Construction and validation of a personalized risk prediction model for in-hospital mortality in patients with acute myocardial infarction undergoing percutaneous coronary intervention.

BACKGROUND: Although emergency Percutaneous Coronary Intervention (PCI) has been shown to reduce mortality in patients with Acute Myocardial Infarction (AMI), the risk of in-hospital death remains high. In this study, the authors aimed to identify risk factors associated with in-hospital mortality in AMI patients who underwent PCI, develop a nomogram prediction model, and evaluate its effectiveness. METHODS: The authors retrospectively analyzed data from 1260 patients who underwent emergency PCI at Dongyang People's Hospital between June 1, 2013, and December 31, 2021. Patients were divided into two groups based on in-hospital mortality: the death group (n = 61) and the survival group (n = 1199). Clinical data between the two groups were compared. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select non-zero coefficients of predictive factors. Multivariable logistic regression analysis was then performed to identify independent risk factors for in-hospital mortality in AMI patients after emergency PCI. A nomogram model for predicting the risk of in-hospital mortality in AMI patients after PCI was constructed, and its predictive performance was evaluated using the c-index. Internal validation was performed using the bootstrap method with 1000 resamples. The Hosmer-Lemeshow test was used to assess the goodness of fit, and a calibration curve was plotted to evaluate the model's calibration. RESULTS: LASSO regression identified d-dimer, B-type natriuretic peptide, white blood cell count, heart rate, aspartate aminotransferase, systolic blood pressure, and the presence of postoperative respiratory failure as important predictive factors for in-hospital mortality in AMI patients after PCI. Multivariable logistic regression analysis showed that d-dimer, B-type natriuretic peptide, white blood cell count, systolic blood pressure, and the presence of postoperative respiratory failure were independent factors for in-hospital mortality. A nomogram model for predicting the risk of in-hospital mortality in AMI patients after PCI was constructed using these independent predictive factors. The Hosmer-Lemeshow test yielded a Chi-Square value of 9.43 (p = 0.331), indicating a good fit for the model, and the calibration curve closely approximated the ideal model. The c-index for internal validation was 0.700 (0.560‒0.834), further confirming the predictive performance of the model. Clinical decision analysis demonstrated that the nomogram model had good clinical utility, with an area under the ROC curve of 0.944 (95 % CI 0.903‒0.963), indicating excellent discriminative ability. CONCLUSION: This study identified B-type natriuretic peptide, white blood cell count, systolic blood pressure, d-dimer, and the presence of respiratory failure as independent factors for in-hospital mortality in AMI patients undergoing emergency PCI. The nomogram model based on these factors showed high predictive accuracy and feasibility.

Evaluating the Influence of Eye Rubbing and Genetic Predisposition on Keratoconus in Bucaramanga (Colombia): A Case-control Study.

AIM: To determine risk factors associated with keratoconus in Bucaramanga, Colombia. MATERIAL AND METHODS: A paired case-control study was conducted at Bucaramanga, Colombia, between November 2022 and December 2023. The controls were age- and sex-matched. Patients answered a questionnaire designed for this study regarding their family history of keratoconus, eye rubbing, atopy, sun exposure, and sleeping habits. Information from medical records was also obtained. Univariate and multivariate conditional analyses were used to test the significance of associations. RESULTS: One hundred fifty-six patients with a diagnosis of keratoconus and 312 controls were included. Univariate analyses revealed significant differences between cases and controls in the following factors: very frequent eye rubbing (OR = 20.9, 95% CI 6.2-70.1), a positive family history of keratoconus (OR = 13.0, 95% CI 5.5-30.8), a personal history of atopy (OR = 2.2), and nocturnal eye compression (OR = 1.7, 95% CI 1.0-2.7). Multivariate analysis showed a statistical significance for eye rubbing (OR = 6.9, 95% CI 3.8-12.5), and family history of keratoconus (OR = 10.3, 95% CI 2.3-44.9). There was a significant mild interaction between both, since when the two coincided the OR increased up to 74.1 times. CONCLUSION: Eye rubbing and family history of keratoconus were the most important risk factors for keratoconus in our population. Although it is impossible to establish causal relationships, our results suggest that controlling eye rubbing could be a potentially useful preventive measure, particularly in individuals with a family history of keratoconus. Other factors, such as sun exposure, sleeping position, and atopy, may play a role in the pathophysiology of the disease.

Predictors of Salmonella enterica contamination in agricultural and livestock-impacted natural watersheds.

