This study aims to determine the prevalence of erectile dysfunction (ED) and identify its associated risk factors among young and middle-aged Filipino male patients diagnosed with diabetes mellitus. This study utilized a cross-sectional design to investigate the prevalence and associated factors of ED among male patients with diabetes. A total of 423 participants were recruited from clinical settings using purposive sampling. Data were collected using structured interviews and medical records, including demographics, comorbidities and laboratory results. Among 423 male diabetic patients, 78% were found to have ED. Patients with ED were significantly older (median: 49.5 versus 42 years, p<0.001), had higher body mass index (BMI), longer diabetes duration and more comorbidities. Univariable logistic regression showed that age (OR: 1.06, p<0.001), diabetes duration (OR: 1.11, p<0.001), hypertension (OR: 1.62, p = 0.042), dyslipidemia (OR: 1.75, p = 0.022), elevated HbA1c (>9.0%; OR: 3.43, p = 0.034) and serum creatinine (OR: 1.01, p = 0.008) were significantly associated with ED. However, none remained significant in the multivariable model. Male Filipino patients with diabetes have a significant burden of ED. Results of the univariable models show that age, duration of diabetes, hypertension, dyslipidemia, HbA1c and serum creatinine are significant individual predictors of ED.

Human ; Male ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Tertiary Care Centers ; Risk Factors ; Risk ; Medical Records ; Erectile Dysfunction ; Diabetes Mellitus ; Philippines

BACKGROUND

Diabetic retinopathy (DR) remains to be the leading cause of blindness worldwide. Traditionally, risk factors such as diabetes duration, HbA1c levels, hypertension and dyslipidemia have been closely linked to the development of this condition. However, recent research suggests that these factors account for only a portion of DR cases. Emerging studies highlight additional potential risk factors including diabetic nephropathy, insulin use, and body mass index -though data on these factors remain limited and at times contradictory. While there have been a few local studies exploring some of these variables, none have comprehensively examined how these factors collectively influence the occurrence and severity of diabetic retinopathy. This study aims to asses both the factors associated with presence and occurrence of diabetic retinopathy.

METHODOLOGY

This analytical cross-sectional study included patients with diabetes (n=201, aged 18 years and older) who underwent fundus photography at The Medical City Ortigas between January 1, 2022, and December 31, 2022. Data collection involved a thorough review of patient records, which provided demographic information and details on potential risk factors. The presence and severity of diabetic retinopathy (DR) were assessed based on fundus photography results, as interpreted by ophthalmologists. To evaluate the statistical significance of the association between risk factors and DR status, logistic regression analysis was done

RESULTS

Duration of diabetes (odds ratio [OR] 1.07; 95% CI, 1.01-1.13 per year increase), HBA1c (OR 1.4; 95% CI, 1.1-1.86),
fasting blood sugar (OR 1.4; 95% CI, 0.977-0.998), hypercholesterolemia (OR 5.02; 95% CI 1.67-16.44) and presence of
nephropathy (OR 3.39; 95% CI 1.49-8) were correlated with diabetic retinopathy.

CONCLUSION

The presence of diabetic retinopathy was significantly associated with several clinical factors. Each additional year of diabetes mellitus duration was associated with a 1.07-fold increase in the likelihood of DR. Additionally, each 1% increase in HbA1c was linked to a 1.40-fold increase in DR risk. The presence of diabetic nephropathy and hypercholesterolemia were also strong predictors, associated with a 3.39-fold and 5-fold increase in the likelihood of DR, respectively. Glycemic control, dyslipidemia and nephropathy appear to be associated with more severe forms of diabetic retinopathy. Clinicians handling diabetes patients with this patient profile should be wary of this diabetes complication.

Human ; Male ; Female ; Adolescent: 13-18 Yrs Old ; Young Adult: 19-24 Yrs Old ; Adult: 25-44 Yrs Old ; Diabetic Retinopathy ; Hospitals ; Risk ; Risk Factors ; Tertiary Care Centers

BACKGROUND

Early-stage endometrial cancer often presents with favorable survival rates, but high-risk factors, including TP53 mutations and high-grade serous pathology, can lead to recurrence and poor prognosis. The standard primary treatment for endometrial cancer is surgical staging, and lymph node metastases significantly impact adjuvant therapy decisions. The subgroup of p53-abnormal (p53abn) indicates the worst prognosis and potential benefits from adjuvant chemotherapy. Molecular classification, while recommended, faces practical challenges due to resource constraints.

OBJECTIVES

The study aimed to assess the incidence of p53 abnormal expression in clinical stage 1 endometrial cancer cases that underwent surgery at a government tertiary hospital, and assess its relationship with clinicopathologic factors and pelvic and paraaortic lymph node metastasis (LNM).

