Changes in the Appropriateness of US Outpatient Antibiotic Prescribing After the Coronavirus Disease 2019 Outbreak: An Interrupted Time Series Analysis of 2016-2021 Data.

BACKGROUND: No national study has evaluated changes in the appropriateness of US outpatient antibiotic prescribing across all conditions and age groups after the coronavirus disease 2019 (COVID-19) outbreak in March 2020. METHODS: This was an interrupted time series analysis of Optum's de-identified Clinformatics Data Mart Database, a national commercial and Medicare Advantage claims database. Analyses included prescriptions for antibiotics dispensed to children and adults enrolled during each month during 2017-2021. For each prescription, we applied our previously developed antibiotic appropriateness classification scheme to International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes on medical claims occurring on or during the 3 days prior to dispensing. Outcomes included the monthly proportion of antibiotic prescriptions that were inappropriate and the monthly proportion of enrollees with ≥1 inappropriate prescription. Using segmented regression models, we assessed for level and slope changes in outcomes in March 2020. RESULTS: Analyses included 37 566 581 enrollees, of whom 19 154 059 (51.0%) were female. The proportion of enrollees with ≥1 inappropriate prescription decreased in March 2020 (level decrease: -0.80 percentage points [95% confidence interval {CI}, -1.09% to -.51%]) and subsequently increased (slope increase: 0.02 percentage points per month [95% CI, .01%-.03%]), partly because overall antibiotic dispensing rebounded and partly because the proportion of antibiotic prescriptions that were inappropriate increased (slope increase: 0.11 percentage points per month [95% CI, .04%-.18%]). In December 2021, the proportion of enrollees with ≥1 inappropriate prescription equaled the corresponding proportion in December 2019. CONCLUSIONS: Despite an initial decline, the proportion of enrollees exposed to inappropriate antibiotics returned to baseline levels by December 2021. Findings underscore the continued importance of outpatient antibiotic stewardship initiatives.

Receipt of Eye Care Services among Medicare Beneficiaries with and without Dementia.

PURPOSE: To examine the relationship between dementia status and receipt of eye care among US Medicare beneficiaries. DESIGN: Retrospective, claims-based analysis. PARTICIPANTS: A 20% representative sample of Medicare beneficiaries who received care between January 1, 2006, and December 31, 2015. METHODS: Dementia was identified from diagnosis codes documented in a beneficiary's first 3 years of observed Medicare enrollment. Eye care visits were identified from provider specialty codes on each encounter claim. We used multivariable Cox proportional hazards regression models with time-varying covariates to compare the likelihood of receiving eye care between beneficiaries with and without dementia. All models were adjusted for potential confounders, including demographics, urban/rural residence, systemic health (Charlson Index), and ocular comorbidities. MAIN OUTCOME MEASURES: Hazard ratio (HR) and 95% confidence interval (CI) for (1) being seen by any eye care provider (ophthalmologist or optometrist); (2) being seen by an ophthalmologist specifically; and (3) receiving cataract surgery (among beneficiaries with ophthalmologist encounters). RESULTS: A total of 4 451 200 beneficiaries met inclusion criteria; 3 805 718 (85.5%) received eye care during the study period, and 391 556 (8.8%) had diagnosed dementia. Some 73.4% of beneficiaries diagnosed with dementia saw an eye care provider during the study period and 55.4% saw an ophthalmologist versus 86.7% and 74.0% of beneficiaries, respectively, without dementia diagnoses. Compared with those without dementia diagnoses, beneficiaries with diagnosed dementia had lower likelihood of seeing any eye care provider (adjusted HR, 0.69; 95% CI, 0.69-0.70) and were less likely to see an ophthalmologist (adjusted HR, 0.55; 95% CI, 0.55-0.55). Among the subset of beneficiaries who did see ophthalmologists, those with diagnosed dementia were also less likely to receive cataract surgery than beneficiaries without diagnosed dementia (HR, 0.62; 95% CI, 0.62-0.63) and less likely to receive a cataract diagnosis (18% vs. 82%). CONCLUSIONS: US Medicare beneficiaries diagnosed with dementia are less likely to receive eye care than those without diagnosed dementia. Depending on visual acuity and functional status, this may have implications for injury prevention, physical and cognitive function, and quality of life. Further work is needed to identify barriers to receiving eye care, determine eye care services and settings that provide greatest value to patients with dementia, and implement measures to improve access to appropriate eye care.

