Introduction: Hyperthyroidism in children and adolescents, although uncommon, has significant effects on growth, neurodevelopment, and quality of life. Local data in Malaysia are limited, and regional variations may influence disease presentation and outcomes. This study aimed to determine the incidence, clinical characteristics, and treatment outcomes of paediatric hyperthyroidism at a tertiary centre. Methodology: A retrospective cohort study was conducted at the Paediatric Endocrine Clinic, Universiti Malaya Medical Centre, from 2014 to 2024. Patients aged below 18 years with confirmed hyperthyroidism were included. Demographic, clinical, biochemical, and treatment data were analyzed. Descriptive statistics were used, and associations were tested using chisquare and Fisher’s exact tests, with p <0.05 considered significant. Results: Forty-three patients were included, representing 9.7% of paediatric thyroid disorders. The cohort was predominantly female (74.4%) and majority Malay, with a median age of 11.7 years. Most patients presented with typical features, including palpitations (72.5%), goiter (62.5%), weight loss (45.0%), and heat intolerance (40.0%). However, atypical presentations such as learning difficulties and psychological disturbances were also observed and, in some cases, constituted the chief complaints. Notably, 82.5% of patients presented with severe thyrotoxicosis. Grave’s disease was the predominant etiology. All patients received antithyroid drugs, mainly carbimazole, with 80.0% achieving disease control and a median time to euthyroid state of 2 months. The duration of antithyroid drug therapy prior to cessation was shorter than international recommendations, indicating a significant reduction in time to treatment completion. Relapse occurred in 25.0% and was significantly associated with poor disease control (p = 0.014), while no significant associations were found with demographic or biochemical factors. Definitive therapy was required in 35.0%, with older age, growth stunting, and prior relapse identified as significant predictors (p <0.05). Conclusion Paediatric hyperthyroidism in this Malaysian cohort is predominantly due to Graves’ disease and frequently presents with both classical and atypical manifestations, which may delay diagnosis. Despite a high proportion of severe thyrotoxicosis at presentation, antithyroid drug therapy was effective, with a shorter duration to treatment cessation compared to international standards. Poor disease control emerged as the strongest predictor of relapse, while older age, growth stunting, and prior relapse predicted progression to definitive therapy. Early recognition and individualized management are essential to optimize outcomes. Larger multicentre studies are needed to inform national clinical practice guidelines.
Adolescent ; Child ; Incidence ; Hyperthyroidism

OBJECTIVE

This study aimed to estimate the incidence of hypertension and determine the risk factors for hypertension among apparently healthy adult Filipinos.

This observational prospective community-based study included apparently healthy adult individuals aged 20–50 years from the Life Course Study in Cardiovascular Disease Epidemiology (LIFECARE) Philippine cohort at baseline and followed-up after an average of four years. Sociodemographic data, psychosocial stress, and clinical and metabolic profiles were obtained and analyzed. Multivariable Cox regression analysis was performed to identify factors associated with the development of hypertension.

A total of 2,089 non-hypertensive participants were included, with 59% women and average age of 35 years (SD = 8.4). The incidence rate of hypertension was 38.1 per 1,000 person-years. The cumulative incidence of hypertension over a mean follow-up time of four years was 15.4% (95% CI = 13.9–17.0%). The risk of incident hypertension was higher among males (aHR=1.3, 95% CI: 1.0–1.8; p=0.044), ≥40 years old (aHR=3.9, 95% CI: 2.6–5.8; pCONCLUSION

The 4-year incidence rate of hypertension among apparently healthy adult Filipinos is high. Increased age, male sex, family history of hypertension, abdominal obesity, and high normal blood pressure were significantly associated with the development of hypertension.