METHODS

A cross-sectional retrospective analysis was conducted on clinical early-stage endometrial cancer cases that underwent surgical primary treatment between January 2018 and December 2022. Patient records were reviewed to gather demographics, surgical information, and pathological evaluations. Preoperative clinical staging was determined through imaging, and surgical staging involved comprehensive lymphadenectomy. Immunohistochemistry studies for p53 were carried out on formalin-fixed paraffin-embedded tissue samples.

RESULTS

A total of 233 endometrial cancer cases were included. The mean age at diagnosis was 53.7 years. Common comorbidities included hypertension (47.2%) and dyslipidemia (20.6%). Most cases were endometrioid histology (82.8%) and low-grade tumors (85.8%). Tumor grade (p=0.010), myometrial invasion (p<0.001) and lymphovascular space invasion (p<0.001) significantly correlated with lymph node metastasis. However, tumor size and p53abn were not significantly associated with lymph node metastasis. p53abn overexpression was significantly associated with non-endometrioid histology at 33% and Grade 3 tumors at 23%. Preoperative grading demonstrated moderate reliability (0.51) with postoperative grading, with an agreement of 65.4%.

CONCLUSION

Tumor grade, myometrial invasion, and LVSI were all significantly associated with lymph node involvement. While p53 immunohistochemical stains show promise in predicting metastasis and has been associated with tumor aggressiveness, this should still be correlated with clinicopathological parameters to carry out a more accurate risk stratification of early-stage patients.

Therapeutics ; Survival Rate ; Risk Factors ; Recurrence ; Prognosis ; Pathology ; Endometrial Neoplasms ; Immunohistochemistry ; Tumor Suppressor Protein P53 ; Lymph Node Excision ; Risk Assessment

INTRODUCTION

Multisystem Inflammatory Syndrome in Children (MIS-C) is a delayed hyperinflammatory condition affecting multiple organ systems. Prominent symptoms include fever, skin rashes, and gastrointestinal symptoms, manifesting prior to critical signs such as cardiac involvement, hypotension, and shock.

OBJECTIVE

To determine if certain demographic, clinical, and laboratory markers are predictive of poor outcomes in patients diagnosed with MIS-C.

METHOD

This is a retrospective, cross-sectional study (2020-2023) of children who met the 2020 CDC MIS-C criteria. Data on demographics, comorbidities, clinical course, outcomes, laboratory results and 2D Echocardiogram findings were obtained and analyzed.

RESULTS

There were 28 patients with MIS-C, with a median age of 4.5 years. The majority of patients were male (64%). The percentage of neutrophils showed a significant association with hypotension/shock (OR 1.16). White blood cell count (WBC) and ferritin were significantly associated with ICU admission (OR 3.5 and 2.9, respectively). Pericardial effusion was observed in 71.4% while myocarditis was present in 67.9% of patients. The most notable risk factor was HIV infection, which was significantly associated with a more than 50-fold increase in the odds of developing ARDS and 165-fold increase in the odds of mortality; there was only one mortality, and only one patient with documented HIV infection.

CONCLUSIONS

The outcome was good in non-immunocompromised patients and the only recorded mortality was a patient not previously known to have HIV. We identified statistically significant factors that were associated with adverse outcome measures, with the limitation of a small sample, such as HIV infection and risk for ARDS and mortality; elevated neutrophil percentage and risk for hypotension/shock; elevated WBC and ferritin and risk for ICU admission; and saw a high prevalence of pericardial effusion and myocarditis in these patients, highlighting the critical role of hyperinflammation and cardiac involvement in disease progression and outcome.

Human ; Covid-19 ; Risk Factors

OBJECTIVE: The aim of this study is to investigate the risk factors of prognosis in patients with early-onset prostate cancer treated without surgery. A nomogram will be constructed and validated to predict overall survival (OS) of patients with early-onset prostate cancer treated without surgery. METHODS: The clinical data was obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database on prostate cancer patients aged 18－55 years who were treated without surgery between 2010 and 2015. The clinical data set was divided into training set and validation set according to 7∶3 ratio, including age, race, marital status, Gleason score, prostate specific antigen (PSA) and other 8 factors. And significant variables were screened by univariate Cox regression analysis. Multivariate Cox regression analysis was used to identify the influence factors. Stepwise regression method was used to select the most influential factors on the total OS, and R software was used to build a nomogram model. The accuracy and prediction ability of the model were verified by drawing receiver operating characteristic (ROC) and Calibration Plot. The clinical benefit of the model was evaluated by decision curve analysis (DCA). RESULTS: A total of 8 212 patients who met the criteria were randomly assigned to the training set (n=5 752) or validation set (n=2 460), with no statistical difference between the two groups (all P>0.05). Six factors were identified through univariate and multivariate Cox regression analysis including marital status, N stage, M stage, radiotherapy, PSA and Gleason score, which were most closely associated with the OS of prostate cancer patients, and a column graph model was constructed based on these factors. The Consistency index (C-index) of the model in the training set and the verification set were 0.802 and 0.794, respectively. And the apparent diffusion coefficient (AUC) was 0.851, 0.855 and 0.855 for training sets 1, 3 and 5 years, and 0.694, 0.860 and 0.832 for verification sets 1, 3 and 5 years. The calibration chart showed a good agreement between the predicted and actual values of the model. In the analysis of decision curve, the model showed good clinical application value. CONCLUSION The prediction model based on marital status, radiotherapy, M stage, N stage, PSA and Gleason score for early-onset prostate cancer patients without surgical treatment has certain reference value which is expected to become an effective tool for clinicians to treat in future prospective studies on large and multi-center samples.
Humans ; Male ; Prostatic Neoplasms/diagnosis* ; Middle Aged ; Nomograms ; SEER Program ; Prognosis ; Adult ; Prostate-Specific Antigen ; Risk Factors ; Proportional Hazards Models ; Neoplasm Grading ; ROC Curve