Silencing Bruton's tyrosine kinase in alveolar neutrophils protects mice from LPS/immune complex-induced acute lung injury.

Previous observations made by our laboratory indicate that Bruton's tyrosine kinase (Btk) may play an important role in the pathophysiology of local inflammation in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). We have shown that there is cross talk between FcγRIIa and TLR4 in alveolar neutrophils from patients with ALI/ARDS and that Btk mediates the molecular cooperation between these two receptors. To study the function of Btk in vivo we have developed a unique two-hit model of ALI: LPS/immune complex (IC)-induced ALI. Furthermore, we conjugated F(ab)2 fragments of anti-neutrophil antibodies (Ly6G1A8) with specific siRNA for Btk to silence Btk specifically in alveolar neutrophils. It should be stressed that we are the first group to perform noninvasive transfections of neutrophils, both in vitro and in vivo. Importantly, our present findings indicate that silencing Btk in alveolar neutrophils has a dramatic protective effect in mice with LPS/IC-induced ALI, and that Btk regulates neutrophil survival and clearance of apoptotic neutrophils in this model. In conclusion, we put forward a hypothesis that Btk-targeted neutrophil specific therapy is a valid goal of research geared toward restoring homeostasis in lungs of patients with ALI/ARDS.

Heavy metals in afforested mangrove sediment from the world's largest delta: Distributional mapping, contamination status, risk assessment and source tracing.

This study aims to assess seasonal and spatial variations, contamination status, ecological risks, and metal sources (Ni, Pb, Cr, Cu, Mn, and Zn) in human-afforested mangrove sediments in a deltaic region. Five sampling locations were sampled during dry and wet seasons. Heavy metal concentrations followed the order: Mn > Zn > Ni > Cr > Cu > Pb. Metal loads, except Cu and Pb, were higher during the dry season, aligning with national and international recommendations. Sediment quality guidelines, contamination factor, geoaccumulation index, enrichment factors, and pollution load index indicated uncontaminated sediment in both seasons. Potential ecological risk assessment showed low risk conditions in all sites. However, modified hazard quotient indicated moderate pollution risk from all metals except Pb. Analysis suggests anthropogenic sources, particularly evident near shipbreaking yards in Sitakunda. While initially uncontaminated, ongoing metal influx poses a potential risk to mangrove ecosystems.

Recurrent artery of Heubner aneurysms in focus: insights into occurrence and current treatment paradigms.

INTRODUCTION: The recurrent artery of Heubner (RAH), also known as the medial striate artery, is the most clinically important perforator of the anterior cerebral artery. RAH aneurysm is relatively rare, with 11 cases found in the present literature review, but poses significant clinical challenges due to potential impact on cognitive and motor functions. This systematic review explored available case reports to comprehensively understand clinical presentation, diagnosis, management and outcome in RAH aneurysm. MATERIALS AND METHODS: Following PRISMA guidelines, this systematic review extensively explored RAH aneurysms, covering demographics, symptoms, diagnosis, treatments and outcomes. Comprehensive searches on PubMed, Scopus, Google Scholar, and Science Direct employed keywords such as "recurrent artery of Heubner aneurysm" and "Heubner's artery." RESULTS: After extensive screening, 9 qualifying studies were identified, with 11 patients diagnosed with rare RAH aneurysm. Median age was 55 years (standard deviation, 15.3 years), with 54.5% males. 45.5% of patients presented risk factors, including Moyamoya disease in 2 patients. The majority were classified as grade I/II on the Hunt and Hess (H&H) and World Federation of Neurological Societies (WFNS) systems. Aneurysms were predominantly located in the A1 segment, with a mean size of 4.7 mm. Treatments varied, with clipping being the most frequent (63.6%). The mortality rate was 18.2%. Clipping was associated with favorable outcomes but higher rates of infarction. CONCLUSION: This analysis highlighted the various symptoms, therapy methods and outcomes of RAH aneurysm, with A1 being the predominant origin. Future research should explore potential genetic predisposition factors and novel therapeutic interventions to address gaps in our knowledge.

Bruton's tyrosine kinase mediates FcγRIIa/Toll-like receptor-4 receptor crosstalk in human neutrophils.

