lipohipertrofias eran muslos (superando el 50 por ciento), seguido de brazos y abdomen. Conclusiones: Se detectaron diferencias significativas en la aparición de lipohipertrofias entre los niños que portan bomba de insulina y los que utilizan un régimen de múltiples dosis de insulina. Por lo tanto, se podría recomendar la utilización de bomba de insulina o de catéteres de infusión subcutánea (i-Port ®) para la disminución de estas(AU)

Introduction: Type 1 diabetes mellitus (T1DM) is the most common chronic disease in the pediatric age. In order to obtain a positive control of this illness, the T1DM child education is basic. Lipohypertrophies are one of the most frequent difficulties that appear as a consequence of the insulin treatment. When this happen, is nurse's responsibility to monitor the appearance of lipohypertrophies and to try to reduce their consequences. Objectives: Establish the prevalence of lipohypertrophy in children with T1DM performed at the Pediatric Endocrinology Unit of the Hospital Universitario La Paz. Methods: To analyze lipohypertrophy it has been performed a descriptive study. The method used for the sampling was for convenience. Appearance, location and size of lipohypertrophies were evaluated. This has been related with person who administers the insulin and the treatment regimen. Results: Lipohypertrophy prevalence in the sample represented a 44.5 percent, however, between patients which were in a treatment with multiple daily injections this was 53.8 percent. Quick action analogues were mainly injected in abdomen and arms, slow action analogues were aministered in buttocks and leg. Legs were the part of the body with the most lipohypertrophies concentration (exceeded 50 percent), follow by arms and abdomen. Conclusions: Meaningful differences are shown in the appearance of lipohypertrophies between children in treatment with continuous subcutaneous insulin infusion and those that use a multiple daily injections treatment. Therefore, we concluded considering the possibility to recommend the use of continuous subcutaneous insulin infusion or indwelling catheters (i-Port ®) in order to decrease lipohypertrophies(AU)