Salmonella enterica (S. enterica), a ubiquitous zoonotic foodborne pathogen, remains a worldwide public health hazard and economic burden. In recent years, outbreaks associated with the consumption of plant-based foods probably contaminated by irrigation water highlights the importance of water sources. This study investigated anthropogenic and environmental factors influencing S. enterica occurrence in natural watersheds impacted by agricultural and livestock industries in a 10-month longitudinal study in Paraiba, Brazil. Water samples were obtained from multiple sites within the three major river basins by modified Moore Swabs (MMS) and processed by conventional S. enterica isolation methodologies. Physicochemical parameters, climate, and human activities near the water sources were recorded. A logistic regression model was fitted using Generalized Linear Model (GLM) and further adjusted according to the selected variables using the Least Absolute Shrinkage and Selection Operator (LASSO) method. A non-statistical decision tree model was also fitted using the rpart package in R. Season, rainfall regime, water physicochemical features, and anthropogenic activities were significantly associated with S. enterica contamination. According to the regression tree analysis, rainfall within the sampling month was the strongest predictor of S. enterica recovery, potentially due to leaching from soil or runoff from adjacent human and animal activities. The complexity of multivariate conditions driving S. enterica contamination in surface waters highlights the need for region-specific investigations.

Investigating temporal trends in risk factors related to injury severity of crashes with pedestrians in urban areas.

OBJECTIVE: The implementation of road safety policy in urban areas can potentially change the severity profile of crashes, as well as how risk factors influence crash severity. In this sense, this study aims to empirically evaluate possible changes in the severity profile of crashes with pedestrians and in the influence of risk factors for pedestrian injuries after the efforts of the Decade of Action for Road Safety in the city of Fortaleza, Brazil. METHODS: This was done using data from crashes with pedestrians between 2009 and 2019; divided into three periods. Two categorical modeling analyses were performed using the mixed logit modeling approach, including sociodemographic, environmental, vehicle, road type, and traffic control device factors. In the first analysis, a single model was estimated, and time (period) was included as an explanatory variable; in the second one, models were estimated for each period. RESULTS: According to temporal analysis, a reduction was evident in the severity profile of crashes with pedestrians over the decade of action. In general, the safety interventions seemed to have little or no impact on pedestrian gender, young pedestrians (up to 15 years old), crashes at night, crashes during weekends and crossings near traffic lights. Regarding crashes on arterial roads, the results suggest an increase in the marginal effects for fatal crashes after the decade of action, while other variables, such as heavy vehicles and expressways, showed positive marginal effects in all periods, indicating that the direction of their effect did not change. This is a potential indication that the overall safety impact of policies during the decade were not effective for these types of crashes. It was possible to identify considerable reduction in the marginal effects for older pedestrians (60+) for both severe and fatal crashes. CONCLUSION: Although it is not possible to claim that this change comes from specific actions or controlled factors, the results presented here indicate an improvement in road safety for these users, in line with the goals of the Safe Systems Approach and the Decade of Action for Road Safety to reduce severe and fatal traffic injuries.

[Can changes in diastolic function be predicted according to risk factors?] / ¿Se pueden predecir cambios en la función diastólica acorde a los factores de riesgo?

INTRODUCTION: Diastolic function has a dynamic behavior according to modifying factors. We describe the variables used in its assessment by echocardiography in different population groups of men and women to determine whether changes can be predicted according to their risk factors. MATERIALS AND METHODS: Observational and descriptive cross-sectional registry. A systematic collection of anthropometric characteristics, risk factors and specific echocardiographic variables of diastolic function was performed in an outpatient echocardiography laboratory. Quantitative variables were expressed as mean and standard deviation for Gaussian distribution variables. Discrete variables were analyzed using contingency tables, qualitative variables are expressed as percentages. Means were compared using the Student t test. RESULTS: A total of 107 patients were admitted. Those with sedentary lifestyle had a mean left atrial volume of 29 ml/m2, a deceleration time of 218 ms, a transmittal flow ratio E/A (EA) of 1.5, tissue Doppler ratio Ee´ (Ee) of 6 and e´a´ (ea) of 1.4; those who performed physical activity 3 times a week were characterized by having a left atrial volume of 35 ml/m2, a deceleration time of 210 ms, EA of 1.8, Ee of 5 and ea of 1.8. Patients with obesity had a left atrial volume of 35 ml/m2, deceleration time of 226 ms, E/A 1.1, Ee of 9 and ea of 1.2. Those with arterial hypertension had a left atrial volume of 33 ml/m2, deceleration time of 224 ms and E/A ratio of 1, Ee of 8 and ea of 1. DISCUSSION: The inclusion of certain risk factors in the history prior to echocardiographic evaluation can predict subgroups with different diastolic function.