Previous observations by our laboratory indicate that the presence of anti-IL-8 autoantibody:IL-8 immune complexes in lung fluids from patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) comprises an important prognostic indicator in the development and ultimate outcome of ALI/ARDS. We also showed that these complexes display proinflammatory activity toward neutrophils through the engagement of FcγRIIa receptors. Because sepsis is one of the most common risk factors for ALI/ARDS, the initial goal of our present study involved investigating the effects of LPS on the expression of FcγRIIa receptors in neutrophils. Our results indicate that LPS triggers an increase in the expression of FcγRIIa on the neutrophil surface, which leads to shortening of the molecular distance between FcγRIIa and Toll-like receptor-4 (TLR4). When such neutrophils are stimulated with anti-IL-8:IL-8 complexes, the TLR4 cascade becomes activated via the engagement of FcγRIIa. The underlying molecular mechanism has been subsequently examined and involves Bruton's tyrosine kinase (Btk). In conclusion, our study reveals the existence of Btk-dependent molecular cooperation between FcγRIIa and TLR4 signaling cascades in LPS-"primed" human neutrophils. Furthermore, we used fluorescence lifetime imaging to study the interactions between TLR4 and FcγRIIa in human alveolar neutrophils from patients with ALI/ARDS. The results from these experiments confirm the existence of the molecular cooperation between TLR4 and FcγRIIa.

An atypical concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma: First case reported in Saudi Arabia.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most frequent endocrine cancer and most common thyroid cancer. The concurrent occurrence of both tumors however is a very rare occasional finding. Surgical treatment via excision is the only definitive. Our study aims to highlight a rare occurrence of concurrent parathyroid adenoma and micropapillary thyroid carcinoma. CASE PRESENTATION: We describe a 36-year-old female who presented to the outpatient clinic with a left thyroid nodule. Both a Tc-99m-MIBI parathyroid scan and Tc-99m thyroid scan were performed. A left total thyroidectomy was performed then subsequently the parathyroid adenoma was localized. Intra-operative parathyroid hormone decreased by >50 % from 531.5 pg/ml iPTH Stat to 39.8 pg/ml iPTH Stat which is diagnostic for proper localization. Two specimens were sent for histopathological evaluation. Histopathological evaluation of the first specimen confirmed the diagnosis of parathyroid adenoma. Histopathological evaluation of the second specimen revealed that the presence of papillary microcarcinoma of a size of 0.8 cm and pathologic staging to be pT1a, pNx, pMx. CONCLUSION: To our knowledge, this is the first case of concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma reported in the Kingdom of Saudi Arabia. Intraoperatively, management was done by via excision and confirmation of the parathyroid localization was done via intraoperative parathyroid hormone level measurement. We recommend more extensive studies to identify any possible patterns or predictors of finding these two concurrent tumors.

An accidental finding of a retroperitoneal desmoid tumor: case report and review of the literature.

Retroperitoneal desmoid-type fibromatosis is a rare benign mesenchymal neoplasm that develops as a result of fibroblastic proliferation within the musculoaponeurotic stroma. The authors present the case of a 41-year-old male patient who was referred for a retroperitoneal neoplasm. A mesenteric mass core biopsy was done, and it revealed a low-grade spindle cell lesion consistent with desmoid fibromatosis.

Knowledge, Attitudes and Practices of Pregnant Women and Healthcare Providers in Bangladesh regarding Multivitamin Supplements during Pregnancy.

Micronutrient deficiencies are widespread among pregnant women in low- and middle-income countries (LMIC) and lead to potentially adverse effects for mother and baby. In Bangladesh, maternal malnutrition remains a severe problem, with high rates of anemia (49.6% of pregnant women and 47.8% of lactating women are anemic) and other nutritional deficiencies. A Knowledge, Attitudes, and Practices (KAP) study was conducted to assess Bangladeshi pregnant women's perceptions and related behaviors, as well as awareness and knowledge among pharmacists and healthcare professionals concerning prenatal multivitamin supplements. This was done in both rural and urban areas across Bangladesh. A total of 732 quantitative interviews were conducted (330 with providers and 402 with pregnant women, with an equal split between urban and rural areas for both sets of audiences; 200 women were users of prenatal multivitamin supplements, while 202 women were aware non-users). The study identified a few findings that can guide further research or market-based interventions to reduce micronutrient deficiencies. These include most pregnant women not knowing the right time to start multivitamin supplements (56.0%, [n = 225], stating that a woman should start taking supplements 'after the first trimester'), not knowing their benefits, and how they help both the mother and baby-only 29.5% [n = 59] stated that they believed the supplements helped their baby to grow well). Further, barriers to taking the supplements include women believing a nutritious diet is a substitute (88.7% [n = 293]), and a perceived lack of support from other family members (21.8%, [n = 72]). This suggests that there is a need for further awareness-raising among all pregnant women, their family members, and providers.

