OBJECTIVES

While many healthcare workers (HCWs) contracted COVID-19 during the pandemic, more information is needed to fully understand the potential for adverse health effects in this population segment. The aim of the present study is to examine the association between healthcare worker status and neurologic and clinical outcomes in COVID-19 infected inpatients.

Using the nationwide database provided by the retrospective cohort Philippine CORONA study, we extracted relevant data and performed a secondary analysis primarily focusing on the presentation and outcomes of healthcare workers. Propensity score matching in a 3:1 ratio was performed to match HCWs and non-HCWs. We performed multiple logistic and Cox regression analyses to determine the relationship between HCWs and COVID-19 clinical outcomes.

We included 3,362 patients infected with COVID-19; of which, 854 were HCWs. Among the HCWs, a total of 31 (3.63%) and 45 (5.27%) had the primary outcomes of in-hospital mortality and respiratory failure, respectively. For both overall and 3:1 propensity-matched cohorts, being an HCW significantly decreased the odds of the following outcomes: severe/critical COVID-19 at nadir; in-hospital mortality; respiratory failure; intensive care unit admission; and hospital stay >14 days.

We found that being an HCW is not associated with worse neurologic and clinical outcomes among patients hospitalized for COVID-19.

OBJECTIVE: To compare the effect of acupuncture-moxibustion on idiopathic facial palsy (IFP) at acute phase and recovery phase. METHODS: According to whether received acupuncture-moxibustion at acute phase or not, 198 IFP patients were divided into an early-phase intervention group (118 cases) and a non-early-phase intervention group (80 cases). With the propensity score matching employed, 70 cases were included in each group. On the basis of the conventional treatment of western medicine, acupuncture-moxibustion was supplemented in the two groups. In the early-phase intervention group, acupuncture-moxibustion was delivered at the acute phase (duration of illness≤7 days); in the non-early-phase intervention group, acupuncture-moxibustion was operated at the recovery phase (duration of illness>7 days). At the acute phase, warm needling was performed at Yifeng (TE17), Xiaguan (ST7), Hegu (LI4) and Zusanli (ST36) on the affected side; and at the recovery phase, electroacupuncture was delivered at Cuanzhu (BL2), Sizhukong (TE23) and Yangbai (GB14), etc. on the affected side, with the disperse-dense wave and 2 Hz/100 Hz of frequency. The intervention was operated for 30 min each time, once every two days, three treatments weekly and for 4 weeks. Before treatment, 1 week and 4 weeks of treatment, the House-Brackmann (H-B) facial nerve function grade, the score of Sunnybrook facial nerve function, and the score of facial disability index (FDI) were compared between the two groups. The clinical effect in 1 and 4 weeks of treatment and safety were evaluated. RESULTS: In 1 and 4 weeks of treatment, the H-B grade was improved when compared with that before treatment in each group (P<0.05), and in 4 weeks of treatment, H-B grade in the early-phase intervention group was superior to that of the non-early-phase intervention group (P<0.05). In 1 and 4 weeks of treatment, Sunnybrook scores and the scores of physical function of FDI were elevated in comparison with those before treatment in the two groups (P<0.05); and in 4 weeks of treatment, the elevation of these two indexes in the early-phase intervention group was greater than that of the non-early-phase intervention group (P<0.05). In 4 weeks of treatment, the scores of social function in FDI were reduced when compared with those before treatment in the two groups (P<0.05). In 4 weeks of treatment, the total effective rate (97.1%, 68/70) in the early-phase intervention group was higher than that (87.1%, 61/70) of the non-early-phase intervention group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05). CONCLUSION Acupuncture-moxibustion therapy starting at the acute phase is more beneficial to the functional recovery of the impaired facial nerve than at the recovery phase in the IFP patients.
Humans ; Female ; Male ; Acupuncture Therapy ; Moxibustion ; Adult ; Middle Aged ; Young Adult ; Acupuncture Points ; Treatment Outcome ; Facial Paralysis/therapy* ; Cohort Studies ; Aged ; Bell Palsy/therapy* ; Adolescent