Introducción: La función diastólica tiene un comportamiento dinámico según factores modificantes. Describimos las variables utilizadas en su valoración por ecocardiografía en diferentes grupos poblacionales de hombres y mujeres, para determinar si pueden predecirse cambios acordes a sus factores de riesgo. Materiales y métodos: Registro transversal observacional y descriptivo. En laboratorio ambulatorio de ecocardiografía se efectuóla recolección sistemática de características antropométricas, factores de riesgo y variables ecocardiográficas específicas de función diastólica. Las variables cuantitativas se expresaron como media, y las de distribución gausiana como desviación estándar. Las variables discretas se analizaron por tablas de contingencia, las cualitativas se expresan como porcentaje. Se usóT de Student para comparar las medias. Resultados: Ingresaron 107 pacientes. Aquellos con sedentarismo presentaron volumen medio-auricularizquierdo: 29 ml/m2, tiempo de desaceleración: 218 ms, relación flujo transmitral E/A (EA): 1.5, relación Doppler tisular Ee´(Ee): 6, y e´a´ (ea): 1.4; quienes realizaban actividad física 3 veces/ semana tenían un volumen-auricularizquierdo de 35 ml/m2, tiempo de desaceleración de 210 ms, EA de 1.8, Ee de 5 y ea de 1.8. Los pacientes con obesidad presentaron un volumen-auricular-izquierdo de 35 ml/m2, tiempo de desaceleración de 226 ms, E/A 1.1, Ee: 9 y ea: 1.2. Quienes presentaban hipertensión arterial tenían un volumen-auricular-izquierdo de 33 ml/m2, tiempo de desaceleración 224 ms, relación E/A 1, Ee 8 y ea 1. Discusión: La inclusión de determinados factores de riesgo en la anamnesis previa a la valoración ecocardiográfica puede predecir subgrupos con función diastólica diferente.

[Evolution of inpatients with diabetes and ischemic strokes: retrospective cohort study]. / Evolución de pacientes internados con diabetes y accidente cerebrovascular isquémico: estudio de cohorte retrospectiva.

INTRODUCTION: Type 2 diabetes (T2DM) together (along) with age and the presence of atrial fibrillation, high blood pressure, smoking, dyslipidemia (DLP), carotid stenosis, and an unhealthy lifestyle are risk factors (RF) to develop an ischemic stroke. The objective of this work was to analyze and compare risk factors and evolution of inpatients with ischemic stroke with and without T2DM. MATERIALS AND METHODS: This study was a retrospective and observational analysis. Data on habits, comorbidities, medication and laboratory parameters were collected patients' medical records hospitalized for stroke between January 1, 2022 and December 31, 2022. The sample was divided into patients with and without T2DM. RESULTS: One hundred and ninety three patients experienced stroke. The average age: 73.6 ±11.8 years. Among them, 100 patients had T2DM, displaying a higher prevalence of obesity (p= 0.000), DLP (p=0.000), and chronic kidney disease (p= 0.045). Elevated levels of glycemia (p=0.001), HbA1C (p=0.001), triglycerides (TG) (p=<0.001) and TG/HDL index (p= <0.001) as well as and lower HDL (p=<0.001) were also observed. Patients with T2DM showed lower survival (p= 0.012). DISCUSSION: Patients hospitalized for stroke with T2DM had more risk factors and higher mortality than the population without T2DM.

Introducción: La diabetes tipo 2 (DM2) junto con la edad y la presencia de fibrilación auricular, hipertensión arterial, tabaquismo, dislipidemia (DLP), estenosis carotídea, y un estilo de vida no saludable, son factores de riesgo (FR) para el desarrollo de un accidente cerebrovascular isquémico (ACVi). El objetivo de este trabajo fue analizar y comparar factores de riesgo y evolución de pacientes internados con ACV isquémico con y sin DM2. Materiales y métodos: Estudio retrospectivo y longitudinal. Se recolectaron datos (hábitos, comorbilidades, medicación y laboratorio) de las historias clínicas de pacientes internados por ACVi desde el 1 de enero de 2022 al 31 de diciembre de 2022. Se dividióla muestra en pacientes con y sin DM2. Resultados: Ciento noventa y tres pacientes presentaron ACVi. La edad promedio: 73.6 ±11.8 años; 100 pacientes tenían DM2, quienes presentaron mayor obesidad (p=<0.001, DLP (p=<0.001), enfermedad renal crónica (p=0.045). También se observómayores niveles de glucemia (p=0.001), HbA1C (p=0.001), triglicéridos (TG) (p=<0.001) e índice TG/HDL (p=<0.001) y HDL más bajo (p=<0.001). Los pacientes con DM2 presentaron menor supervivencia (p=0.012). Discusión: Los enfermos hospitalizados por accidente cerebrovascular con DM2 tuvieron más factores de riesgo y mayor mortalidad que la población sin DM2.

Linking common mental disorders and asthma in Brazilian adolescents: a cross-sectional analysis of the ERICA study.