Long segment Rosai-Dorfman disease-causing spinal cord compression: A case report.

INTRODUCTION AND IMPORTANCE: Rosai-Dorfman disease is a rare, histiocytic lymphoproliferative disease of unknown etiology. It manifests mainly as painless cervical lymphadenopathy, with very few cases reported extranodal involvement in the central nervous system. Isolated spinal Rosai-Dorfman disease is sporadic. CASE PRESENTATION: This case report documents a rare instance of an isolated long-segment spinal Rosai-Dorfman disease (C4-D6) along with the review of relevant literature. A 33-year male presented with progressive quadriparesis and urinary retention. A magnetic resonance scan (MRI) revealed a long segment epidural lesion from C4-D6 levels that led to the displacement of the cord. A core biopsy of the spinal tumor revealed characteristic histiocytic emperipolesis and confirmational immunocytohistochemistry markers, confirming the diagnosis. Surgical resection and laminoplasty were performed. CLINICAL DISCUSSION: The following histopathology and immunocytohistochemistry findings showed the presence of histiocytes positive for S100 and CD68 positive. Therefore, it was diagnosed to be a case of Rosai-Dorfman disease. The patient had a smooth postoperative recovery and displayed marked motor improvement in the ensuing days. This is a rare case that posed an intriguing challenge to approach. CONCLUSION: To our knowledge, we have encountered one of the most prolonged segmental lesions in isolated spinal Rosai-Dorfman diseases, where surgical management (surgical resection and laminoplasty) has proven to bring about remarkable improvement.

Board Certification Is Associated With a Reduced Risk of Endophthalmitis After Intravitreal Injections.

Purpose: This work investigates associations between physician qualifications and the risk of postintravitreal injection endophthalmitis. Methods: This retrospective analysis of data from medical claims studied Medicare beneficiaries undergoing 1 or more intravitreal injections between January 1, 2013, and December 31, 2017. Logistic regression analysis was performed to assess whether board certification status or retina subspecialty training was associated with lower risk of postinjection endophthalmitis, controlling for patient's age, race, and sex, type of agent injected, diagnosis, and year of injection. The main outcome measure was odds ratio (OR) of receiving a diagnosis of endophthalmitis in the 14 days after intravitreal injection. Clinical outcome and quality of care were not evaluated in this study. Results: A total of 2 907 324 intravitreal injections were performed on 219 640 patients by 4315 ophthalmologists, 3196 (74%) of whom were retina specialists and 4021 (92%) of whom were certified by the American Board of Ophthalmology (ABO). Overall, there were 1088 (0.037%) cases of postinjection endophthalmitis, of which 1024 (0.037%) were injected by ABO-certified ophthalmologists and 64 (0.050%) by non-board-certified ophthalmologists. Injections by ABO-certified ophthalmologist had 28% reduced odds of endophthalmitis (OR = 0.72; 95% CI, 0.523-0.996, P = .05). Higher odds of endophthalmitis were observed for corticosteroid injections (OR = 3.91; 95% CI, 2.75-5.56, P < .001) and aflibercept injections (OR = 1.47; 95% CI, 1.19-1.80, P < .001). Patients' sex and race, the diagnosis associated with the injection, and providers' retina subspeciality training were not associated with the rate of endophthalmitis (P < .20 for all comparisons). Conclusions: We found evidence that endophthalmitis may be reduced when ABO-certified physicians perform an intravitreal injection.

Bilateral Nonsyndromic Sensorineural Hearing Loss Caused by a NARS2 Mutation.