INTRODUCTION: Interpretation and analysis of magnetic resonance imaging (MRI) scans in clinical settings comprise time-consuming visual ratings and complex neuroimage processing that require trained professionals. To combat these challenges, artificial intelligence (AI) techniques can aid clinicians in interpreting brain MRI for accurate diagnosis of neurodegenerative diseases but they require extensive validation. Thus, the aim of this study was to validate the use of AI-based AQUA (Neurophet Inc., Seoul, Republic of Korea) segmentation software in a Southeast Asian community-based cohort with normal cognition, mild cognitive impairment (MCI) and dementia. METHOD: Study participants belonged to the community-based Biomarker and Cognition Study in Singapore. Participants aged between 30 and 95 years, having cognitive concerns, with no diagnosis of major psychiatric, neurological or systemic disorders who were recruited consecutively between April 2022 and July 2023 were included. Participants underwent neuropsychological assessments and structural MRI, and were classified as cognitively normal, with MCI or with dementia. MRI pre-processing using automated pipelines, along with human-based visual ratings, were compared against AI-based automated AQUA output. Default mode network grey matter (GM) volumes were compared between cognitively normal, MCI and dementia groups. RESULTS: A total of 90 participants (mean age at visit was 63.32±10.96 years) were included in the study (30 cognitively normal, 40 MCI and 20 dementia). Non-parametric Spearman correlation analysis indicated that AQUA-based and human-based visual ratings were correlated with total (ρ=0.66; P<0.0001), periventricular (ρ=0.50; P<0.0001) and deep (ρ=0.57; P<0.0001) white matter hyperintensities (WMH). Additionally, volumetric WMH obtained from AQUA and automated pipelines was also strongly correlated (ρ=0.84; P<0.0001) and these correlations remained after controlling for age at visit, sex and diagnosis. Linear regression analyses illustrated significantly different AQUA-derived default mode network GM volumes between cognitively normal, MCI and dementia groups. Dementia participants had significant atrophy in the posterior cingulate cortex compared to cognitively normal participants (P=0.021; 95% confidence interval [CI] -1.25 to -0.08) and in the hippocampus compared to cognitively normal (P=0.0049; 95% CI -1.05 to -0.16) and MCI participants (P=0.0036; 95% CI -1.02 to -0.17). CONCLUSION Our findings demonstrate high concordance between human-based visual ratings and AQUA-based ratings of WMH. Additionally, the AQUA GM segmentation pipeline showed good differentiation in key regions between cognitively normal, MCI and dementia participants. Based on these findings, the automated AQUA software could aid clinicians in examining MRI scans of patients with cognitive impairment.
Humans ; Cognitive Dysfunction/pathology* ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Female ; Aged ; Artificial Intelligence ; Software ; Dementia/diagnostic imaging* ; Aged, 80 and over ; Adult ; Singapore ; Neuropsychological Tests ; Brain/pathology* ; Cohort Studies ; Gray Matter/pathology* ; Southeast Asian People

INTRODUCTION: Takayasu arteritis is the most common large-vessel vasculitis in childhood, but there is a lack of literature regarding childhood-onset Takayasu arteritis (c-TAK) in Southeast Asia. We aim to describe a c-TAK cohort in Singapore and highlight a unique subset that first presents with Kawasaki-like disease (KD). METHOD: A single-centre cohort study in Singapore of consecutive children diagnosed with c-TAK between 2002 and 2023 was performed. Demographic and clinical features, laboratory and angiographic findings, treatment, and outcomes were summarised. Disease activity was evaluated using the Paediatric Vasculitis Disease Activity Score and inflammatory markers. RESULTS: Twenty-three patients, fulfilling both the EULAR/ PRINTO/PReS and ACR/EULAR 2022 criteria, were recruited. The most common clinical features at diagnosis were fever (15, 65%) and neurological symptoms (11, 48%, half of which presented with stroke), while the most prevalent angiographic pattern by Hata's classification was Type V (21, 91%). Eight children (35%) initially presented with refractory KD, and these patients were significantly younger, more male-predominant, and had higher inflammatory markers at diagnosis; all of them had coronary artery involvement, but none had intracranial vascular findings. Of the entire cohort, 16 (70%) achieved inactive disease on medications with a median duration of 6 months (interquartile range [IQR]: 4-11), and 8 (35%) achieved remission off medications with a median duration of 43 months (IQR 35-60). CONCLUSION Our c-TAK cohort has high proportions of neurological involvement and stroke. This is also the first cohort study to describe a distinct group of patients who first presented with refractory KD.
Humans ; Takayasu Arteritis/complications* ; Singapore/epidemiology* ; Male ; Female ; Child ; Adolescent ; Age of Onset ; Mucocutaneous Lymph Node Syndrome/diagnosis* ; Cohort Studies ; Child, Preschool ; Fever/etiology* ; Stroke/epidemiology* ; Retrospective Studies