OBJECTIVE: Asthma is a heterogeneous chronic disease of the airways, affecting all age groups, especially children and adolescents. The aim of this study was to evaluate several factors associated with asthma in Brazilian adolescents. METHODS: Cross-sectional study of a national representative sample of school-based adolescents aged 12-17 years from The Study of Cardiovascular Risk in Adolescents (ERICA) stratified by region and conglomerate by schools. The authors studied the following variables: sociodemographic characteristics, lifestyle, smoking, eating habits, sleeping and mental conditions. RESULTS: Data from 66,567 adolescents were analyzed, 50.2 % of whom were female. Of the total, 52.7 % were between 12 and 14 years old. The overall prevalence of asthma was 14.5 % (95 %CI: 13.6-15.5). Asthma was associated with female sex (PR 1.35; 95 %CI: 1.15-1.57), white skin color (PR 1.25; 95 %CI: 1.04-1.50), private school (PR 1.26; 95 %CI: 1.05-1.52), smoking (PR 1.93; 95 %CI: 1.54-2.38); and alcohol consumption (PR 1.74; 95 %CI: 1.52-2.03). Excessive screen time (PR 1.19; 95 %CI 1.01-1.42) and short sleep duration (PR 1.28; 95 %CI 1.05-1.57) were also associated. Healthy eating habits, such as adolescents who ate breakfast, drank water, and ate meals with their parents, were associated with a lower prevalence of asthma. In relation to comorbidities, asthma was associated with common mental disorders (CMD) (PR 1.94; 95 %CI 1.64-2.27; p < 0,00,001), but not with overweight or obesity (PR 1.09; 95 %CI 0.87-1.38). In the correspondence analysis, CMD was the strongest factor associated with asthma. CONCLUSION: Asthma was associated with several determinants in Brazilian adolescents, but the association with CMD deserves special attention in this age group.

Risk factors for mortality in patients with chikungunya: A systematic review and meta-analysis.

INTRODUCTION: Chikungunya fever is a debilitating arthritic disease that can lead to atypical severe complications and sometimes be fatal. The risk factors for fatal outcomes of chikungunya fever have not been thoroughly studied. This systematic review and meta-analysis aimed to identify mortality risk factors in patients with chikungunya. These findings will aid clinicians in targeting high-risk groups with severe chikungunya for timely interventions, ultimately improving patient outcomes. OBJECTIVE: The objective of this study is to identify mortality risk factors in patients with chikungunya. METHODS: We conducted a systematic review and meta-analysis by searching the MEDLINE, Embase, Cochrane, BVS, BDTD and OpenGrey databases to identify eligible observational studies on patients with chikungunya. These studies analysed mortality risk factors, providing adjusted risk measures along with their corresponding confidence intervals (CIs). We estimated the pooled weighted mean difference and 95% CIs using a random-effects model, and the methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS: Our search yielded a total of 334 records. After removing duplicates, we screened 275 records, reviewed 31 full articles and included seven studies in the systematic review and four in the meta-analysis, with a total of 220,215 patients and 908 fatal cases. Diabetes Mellitus (OR = 2.86, 95% CI 1.75-4.69), hypertension (OR = 3.10, 95% CI 2.02-4.77), age ≥ 60 years (OR = 19.49, 95% CI 1.98-191.88), chronic kidney disease (OR = 5.81, 95% CI 1.30-25.99), male sex (OR = 2.07, 95% CI 1.71-2.51) and vomiting (OR = 2.18, 95% CI 1.75-2.73) are significantly and positively associated with mortality in chikungunya. CONCLUSION: Elderly men with chronic diseases have a higher risk of death from chikungunya; therefore, they deserve more careful evaluation.

Profiling Sociodemographic Risk Factors and Clinical Outcomes of Women with Endometrial Cancer in Puerto Rico: The Central Role of Obesity and Obstetric Features.

INTRODUCTION: Incidence of endometrial cancer (EC) in Hispanic/Latina (H/L) women are higher compared to other race/ethnicities in the United States. EC is the third most common cancer and the fourth cause of cancer-related deaths in Puerto Rican women, yet demographic and clinical information is limited. High rates of EC risk factors such as obesity, diabetes mellitus type 2 (DM2) and hypertension (HTN) have been documented in the Puerto Rican population. OBJECTIVE: To describe the demographic, clinical history, lifestyle, obstetrical-gynecological, pathologic, and molecular profiles of women with EC predominantly from Southern/Central Puerto Rico. METHODS: We conducted a retrospective secondary analysis of data abstracted from the Puerto Rico Central Cancer Registry (PRCCR), self-administered questionnaires and medical records of EC cases. Descriptive statistics were conducted using SPSS V28 and RStudio. RESULTS: We identified 105 EC cases aged 28-82. The major risk factors were BMI ≥ 30 (72%), HTN (33%), and DM2 (20%). Endometrioid adenocarcinoma was the main histological tumor type (80%), of which 74% were Type I. Obesity and nulliparity were associated with younger age at diagnosis. Older age at diagnosis (> 65 y/o) was associated with more advanced disease. CONCLUSIONS: This study defined the clinical-demographic profile of women with EC from Puerto Rico and identified risks factors that are associated with younger or older age at diagnosis. IMPACT: Profiling the risk factors for EC may help improve diagnostic accuracy and clinical management and result in better outcomes for this under-served, under-researched cancer patient population.