Mitochondrial diseases disrupt the process of energy generation by the mitochondria, leading to manifestations that can affect almost any organ in the body. Although various possible clinical phenotypes can result, neurological and neuromuscular affection is most frequently encountered. NARS2 encodes an enzyme responsible for the conjugation of asparagine to its cognate mitochondrial transfer ribonucleic acid (tRNA) molecule, representing an essential step necessary for effective mitochondrial protein synthesis. As such, mutations in this gene can lead to poor mitochondrial gene expression and, consequently, poor energy output resulting in disease. Pathogenic variants in NARS2 have been known to cause neurodegenerative and myopathic syndromes in combined oxidative phosphorylation deficiency 24 (COXPD24). However, nonsyndromic autosomal recessive deafness 94 (DFNB94), with which only one family is known to be affected, has also been reported concerning NARS2. Our report demonstrates the association of a new pathogenic variant in mitochondrial asparaginyl-tRNA synthetase (NARS2) with nonsyndromic sensorineural hearing loss, thus confirming biallelic mutations in NARS2 as a cause of nonsyndromic deafness.

The Impact of COVID-19 and Pandemic Mitigation Measures on Persons With Sensory Impairment.

PURPOSE: To assess the impact of the COVID-19 pandemic and associated mitigation measures on persons with sensory impairments (SI), including visual impairments (VI) and hearing impairments (HI). DESIGN: Cross-sectional survey. METHODS: Adults with VI (best-corrected visual acuity <20/60 in the better-seeing eye), HI (International Classification of Diseases, Tenth Revision, codes), and age- and sex-matched controls (n = 375) were recruited from the University of Michigan. The 34-item Coronavirus Disability Survey was administered. Both χ2 tests and logistic regression were used to compare survey responses between groups. RESULTS: All groups reported high levels of disruption of daily life, with 80% reporting "a fair amount" or "a lot" of disruption (VI: 76%, HI: 83%, CT: 82%, P = .33). Participants with VI had greater difficulty with day-to-day activities and were more likely to cite the following reasons: caregiver was worried about COVID-19 (odds ratio [OR]VI = 7.2, 95% CI = 3.5-14.4, P < .001) and decreased availability of public transportation (ORVI = 5.0, 95% CI = 1.5-15.6, P = .006). Participants with VI, but not HI, showed a trend toward increased difficulty accessing medical care (ORVI = 2.0, 95% CI = 0.99-4.0, P = .052) and began relying more on others for day-to-day assistance (ORVI = 3.1, 95% CI = 1.6-5.7, P < .001). Overall, 30% reported difficulty obtaining trusted information about the pandemic. Those with VI reported more difficulty seeing or hearing trusted information (ORVI = 6.1, 95% CI = 1.6-22.1, P = .006). Employed participants with HI were more likely to report a reduction in wages (ORHI = 2.5, 95% CI = 1.2-5.3, P = .02). CONCLUSIONS: Individuals with VI have experienced increased disruption and challenges in daily activities related to the pandemic. People with SI may benefit from targeted policy approaches to the current pandemic and future stressors. Minimal differences in some survey measures may be due to the large impact of the pandemic on the population as a whole. The SARS-CoV-2 (COVID-19) pandemic and public health mitigation measures have had an exceedingly large impact around the globe. As of the time of writing, more than 114 million global cases (28 million US) had been diagnosed, and there had been more than 2.5 million fatalities attributed to COVID-19 (517,000 US).1,2.

Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and RH status: Bangladesh.

BACKGROUND: Cost of delivering reproductive health services to low-income populations will always require total or partial subsidization by the government and/or development partners. Broadly termed "Demand-Side Financing" or "Output-Based Aid", includes a range of interventions that channel government or donor subsidies to the service user rather than the service provider. Initial findings from the few assessments of reproductive health voucher-and-accreditation programs suggest that, if implemented well, these programs have great potential for achieving the policy objectives of increasing access and use, reducing inequities and enhancing program efficiency and service quality. At this point in time, however, there is a paucity of evidence describing how the various voucher programs function in different settings, for various reproductive health services. METHODS/DESIGN: Population Council-Nairobi, funded by the Bill and Melinda Gates Foundation, intends to address the lack of evidence around the pros and cons of 'voucher and accreditation' approaches to improving the reproductive health of low income women in five developing countries. In Bangladesh, the activities will be conducted in 11 accredited health facilities where Demand Side Financing program is being implemented and compared with populations drawn from areas served by similar non-accredited facilities. Facility inventories, client exit interviews and service provider interviews will be used to collect comparable data across each facility for assessing readiness and quality of care. In-depth interviews with key stakeholders will be conducted to gain a deeper understanding about the program. A population-based survey will also be carried out in two types of locations: areas where vouchers are distributed and similar locations where vouchers are not distributed. DISCUSSION: This is a quasi-experimental study which will investigate the impact of the voucher approach on improving maternal health behaviors and status and reducing inequities at the population level. We expect a significant increase in the utilization of maternal health care services by the accredited health facilities in the experimental areas compared to the control areas as a direct result of the interventions. If the voucher scheme in Bangladesh is found effective, it may help other countries to adopt this approach for improving utilization of maternity care services for reducing maternal mortality.