BACKGROUND: This study aims to compare the efficacy between neoadjuvant immune checkpoint inhibitors (ICIs) plus chemotherapy vs . chemotherapy, and neoadjuvant triplet vs . doublet chemotherapeutic regimens in locally advanced gastric/esophagogastric junction cancer (LAGC). METHODS: We included LAGC patients from 47 hospitals in China's National Cancer Information Database (NCID) from January 2019 to December 2022. Using propensity score matching (PSM), we retrospectively analyzed the efficacy between neoadjuvant ICIs plus chemotherapy vs . chemotherapy alone, and neoadjuvant triplet vs . doublet chemotherapeutic regimens. The primary study result was the pathologic complete response (pCR) rate. The secondary study results were disease-free survival (DFS) and overall survival (OS). RESULTS: A total of 1205 LAGC patients were included. After PSM, the ICIs plus chemotherapy and the chemotherapy cohorts had 184 patients each, while the doublet and triplet chemotherapy cohorts had 246 patients each. The pCR rate (14.13% vs . 7.61%, χ2 = 4.039, P = 0.044), and the 2-year (77.60% vs . 61.02%, HR = 0.67, 95% con-fidence interval [CI] 0.43-0.98, P = 0.048) and 3-year (70.55% vs . 61.02%, HR = 0.58, 95% CI 0.32-0.93, P = 0.048) DFS rates in the ICIs plus chemotherapy cohort were improved compared to those in the chemotherapy cohort. No significant increase was observed in the OS rates at both 1 year and 2 years. The pCR rates, DFS rates at 1-3 years, and OS rates at 1-2 years did not differ significantly between the doublet and triplet cohorts, respectively. No differences were observed in postoperative complications between any of the group comparisons. CONCLUSIONS Neoadjuvant ICIs plus chemotherapy improved the pCR rate and 2-3 years DFS rates of LAGC compared to chemotherapy alone, but whether short-term benefit could translate into long-term efficacy is unclear. The triplet regimen was not superior to the doublet regimen in terms of efficacy. The safety after surgery was similar between either ICIs plus chemotherapy and chemotherapy or the triplet and the doublet regimen.
Humans ; Stomach Neoplasms/metabolism* ; Female ; Neoadjuvant Therapy/methods* ; Immune Checkpoint Inhibitors/therapeutic use* ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies ; Aged ; Receptor, ErbB-2/metabolism* ; Adult ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Disease-Free Survival ; Cohort Studies

BACKGROUND: Leukocyte telomere length (LTL) shortening, a biomarker of telomere attrition, has been linked to multiple diseases. However, the relationship between LTL and digestive diseases remains uncertain. This study aimed to investigate the association between LTL and the risk of digestive diseases. METHODS: A cohort analysis of over 500,000 participants from the UK Biobank (UKB) between 2006 and 2021 was conducted to estimate the associations of LTL with more than 90 common digestive diseases. LTL was quantified using multiplex quantitative polymerase chain reaction, and cases of each disease were determined according to inpatient and primary care data. Multivariable Cox proportional hazards regression analysis was used to evaluate the associations of LTL with the risk of digestive diseases. Furthermore, such associations were also evaluated after stratification by sex and ethnicity. RESULTS: After a mean follow-up time of 11.8 years, over 20 International Classification of Diseases, 10th Revision ( ICD-10 ) codes were showed to be associated with telomere attrition. LTL shortening is associated with an increased risk of several digestive diseases, including gastroesophageal reflux disease (K21: hazard ratio [HR] = 1.30, 95% confidence interval [95% CI]: 1.19-1.42), esophageal ulcer (K221: HR = 1.81, 95% CI: 1.22-2.71), Barrett's esophagus (K227: HR = 1.58, 95% CI: 1.14-2.17), gastritis (K29: HR = 1.39, 95% CI: 1.26-1.52), duodenal ulcer (K26: HR = 1.55, 95% CI: 1.14-2.12), functional dyspepsia (K30X: HR = 1.36, 95% CI: 1.06-1.69), non-alcoholic fatty liver disease (NAFLD) (K760: HR = 1.39, 95% CI: 1.09-1.78), liver cirrhosis (K74: HR = 4.73, 95% CI: 3.27-6.85), cholangitis (K830: HR = 2.55, 95% CI: 1.30-5.00), and hernia (K43: HR = 1.50, 95% CI: 1.17-1.94; K44: HR = 1.29, 95% CI: 1.17-1.42). The risk of rectal polyps (K621: HR = 0.77, 95% CI: 0.63-0.92) decreased per unit shortening of LTL. CONCLUSIONS This study suggests that LTL shortening is associated with an increased risk of most digestive diseases except for rectal polyps. These findings may provide some clues for understanding the pathogenesis of digestive diseases.
Humans ; Male ; Female ; Middle Aged ; Cohort Studies ; Leukocytes/metabolism* ; Telomere/genetics* ; Proportional Hazards Models ; Adult ; Digestive System Diseases/genetics* ; Aged ; Risk Factors ; Telomere Shortening