Risk of mortality by aggression: A retrospective cohort study in women with notification of interpersonal violence in Brazil.

OBJECTIVES: The present study investigated the incidence of mortality by aggression in women who experienced interpersonal violence. The study also aimed identify whether intimate partner violence (IPV) was associated with the risk of death by aggression. STUDY DESIGN: This was a population-based retrospective cohort study linking data from the National Disease Notification System and the Mortality Information System. METHODS: The study population included women, aged 15-59 years, with notification of interpersonal violence in a 1-year period. Data were also collected on deaths by any cause within 2 years of notification of interpersonal violence in the study population. For survival analysis, this study used the following two approaches: (1) specific risk by aggression; and (2) the subdistribution of risks. In addition, the Cox and Fine-Gray models were used to verify if IPV was associated with the risk of death by aggression. RESULTS: This study identified 117,743 women, aged 15-59 years, with notification of interpersonal violence. In total, 818 of the study population died within 2 years of notification. The cumulative incidence at the end of 2 years was 0.003; thus, a mortality rate of approximately 300 deaths/100,000 women who had experienced interpersonal violence. In the two survival analysis approaches, IPV showed no significant association with death by aggression. Only the 'Black and Others' ethnic group was associated with death by aggression, with a 33 % increase in the death rate (hazard ratio [HR] 1.33; 95 % confidence interval [CI] 1.08-1.65). CONCLUSION: The results of this study highlight the impact of ethnic group on the risk of death among women experiencing interpersonal violence. Intersectoral coordination strategies are required to promote early detection of violence and comprehensive care.

Research and characterization of Cryptosporidium spp. in the domestic cat (Felis catus): First description of C. felis in the state of Goiás and C. muris in the Midwest region of Brazil.

With the increasingly close coexistence between pets and humans, coupled with reports of Cryptosporidium cross-infection between felines and their guardians, research aimed at understanding the epidemiology of these parasites in specific regions has become necessary. The principal objective of this study was to undertake a molecular characterization of Cryptosporidium in fecal samples from felines in the state of Goiás, Brazil (which is unprecedented for the region), and to assess the risk factors involved in the infection of these animals in the aforementioned locale. A total of 95 fecal samples were collected from domestic felines in the municipality of Goiânia, Goiás, Brazil. All the animals involved were categorized by sex (male or female), lifestyle (stray or domiciled), and age (under six months or six months and older). After collection, all fecal aliquots underwent genomic DNA extraction, followed by a nested PCR (nPCR) technique targeting the 18 s rRNA gene. Subsequently, sequencing of all amplified products was performed to diagnose Cryptosporidium parasites. In addition to searching for Cryptosporidium in feces, all felines underwent serological testing for Feline Immunodeficiency Virus (FIV) antibodies (IgG) using the Enzyme-Linked Immunosorbent Assay (ELISA). Of all the fecal samples analyzed, 17.9 % (17/95) tested positive for the presence of Cryptosporidium spp. DNA, with the variable "age under six months" being the only statistically significant risk factor (p ≤ 0.05) for feline infection. C. felis was the most prevalent species, identified in 88.2 % (15/17) of the positive samples. C. muris was the second most diagnosed species, confirmed in 5.9 % (1/17) of the positive samples. Of all the feline serological samples evaluated, 48.42 % (46/95) were positive for anti-FIV IgG. It was confirmed that 75 % (3/4) of all adult animals positive for Cryptosporidium showed positive (50.00 % [2/4]) or indeterminate (25.00 % [1/4]) results for FIV. This unprecedented study provides the first report of parasites from the genus Cryptosporidium in domestic felines in the state of Goiás, including the first report of C. felis in the state and of C. muris in Midwest Brazil.

Syphilis in a blood bank in Argentina: Prevalence trends and risk factors.

BACKGROUND: Worldwide, there has been a worrying increase in the prevalence of syphilis. Blood banks have a major role in monitoring the trend of these events, despite the bias due to the altruistic donation strategy. OBJECTIVES: To determine the seroprevalence of syphilis and analyse its association with defined risk factors among blood donors at the regional blood center at Hospital Prof. Dr. J. P. Garrahan, period 2016-2022. MATERIALS AND METHODS: Donor screening was performed with treponemal and non-treponemal tests to determine the prevalence of active and past syphilis. Sociodemographic characteristics of donors were analysed and the association with potential risk factors was assessed. RESULTS: A total of 72 874 donations were processed during the study period. The overall prevalence of specific anti-Treponema pallidum antibodies was 0.69% (95% CI = 0.63-0.75). Active syphilis seroprevalence was 0.30% (95% CI = 0.25-0.33). Not active syphilis seroprevalence was 0.39% (95% CI = 0.35-0.44). Anti-T. pallidum seroprevalence among first-time donations was 1.26% (95% CI = 1.14-1.38) while in repeat donations it was 0.16% (95% CI = 0.12-0.21). In univariate analysis, we found an association between syphilis and having a history of any sexually transmitted infection (OR: 5.09, 95% CI = 2.20-11.70, p < 0.01) and being first-time donors (OR: 3.48, 95% CI = 1.70-7.09, p = 0.0001). CONCLUSION: Although the overall prevalence of syphilis is 0.69%, among repeat donors prevalence as low as 0.16% was found. This demonstrates the need to maintain and improve screening strategies and promotion of voluntary, altruistic and repeat donation.