Enhancing non-motorist safety by simulating trip exposure using a transportation planning approach.

Traditionally, in developing non-motorized crash prediction models, safety researchers have employed land use and urban form variables as surrogate for exposure information (such as pedestrian, bicyclist volumes and vehicular traffic). The quality of these crash prediction models is affected by the lack of "true" non-motorized exposure data. High-resolution modeling frameworks such as activity-based or trip-based approach could be pursued for evaluating planning level non-motorist demand. However, running a travel demand model system to generate demand inputs for non-motorized safety is cumbersome and resource intensive. The current study is focused on addressing this drawback by developing an integrated non-motorized demand and crash prediction framework for mobility and safety analysis. Towards this end, we propose a three-step framework to evaluate non-motorists safety: (1) develop aggregate level models for non-motorist generation and attraction at a zonal level, (2) develop non-motorists trip exposure matrices for safety evaluation and (3) develop aggregate level non-motorists crash frequency and severity proportion models. The framework is developed for the Central Florida region using non-motorist demand data from National Household Travel Survey (2009) Florida Add-on and non-motorist crash frequency and severity data from Florida. The applicability of the framework is illustrated through extensive policy scenario analysis.

Impact of Scleral Contact Lens Use on the Rate of Corneal Transplantation for Keratoconus.

PURPOSE: To evaluate the association of scleral contact lens (SCL) use on the risk for keratoplasty for people with keratoconus. METHODS: The electronic health records of patients receiving eye care at the University of Michigan Kellogg Eye Center between August 1, 2012, and December 31, 2018, were reviewed. Patients with a diagnostic code of keratoconus or corneal ectasia, no previous history of keratoplasty, and for whom data were available for both eyes were included. Using a multivariable Cox regression model, associations between SCL use and keratoplasty were tested and adjusted for sociodemographic factors, maximum keratometry, and current contact lens (CL) use. RESULTS: Two thousand eight hundred six eyes met the inclusion criteria. CL use in each eye was 36.2% with no CL, 7.2% soft, 33.9% rigid gas permeable (RGP), and 22.7% scleral. A total of 3.2% of eyes underwent keratoplasty. In the adjusted model, SCL or RGP CL use significantly lowered the hazard of undergoing keratoplasty (HR = 0.19, 95% confidence interval [CI] 0.09-0.39, P < 0.0001 and HR = 0.30, 95% CI 0.17-0.52, P < 0.0001, respectively) when compared with no CL use. Factors associated with increased risk of keratoplasty were black race as compared to white (HR = 1.87, 95% CI 1.10-3.16, P = 0.02), younger age (HR = 0.92 per 5-year increment, 95% CI 0.86-0.99, P = 0.032), and lower socioeconomic status (HR = 1.08 per 5-point increase in the Area Deprivation Index, 95% CI 1.03-1.13, P = 0.0008). Keratoplasty was not associated with sex, insurance, or maximum keratometry. CONCLUSIONS: Physicians should maximize the use of scleral or RGP CL because patients who successfully use CL have almost one-fifth the risk of undergoing keratoplasty.

Cataract Surgery Complexity and Surgical Complication Rates Among Medicare Beneficiaries With and Without Dementia.