Objective： The aim of this study is to explore the predictive value of biparametric magnetic resonance imaging(bpMRI)for pelvic lymph node metastasis in prostate cancer patients with PSA≤20 μg/L and establish a nomogram. Methods： The imaging data and clinical data of 363 patients undergoing radical prostatectomy and pelvic lymph node dissection in the First Affiliated Hospital of Nanjing Medical University from July 2018 to December 2023 were retrospectively analyzed. Univariate analysis and multivariate logistic regression were used to screen independent risk factors for pelvic lymph node metastasis in prostate cancer, and a nomogram of the clinical prediction model was established. Calibration curves were drawn to evaluate the accuracy of the model. Results： Multivariate logistic regression analysis showed extrocapusular extension (OR=8.08,95%CI=2.62－24.97, P<0.01), enlargement of pelvic lymph nodes (OR=4.45,95%CI=1.16－17.11,P=0.030), and biopsy ISUP grade(OR=1.97,95%CI=1.12－3.46, P=0.018)were independent risk factors for pelvic lymph node metastasis. The C-index of the prediction model was 0.834, which indicated that the model had a good prediction ability. The actual value of the model calibration curve and the prediction probability of the model fitted well, indicating that the model had a good accuracy. Further analysis of DCA curve showed that the model had good clinical application value when the risk threshold ranged from 0.05 to 0.70.Conclusion： For prostate cancer patients with PSA≤20 μg/L, bpMRI has a good predictive value for the pelvic lymph node metastasis of prostate cancer with extrocapusular extension, enlargement of pelvic lymph nodes and ISUP grade≥4.
Humans ; Male ; Prostatic Neoplasms/diagnostic imaging* ; Lymphatic Metastasis ; Retrospective Studies ; Nomograms ; Prostate-Specific Antigen/blood* ; Lymph Nodes/pathology* ; Pelvis ; Predictive Value of Tests ; Prostatectomy ; Lymph Node Excision ; Risk Factors ; Magnetic Resonance Imaging ; Logistic Models ; Middle Aged ; Aged

BACKGROUND: Hypertension is a serious chronic disease that can significantly lead to various cardiovascular diseases, affecting vital organs such as the heart, brain, and kidneys. Our goal is to predict the risk of new onset hypertension using machine learning algorithms and identify the characteristics of patients with new onset hypertension. METHODS: We analyzed data from the 2011 China Health and Nutrition Survey cohort of individuals who were not hypertensive at baseline and had follow-up results available for prediction by 2015. We tested and evaluated the performance of four traditional machine learning algorithms commonly used in epidemiological studies: Logistic Regression, Support Vector Machine, XGBoost, LightGBM, and two deep learning algorithms: TabNet and AMFormer model. We modeled using 16 and 29 features, respectively. SHAP values were applied to select key features associated with new onset hypertension. RESULTS: A total of 4,982 participants were included in the analysis, of whom 1,017 developed hypertension during the 4-year follow-up. Among the 16-feature models, Logistic Regression had the highest AUC of 0.784(0.775∼0.806). In the 29-feature prediction models, AMFormer performed the best with an AUC of 0.802(0.795∼0.820), and also scored the highest in MCC (0.417, 95%CI: 0.400∼0.434) and F1 (0.503, 95%CI: 0.484∼0.505) metrics, demonstrating superior overall performance compared to the other models. Additionally, key features selected based on the AMFormer, such as age, province, waist circumference, urban or rural location, education level, employment status, weight, WHR, and BMI, played significant roles. CONCLUSION We used the AMFormer model for the first time in predicting new onset hypertension and achieved the best results among the six algorithms tested. Key features associated with new onset hypertension can be determined through this algorithm. The practice of machine learning algorithms can further enhance the predictive efficacy of diseases and identify risk factors for diseases.
Humans ; China/epidemiology* ; Hypertension/diagnosis* ; Machine Learning ; Male ; Female ; Middle Aged ; Adult ; Nutrition Surveys ; Algorithms ; Aged ; Risk Factors