Sociodemographic, behavioral, and clinical risk factors associated with cervical dysplasia: A case-control study. / Factores de riesgo sociodemográficos, conductuales y clínicos asociados a la displasia cervical: estudio de casos y controles.

Introduction: Cervical dysplasia is a precursor lesion of cervical cancer, one of the leading causes of morbidity and mortality in women, especially in developing countries. This study aimed to identify the risk factors associated with the development of cervical dysplasia in women treated at the Santa María del Socorro Hospital in Ica, Peru, between 2017 and 2019. Methods: An observational case-control study was conducted with 92 cases of women with confirmed high-grade intraepithelial lesion and 184 controls with consecutive negative results in Pap smears. Sociodemographic, behavioral, and clinical data were collected. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with precancerous cervical lesions. Results: The factors significantly associated with cervical dysplasia were age under 35 years (odds ratio: 1.2; 95% confidence interval: 0.1 to 0.7), having a partner (7.4; 2.3 to 23.5), body mass index ≥ 25 (12.9; 3.9 to 42.0), more than three sexual partners (71.4; 16.4 to 310.9), bacterial vaginosis (101.2; 12.2 to 838.2), grand multiparity (39.0; 7.1 to 225.4), rural origin (0.2; 0.1 to 0.8), use of injectables (0.2; 0.1 to 0.6), and intrauterine devide (0.04; 0.01 to 0.2). Conclusions: Identifying these risk factors is crucial for cervical cancer prevention. It is recommended to implement early detection programs targeted at women with risk factors, especially those under 35 years and with multiple sexual partners.

Introducción: La displasia cervical es una lesión precursora del cáncer de cuello uterino, una de las principales causas de morbimortalidad en mujeres, especialmente en países en desarrollo. Este estudio tuvo como objetivo identificar los factores de riesgo asociados al desarrollo de displasia cervical en mujeres atendidas en el Hospital Santa María del Socorro de Ica, Perú, entre 2017 y 2019. Métodos: Se realizó un estudio observacional de caso control con 92 casos de mujeres con diagnóstico confirmado de lesión intraepitelial de alto grado y 184 controles con resultados negativos consecutivos en pruebas de Papanicolaou. Se recolectaron datos sociodemográficos, conductuales y clínicos. Se realizaron análisis de regresión logística bivariados y multivariados para identificar los factores asociados a las lesiones cervicales precancerosas. Resultados: Los factores significativamente asociados con la displasia cervical fueron edad menor de 35 años (: 1,2; intervalo de confianza 95%: 0,1 a 0,7), tener pareja (7,4; 2,3 a 23,5), índice de masa corporal igual o superior a 25 (12,9; 3,9 a 42,0), más de tres parejas sexuales (71,4; 16,4 a 310,9), vaginosis bacteriana (101,2; 12,2 a 838,2), gran multiparidad (39,0; 7,1 a 225,4), procedencia rural (0,2; 0,1 a 0,8), uso de inyectables (0,2; 0,1 a 0,6) y dispositivo intrauterino (0,04; 0,01 a 0,2). Conclusiones: La identificación de estos factores de riesgo es crucial para la prevención del cáncer cervical. Se recomienda implementar programas de detección temprana dirigidos a mujeres con factores de riesgo, especialmente aquellas menores de 35 años y con múltiples parejas sexuales.

Self-reported prevalence and risk factors associated with keratoconus among the adult population of Trinidad and Tobago: a cross-sectional study.

AIM: To determine the prevalence of keratoconus and its associated risk factors within the adult population of Trinidad and Tobago. METHOD: A population-based cross-sectional study was conducted among adults in Trinidad and Tobago, utilizing the Keratoconus Risk Assessment Questionnaire (KRIS) for data collection. Data were exported to the Statistical Package for Social Sciences (SPSS) version 27 for analysis. Descriptive statistics were employed to summarize the variables, while logistic regression was used to identify associated risk factors, with a significance level set at p < 0.05. RESULTS: A total of 413 participants were included in the study, yielding a response rate of 97.4% (413/424). The prevalence of keratoconus (KC) was 1.5% (95% CI: 0.33 - 2.67%). The condition was more prevalent among females (98.5%), individuals aged 19-30 years (66.7%), and participants of mixed race (50%). Allergic or atopic diseases were identified as the most common established risk factor for KC, affecting 50.1% of all participants. Among those diagnosed with KC, eye rubbing emerged as the most common established risk factor. Family history of KC (95% CI: 1.841-48.352, p < 0.007) and the use of rigid contact lenses (95% CI: 8.696-286.051, p < 0.001) were statistically significant predictors of KC. Specifically, participants with a family history of KC were 49.8 times more likely to develop the condition (OR = 49.875), while those using rigid contact lenses were 9.4 times more likely (OR = 9.436). CONCLUSION: The prevalence of KC in Trinidad and Tobago was found to be significant. Among the identified risk factors, atopy was the most common. Additionally, a positive family history and the use of rigid contact lenses were significant predictors of KC. Early screening for keratoconus in this country is strongly recommended to facilitate prompt detection and appropriate management of the condition.