BACKGROUND: The role of inflammation in the development of gestational diabetes mellitus (GDM) has recently become a focus of research. The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), novel indices, reflect the body's chronic immune-inflammatory state. This study aimed to investigate the associations between the SII or SIRI and GDM. METHODS: A prospective birth cohort study was conducted at Beijing Obstetrics and Gynecology Hospital from February 2018 to December 2020, recruiting participants in their first trimester of pregnancy. Baseline SII and SIRI values were derived from routine clinical blood results, calculated as follows: SII = neutrophil (Neut) count × platelet (PLT) count/lymphocyte (Lymph) count, SIRI = Neut count × monocyte (Mono) count/Lymph count, with participants being grouped by quartiles of their SII or SIRI values. Participants were followed up for GDM with a 75-g, 2-h oral glucose tolerance test (OGTT) at 24-28 weeks of gestation using the glucose thresholds of the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Logistic regression was used to analyze the odds ratios (ORs) (95% confidence intervals [CIs]) for the the associations between SII, SIRI, and the risk of GDM. RESULTS: Among the 28,124 women included in the study, the average age was 31.8 ± 3.8 years, and 15.76% (4432/28,124) developed GDM. Higher SII and SIRI quartiles were correlated with increased GDM rates, with rates ranging from 12.26% (862/7031) in the lowest quartile to 20.10% (1413/7031) in the highest quartile for the SII ( Ptrend <0.001) and 11.92-19.31% for the SIRI ( Ptrend <0.001). The ORs (95% CIs) of the second, third, and fourth SII quartiles were 1.09 (0.98-1.21), 1.21 (1.09-1.34), and 1.39 (1.26-1.54), respectively. The SIRI findings paralleled the SII outcomes. For the second through fourth quartiles, the ORs (95% CIs) were 1.24 (1.12-1.38), 1.41 (1.27-1.57), and 1.64 (1.48-1.82), respectively. These associations were maintained in subgroup and sensitivity analyses. CONCLUSION The SII and SIRI are potential independent risk factors contributing to the onset of GDM.
Humans ; Female ; Pregnancy ; Diabetes, Gestational/immunology* ; Prospective Studies ; Adult ; Inflammation/immunology* ; Glucose Tolerance Test ; Birth Cohort

BACKGROUND: The American Heart Association (AHA) introduced the concept of cardiovascular-kidney-metabolic (CKM) health and stage, reflecting the interaction among metabolism, chronic kidney disease (CKD), and the cardiovascular system. However, the association between CKM stage and the long-term risk of cardiovascular disease (CVD) has not been validated. This study aimed to evaluate the long-term CVD risk associated with CKM health metrics and CKM stage using data from a population-based cohort study. METHODS: In total, 5293 CVD-free participants were followed up to around 13 years in the Chinese Multi-provincial Cohort Study (CMCS). Considering the pathophysiologic progression of CKM health metrics abnormalities (comprising obesity, central adiposity, prediabetes, diabetes, hypertriglyceridemia, CKD, and metabolic syndrome), participants were divided into CKM stages 0, 1, and 2. The time-dependent Cox regression models were used to estimate the cardiovascular risk associated with CKM health metrics and stage. Additionally, broader CVD outcomes were examined, with a specific assessment of the impact of stage 3 in 2581 participants from the CMCS-Beijing subcohort. RESULTS: Among participants, 91.2% (4825/5293) had at least one abnormal CKM health metric, 8.8% (468/5293), 13.3% (704/5293), and 77.9% (4121/5293) were in CKM stages 0, 1, and 2, respectively; and 710 incident CVD cases occurred during a median follow-up time of 13.3 years (interquartile range: 12.1 to 13.6 years). Participants with each poor CKM health metric exhibited significantly higher CVD risk. Compared with stage 0, the hazard ratio (HR) (95% confidence interval [CI]) for CVD incidence was 1.31 (0.84-2.04) in stage 1 and 2.27 (1.57-3.28) in stage 2. Significant interactive impacts existed between CKM stage and age or sex, with higher CVD risk related to increased CKM stages in participants aged <60 years or females. CONCLUSION These findings highlight the contribution of CKM health metrics and CKM stage to the long-term risk of CVD, suggesting the importance of multi-component recognition and management of poor CKM health in CVD prevention.
Humans ; Female ; Male ; Cardiovascular Diseases/etiology* ; Middle Aged ; Adult ; Cohort Studies ; Renal Insufficiency, Chronic/metabolism* ; Aged ; Risk Factors ; Metabolic Syndrome/metabolism* ; China ; East Asian People