PURPOSE: To evaluate cataract surgery complexity and complications among US Medicare beneficiaries with and without dementia. DESIGN: Retrospective claims-based cohort study. PARTICIPANTS: A 20% representative sample of Medicare beneficiaries, 2006-2015. METHODS: Dementia was identified from diagnosis codes on or prior to each beneficiary's first-eye cataract surgery. For each surgery, we identified setting, routine vs complex coding, anesthesia provider type, duration, and any postoperative hospitalization. We evaluated 30- and 90-day complication rates-return to operating room, endophthalmitis, suprachoroidal hemorrhage, retinal detachment, retinal tear, macular edema, glaucoma, or choroidal detachment-and used adjusted regression models to evaluate likelihood of surgical characteristics and complications. Complication analyses were stratified by second-eye cataract surgery within 90 days postoperatively. RESULTS: We identified 457,128 beneficiaries undergoing first-eye cataract surgery, 23,332 (5.1%) with dementia. None of the evaluated surgical complications were more likely in dementia-diagnosed beneficiaries. There was also no difference in likelihood of nonambulatory surgery center setting, anesthesiologist provider, or postoperative hospitalization. Dementia-diagnosed beneficiaries were more likely to have surgeries coded as complex (15.6% of cases vs 8.8%, P < .0001), and surgeries exceeding 30 minutes (OR = 1.21, 95% CI = 1.17-1.25). CONCLUSIONS: Among US Medicare beneficiaries undergoing cataract surgery, those with dementia are more likely to have "complex" surgery" lasting more than 30 minutes. However, they do not have greater likelihood of surgical complications, higher-acuity setting, advanced anesthesia care, or postoperative hospitalization. This may be influenced by case selection and may suggest missed opportunities to improve vision. Future research is needed to identify dementia patients likely to benefit from cataract surgery.

Exploring the factors influencing pedestrian-vehicle crash severity in Dhaka, Bangladesh.

Although the rate of road crashes and their severity is relatively higher in developing countries, there is still a lack of research on pedestrian-vehicle crash severity in these contexts, particularly in Bangladesh. Therefore, this study aimed to identify the contributing environmental, road, and vehicular factors that influenced pedestrian-single-vehicle crash severity in Dhaka, a megacity and the capital of Bangladesh. A binary logistic regression model was developed in this study by analyzing a data set of pedestrian-single-vehicle crashes involving casualties in Dhaka from 2010 to 2015. The model identified seven significant factors influencing pedestrian-vehicle crash severity. Significant factors increasing the likelihood of fatal crashes included crashes during adverse weather, dawn/dusk period, night period (where street light was absent), off-peak period, crashes where road divider was unavailable, road geometry was straight and flat, and crashes those were occurred by heavier vehicles. Besides, crashes at three-legged intersections were less likely to be fatal. Both similarities and differences were found among the significant factors influencing pedestrian-vehicle crash severity in Dhaka from the findings of the developed countries. The findings of this study would help transport engineers and planners to design safer roadways for both pedestrians and vehicles.

Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey.

BACKGROUND: Nationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh. METHODS: A total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability. RESULTS: A total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n = 716) and urban (n = 1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3-32.5) had MSK conditions. Low back pain (18.6%, 16.9-20.5), knee osteoarthritis (7.3%, 6.1-8.5) and soft tissue rheumatism 3.8% (2.9-4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0-2.1), spondyloarthritis (1.2%, 7-1.8) and adhesive capsulitis (1.4%, 0.9-1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3-28.6) had some degree of disability. Of them, 24.4% (21.0-28.1) had history of work loss during last 12 months. CONCLUSIONS: The high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.

Bioaccumulation and heavy metal concentration in tissues of some commercial fishes from the Meghna River Estuary in Bangladesh and human health implications.

Despite the beneficial aspect of aquatic food's consumption, bioaccumulation of toxic metals in fish can enhance the health risk for the consumers. Heavy metals were measured from editable tissues of some commercial fish species like Latis calcarifer, Silonia silondia, Clupisoma garua, Planiliza subviridis, Otolithoides pama, Tenulosa ilisa, Rhinomugil corsula, and Aila coila in the Meghna river estuary in Noakhali district. Heavy metals such as As, Pb, Cd, Cu, and Cr were detected by ICP-MS, which were significantly different (p ≤ 0.01), and the hierarchy of all mean concentrations were: Cu (5.14 mg/kg) > Pb (3.79 mg/kg) > As (1.08 mg/kg) > Cr (0.78 mg/kg) > Cd (0.12 mg/kg). The mean concentration of Cu (6.62 mg/kg) imparted to the maximum level in L. calcarifer, which slightly exceeded the Bangladesh food safety guideline. The mean BAFs of the contaminants were found as: Pb (1042.29) > Cr (1036.47) > As (934.84) > Cd (832.77) > Cu (772). Further, L. calcarifer, S. silondia, C. garua, and P. subviridis showed the bioaccumulative status. To assess the health risk effects, estimated daily intake (EDI), target hazard quotient (THQ) and carcinogenic risk (CR) were conducted. THQs for both adult and children consumers were <1, indicating that, consumers would not experience the non-carcinogenic health effects. Although children were more susceptible than adults, CR for all the consumers was found in the acceptable range (10-6 to 10-4).