Under the background of climate change, the escalating air pollution and extreme weather events have been identified as risk factors for chronic respiratory diseases (CRD), causing serious public health burden worldwide. This review aims to summarize the effects of changed atmospheric environment caused by climate change on CRD. Results indicated an increased risk of CRD (mainly COPD, asthma) associated with environmental factors, such as air pollutants, adverse meteorological conditions, extreme temperatures, sandstorms, wildfire, and atmospheric allergens. Furthermore, this association can be modified by factors such as socioeconomic status, adaptability, individual behavior, medical services. Potential pathophysiological mechanisms linking climate change and increased risk of CRD involved pulmonary inflammation, immune disorders, oxidative stress. Notably, the elderly, children, impoverished groups and people in regions with limited adaptability are more sensitive to respiratory health risks caused by climate change. This review provides a reference for understanding risk factors of CRD in the context of climate change, and calls for the necessity of adaptive strategies. Further interdisciplinary research and global collaboration are needed in the future to enhance adaptability and address climate health inequality.
Climate Change ; Humans ; Air Pollution/adverse effects* ; Risk Factors ; Respiratory Tract Diseases/etiology* ; Chronic Disease ; Air Pollutants/adverse effects* ; Environmental Exposure/adverse effects*

BACKGROUND: This cohort study aimed to identify the accumulation patterns of objectively measured ambulatory activity (AA) variables in the middle-aged and older Japanese women and examine the relationship of these derivative patterns with onset of metabolic syndrome (MetS). METHODS: A total of 794 women (mean age: 56.2 years) provided objectively assessed AA data using a uniaxial accelerometer. The number of steps, time accumulated in light-intensity AA (LIAA) and moderate-to-vigorous intensity AA (MVAA) and the ratio of MVAA to total AA (LIAA + MVAA) were calculated. Latent profile analysis was used to identify participant groups based on their distinct AA patterns. Logistic regression models were used to assess the association of groups with the onset of MetS after adjusting for age, sex, education, alcohol habit, smoking habit, energy intake, and the number of MetS components present at baseline. RESULTS: Four distinct groups were identified: Group A had low levels of the AA variable; group B accumulated a certain number or more steps primarily through MVAA; group C accumulated a certain number or more steps primarily through LIAA; and group D had high level of the AA variables. Over the course of the 5-year follow-up period, 61 participants (7.7%) developed MetS. The multivariate-adjusted odds ratio (95% confidence interval) for onset of MetS in groups B, C, and D relative to group A were 0.416 (0.166-1.218), 0.451 (0.223-0.914), and 0.933 (0.365-2.382), respectively. Group C had a significantly lower odds ratio of MetS onset than group A. CONCLUSION AA patterns accumulating a certain number or more steps, regardless of the intensity of AA, may help reduce the risk of MetS compared to inactive AA patterns.
Humans ; Metabolic Syndrome/etiology* ; Female ; Middle Aged ; Japan/epidemiology* ; Aged ; Exercise ; Cohort Studies ; Accelerometry ; Risk Factors ; East Asian People

BACKGROUND: To explore the associations of green tea, coffee, black tea, and oolong tea consumption with mortality from chronic kidney disease (CKD) as the underlying cause among Japanese adults. METHODS: We conducted a prospective cohort study of 110,585 men and women aged 40-79 years at recruitment from 1986 to 1990. Baseline information on the consumption of tea and coffee, lifestyles, and medical histories was obtained via self-administered questionnaires. We used multivariable Cox regression models to estimate sex-specific hazard ratios and 95% CIs of mortality from CKD associated with the consumption of green tea, coffee, black tea, or oolong tea. RESULTS: After a median 19-year follow-up, the hazard ratios of mortality from CKD in women were 0.49 (95% CI, 0.22-1.06) for 1-2 cups of green tea per day, 0.56 (0.31-0.99) for 3-4 cups per day, and 0.55 (0.32-0.93) for ≥5 cups per day, compared with <1 cup per day. No such association was found in men. Coffee, black tea, and oolong tea consumption were not associated with CKD risk in either sex. CONCLUSIONS Daily consumption of green tea was associated with a lower risk of mortality from CKD in women.
Humans ; Tea ; Coffee ; Middle Aged ; Male ; Female ; Japan/epidemiology* ; Renal Insufficiency, Chronic/epidemiology* ; Aged ; Adult ; Prospective Studies ; Risk Factors ; Proportional Hazards Models ; East Asian People