Impact of environmental factors on Neospora caninum and Toxoplasma gondii infection in breeding ewes from western Mexico.

In Mexico, Neospora caninum and Toxoplasma gondii are major causes of reproductive problems in sheep. Understanding the environmental factors that influence the spread of these parasites is crucial for developing effective control strategies. The objective of this study was to identify the environmental factors associated with N. caninum and T. gondii infections in sheep in western Mexico. Blood samples were collected from 184 sheep and determine seroprevalence using the ELISA test. Based on the seroprevalence data and information about the climatic regions and geographic characteristics, logistic regression analysis was employed to identify the environmental factors associated with N. caninum and T. gondii infections. Antibodies for N. caninum were found in 27 of the 184 blood samples. The environmental risk factors associated with N. caninum were Köppen climate area Ca(w1) with an OR = 6.55 and rainfall (700-800 mm) with an OR = 3.23. For T. gondii, antibodies were detected in 113 of the 184 sheep sampled. The main risk factors were Köppen climate area Cb(w1) with an OR = 10.5 and rainfall (900-1000 mm) with an OR = 4.6. Identifying these factors is crucial for developing more effective control strategies to reduce the incidence of these infections and improve the reproductive health of sheep flocks in the region.

Periodontal Indices as Predictors of Cognitive Decline: Insights from the PerioMind Colombia Cohort.

Background: Poor oral health and periodontitis have been epidemiologically linked to cognitive decline and mild cognitive impairment (MCI) in older adults. However, specific metrics directly linking these clinical signs are exceedingly limited. Methods: To address this gap and develop novel tools to help clinicians identify individuals at risk of cognitive decline, we established the PerioMind Colombia Cohort, comprising elderly Colombian subjects who underwent comprehensive neurocognitive and periodontal evaluations. Results: The results revealed that subjects diagnosed with MCI exhibited significantly higher scores in specific periodontal indices, including gingival erythema and pocket depth parameters. The predictive model identified positive associations with MCI, with gingival erythema showing the strongest correlation, followed by the presence of periodontitis and variations in pocket depth measurements. Additionally, lower educational attainment was associated with a higher likelihood of being classified in the periodontitis-MCI group. Conclusions: Here, we show that specific altered periodontal metrics are associated with MCI diagnosis, and the generated results provide defined metric ranges for identifying individuals at risk. Upon validation in larger cohorts, the findings reported here could offer dental practitioners and clinicians innovative tools to identify individuals at risk of MCI and age-related dementias through routine oral health assessments, thereby enabling more accessible and highly sought-after early intervention strategies in both developing and developed countries.

Knowledge and Awareness of Medical and Dental Students About Oral Cancer Risk Factors: A Systematic Review and Meta-Analysis.

OBJECTIVE: This systematic review and meta-analysis aims to assess the knowledge and awareness of oral cancer risk factors among medical and dental students. METHODS: This study followed the PRISMA guidelines and was registered in INPLASY (ID: 2024110035). Four databases were consulted (PubMed, Science Direct, Scopus, and Web of Science) from February 20th, 2005, to May 10th, 2024. The study selection and data extraction process was performed independently by 2 investigators. The risk of bias was assessed using the JBI tool, which can be found at: https://jbi.global/critical-appraisal-tools. A third investigator was consulted in case of disagreement. Meta-analysis results were systematically illustrated in a forest plot and expressed as odds ratio with 95% confidence interval. The I2 statistic assessed heterogeneity between studies. Funnel plot and Egger regression analysis were used for bias analysis. A P value <.05 was considered significant. All statistical analyses were performed using the STATA V.15 software. RESULTS: After the selection process, 41 studies met the eligibility criteria, comprising a total of 14,425 participants, 22% medical students and 78% dental students, primarily female (53%). The meta-analysis showed that 98% of students demonstrated relatively good knowledge about oral cancer risk factors. The most recognized risk factor was smoking (99%), followed by advanced age (68%), UV-rays exposure (64%), and alcoholism (57%). Knowledge of several other factors was comparatively lower, with less than 50% of students recognizing them. The studies indicated significant heterogeneity (I2 = 99.8%) and publication bias (P < .001). CONCLUSIONS: These findings suggest that while medical and dental students have a strong understanding of key risk factors for oral cancer, there are gaps in knowledge regarding other important factors. Addressing these gaps through enhanced education and training is essential to improving early detection and prevention efforts.