PURPOSE: Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous (PIV) access can be challenging during hemorrhagic shock due to peripheral vessel collapse. Early intraosseous (IO) device use is suggested as an alternative. This study examines injury characteristics and factors linked to IO access requirements. METHODS: A registry-based cohort study from the Israel Defense Forces Trauma Registry (2010 - 2023) included trauma casualties receiving PIV or IO access prehospital. Casualties who had at least one documented PIV or IO access attempt were included, while those without vascular access were excluded. Casualties requiring both PIV and IO were classified in the IO group. Univariable logistic regression assessed the factors associated with IO access. Results were reported as odds ratios (OR) with 95% confidence intervals (CI), and significant difference was set at p < 0.05. RESULTS: Of 3462 casualties (86.3% male, the median age: 22 years), 3287 (94.9%) received PIV access and 175 (5.1%) had IO access attempts. In the IO group, 30.3% received freeze-dried plasma and 23.4% received low titer group O whole blood, significantly higher than that in the PIV group. Prehospital mortality was 35.0% in the IO group. Univariable analysis showed significant associations with IO access for increased PIV attempts (OR = 1.69; 95% CI: 1.34 - 2.13) and signs of profound shock (OR = 11.0; 95% CI: 5.5 - 23.3). CONCLUSION Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion. IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality, indicating its use in emergent resuscitation situations. Early IO consideration is advised for trauma casualties with profound shock.
Humans ; Male ; Infusions, Intraosseous/methods* ; Female ; Registries ; Israel ; Emergency Medical Services/methods* ; Adult ; Young Adult ; Wounds and Injuries/mortality* ; Military Personnel ; Resuscitation/methods* ; Middle Aged ; Shock, Hemorrhagic/therapy* ; Cohort Studies

PURPOSE: Attention-deficit/hyperactivity disorder (ADHD) increases the risk of road traffic injuries through various mechanisms including higher risky driving behaviors. Therefore, drivers with ADHD are shown to be more prone to road traffic injuries. This study was conducted in a community-based sample of drivers to determine how ADHD affects driving behavior components. METHODS: At the cross-sectional phase of a national population-based cohort, a representative sample of 1769 drivers were enrolled. Manchester driving behavior questionnaire and Conners' adult ADHD rating scales were used to assess driving behavior and ADHD symptom scores, respectively. Data were analyzed using Stata version 17. Multiple linear regression was used to investigate the association of driving behavior with ADHD while adjusting for the potential confounding role of age, sex, marital status, educational level, driving history, etc. RESULTS: According to the results, the normalized driving behavior score of drivers with ADHD was 4.64 points higher than drivers without ADHD. Having an academic compared to school education, increased the driving behavior score by 1.73 points. The normalized driving behavior score of drivers under 18 years of age was 6.27 points higher than drivers aged 31-45 years. The score of the aggressive violation subscale of drivers with ADHD was 7.33 points higher than drivers without ADHD compared to an increment of a range of 4.50-4.82 points for other driving subscales. The score of the ordinary violation subscale of female drivers was 2.23 points lower than that of male drivers. No significant relationship was found between sex and other subscales of driving. CONCLUSION Drivers with ADHD who are in adolescence or early adulthood exhibit more dangerous and aggressive driving behaviors than those who are older. Implementing training interventions to increase awareness of drivers with ADHD, their families, and psychologists regarding the effects of ADHD on driving is an essential step in preventing motor vehicle crashes among drivers with ADHD.
Humans ; Attention Deficit Disorder with Hyperactivity/psychology* ; Automobile Driving/psychology* ; Male ; Adult ; Female ; Middle Aged ; Cross-Sectional Studies ; Accidents, Traffic ; Iran ; Adolescent ; Surveys and Questionnaires ; Young Adult ; Cohort Studies ; Risk-Taking