Prevalence and Individualized Risk Factors of E. bieneusi and E. intestinalis Infections Among People Living with HIV (PLHIV) with Diarrhea in Ecuador: Insights from a Single-Center Cross-Sectional Study.

Background: Microsporidia, particularly E. bieneusi and E. intestinalis, are emerging opportunistic pathogens that pose significant health risks to immunocompromised individuals, especially people living with HIV (PLHIV). Despite the global recognition of microsporidia's impact, there has been limited research on their prevalence and associated risk factors in Ecuador. This study aimed to investigate the prevalence and identify risk factors associated with microsporidia infections among PLHIV with diarrhea in Ecuador. Methods: A cross-sectional study was conducted at the José Daniel Rodríguez Infectious Hospital in Guayaquil, Ecuador, between April 2021 and May 2022. A total of 85 PLHIV with diarrhea were included in the analysis. Fecal samples were tested for microsporidia using fast-hot Gram chromotrope staining, immunofluorescence microscopy, and transmission electron microscopy. Logistic regression was performed to assess the association between demographic, clinical, and behavioral factors and microsporidia infection. Results: The prevalence of microsporidia infections among the study population was 18.8%. Logistic regression analysis identified significant associations with age ≥ 60 years (OR = 19.169, p = 0.036), female sex (OR = 10.491, p = 0.028), and non-adherence to antiretroviral therapy (OR = 8.466, p = 0.077). Marginally significant associations were observed for substance use (OR = 0.262, p = 0.094) and high/very high HIV viral load (≥10,000 copies/mL, OR = 0.457, p = 0.094). CD4 count and marital status showed descriptive trends but were not statistically significant. Conclusions: This study highlights the burden of microsporidia infections among PLHIV in Ecuador and underscores the need for targeted public health interventions. Strategies should prioritize older individuals, females, and those with poor ART adherence to reduce infection risk. Future research is needed to explore additional risk factors and refine precision medicine approaches for this population.

Risk Factors Associated with Hemoparasites in Dual-Purpose Cattle of Colombia.

Hemoparasitic diseases represent a significant problem with a considerable impact on tropical and subtropical areas of the world. These conditions cause economic losses associated with multi-organic failure and even the death of animals. In these areas, the hemoparasites are transmitted in an enzootic cycle when infectious cattle, such as persistently infected animals, including cows, contribute to the success of transmission. However, the factors associated with transmission have always been considered environmental issues, disregarding herd management and practices. In this sense, we conducted a cross-sectional study sampling 360 female cattle older than one year to identify infectious cattle using the PCR technique. We employed a dichotomic questionnaire for association analyses in 150 herds of the southern Andean region of Colombia. Overall prevalence with infectious cattle was 52.5% for Babesia spp., Anaplasma spp., and Trypanosoma spp., and the significant risk factors (p < 0.05) included geographic area, animal weight, purchase of cattle for fattening, disinfection of clothing after contact with neighboring animals, self-medication, separation of animals in pens, supply of mineralized salt, presence of livestock from other owners on the farm, prevention of joint trauma, documented milking routine, and sending blood samples for analysis. These practices permitted the maintenance of persistently infected animals and their movement to shed the agents to other animals in the presence of vectors. This suggests the importance of implementing comprehensive control and training measures to reduce the infectious cattle and, therefore, the profitability of dual-purpose livestock farms in the Andean region of southwestern Colombia.

Impact of Early Childhood Malnutrition on Cardiometabolic Risk Factors in Young Adults from Marginalized Areas of Chiapas, Mexico.

The presence of malnutrition in early life is a determining factor in the onset of metabolic alterations and chronic diseases in adults. Therefore, the objective of this study was to determine the impact of malnutrition in early childhood with the presence of cardiometabolic risk factors in adulthood in marginalized populations from Chiapas, Mexico. The present investigation was based on a prospective cohort study that began in 2002, with young adults aged 18 to 25 years belonging to De Los Bosques region in Chiapas, Mexico. Sociodemographic, anthropometric, clinical and biochemical data were obtained in adulthood. Binary logistic regression models with 95% confidence intervals were fitted to assess the association between nutritional status in childhood (≤5 years of age) and cardiometabolic risk in adulthood. Individuals with overweight/obesity in childhood were more likely to have overweight/obesity (OR = 2.65, 95% CI: 1.09-6.45), high waist circumference (3.78, 95% CI: 1.55-9.24), high waist to height ratio (OR = 5.38, CI 95%: 1.60-18.10), elevated total cholesterol (OR = 3.95, 95% CI: 1.36-11.43) and metabolic syndrome (OR = 4.71, 95% CI: 1.49-14.90) in adulthood. In conclusion, malnutrition presented in early childhood increased the probability of developing cardiometabolic alterations in young adults from southern Mexico.