OBJECTIVES: To investigate the risk factors of overall postoperative complications in elderly patients undergoing gastrointestinal surgeries. METHODS: This study was conducted among a total of 1388 elderly patients, who underwent elective gastrointestinal surgeries at 17 centers across China between April, 2020 and April, 2022. The primary outcome was the incidence of postoperative complications within 30 days, including procedure-related, neuropsychiatric, respiratory, cardiovascular, and gastrointestinal complications as well as acute kidney injury. Baseline characteristics, preoperative psychological and functional status, intraoperative anesthesia and surgical factors, intraoperative medication, use of nerve block, and postoperative analgesia methods were compared between the patients experiencing one or more postoperative complications and those without complications. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for postoperative complications. The relationship between postoperative acute pain and each type of complication were explored. RESULTS: The incidence of overall postoperative complications was 50.8% (705/1388) in these patients. Multivariate analysis showed that age (OR: 1.026; 95% CI: 1.006-1.046), prognostic nutritional index (OR: 0.998; 95% CI: 0.997-1.000), preoperative EuroQol-5 dimensions score (OR: 0.094; 95% CI: 0.018-0.500), blood loss (OR: 1.002; 95% CI: 1.001-1.003), and acute postoperative pain (OR: 1.308; 95% CI: 1.033-1.657) were significantly associated with the occurrence of postoperative complications. Specifically, patients experiencing severe postoperative pain had a significantly higher incidence of neuropsychiatric (27.2% vs 19.8%), procedure-related (17.3% vs 10.2%), and cardiovascular complications (3.6% vs 1.7%). CONCLUSIONS An advanced age, a low preoperative nutritional index, a poor quality of life score, a greater volume of intraoperative blood loss, and acute postoperative pain are independent risk factors for postoperative complications in elderly patients undergoing gastrointestinal surgeries. There is a significant association between acute postoperative pain and multi-system complications.
Humans ; Postoperative Complications/etiology* ; Aged ; Risk Factors ; Digestive System Surgical Procedures/adverse effects* ; Male ; Female ; China/epidemiology* ; Pain, Postoperative/epidemiology* ; Incidence ; Aged, 80 and over

OBJECTIVES: To analyze the trends of disease burden of lip and oral cancers in East Asia from 1990 to 2021 and its future projections. METHODS: We used the Global Burden of Disease 2021 database to conduct a comprehensive analysis of disease burden data from China (including Taiwan Province of China), Japan, Republic of Korea, Democratic People's Republic of Korea and Mongolia. The data were stratified by age, gender and major risk factors, and a Bayesian age-period-cohort model was employed to predict the future trends. RESULTS: From 1990 to 2021, the burden of lip and oral cancers in East Asian countries exhibited a steady increase. Taiwan Province of China experienced the most significant increases in incidence, prevalence, mortality, and disability-adjusted life years (DALYs), while Mongolia saw a decline in both mortality and DALYs. In 2021, Taiwan Province of China reported the highest rates of lip and oral cancer incidence (27.50 per 100 000), prevalence (137.92 per 100 000), mortality (9.59 per 100 000), and DALYs (292.07 person-years per 100 000), particularly among male and elderly populations. Tobacco use and alcohol consumption significantly exacerbated the disease burden in Taiwan Province of China and Japan. Future projections indicate that the incidence and prevalence of lip and oral cancer in China (excluding Taiwan Province of China) will continue to rise, while their mortality rates are expected to decline in most regions, except for Taiwan Province of China and Democratic People's Republic of Korea. CONCLUSIONS By the year 2035, the disease burden of lip and oral cancers in East Asia is expected to continue to increase, especially in Taiwan Province of China. To address this challenge, it is essential to implement effective measures to control major risk factors, promote early screening, and ensure equitable distribution of healthcare resources.
Humans ; Mouth Neoplasms/epidemiology* ; Incidence ; Lip Neoplasms/epidemiology* ; Asia, Eastern/epidemiology* ; Male ; Disability-Adjusted Life Years ; Prevalence ; Female ; Forecasting ; Risk Factors ; Cost of Illness ; Middle Aged ; Global Burden of Disease ; Aged ; Bayes Theorem

OBJECTIVES: To investigate the incidence of ipsilateral upper urinary tract stones after partial nephrectomy and its risk factors. METHODS: We retrospectively analyzed baseline patient characteristics (age, gender, and body mass index), smoking, alcohol consumption, comorbidities (hypertension, diabetes, hypertriglyceridemia, hyperuricemia, and cardiovascular diseases), preoperative tumor conditions (tumor diameter, multiple foci, location, hemorrhage, necrosis, cystic changes, and endophytic growth), preoperative glomerular filtration rate and intraoperative factors (renal collecting system damage, ischemia time, operation time, surgical approach, and estimated intraoperative blood loss) to identify the risk factors for ipsilateral upper urinary tract stones following partial nephrectomy in our center. RESULTS: The overall incidence of upper urinary tract stones following partial nephrectomy was 7.80% (112/1435). The incidence of ipsilateral upper urinary tract stones was significantly higher than those of contralateral stones (4.95% vs 1.46%, P<0.001) and bilateral stones (4.95% vs 1.39%, P<0.001). Intraoperative damage to the renal collecting system was identified as a significant risk factor for ipsilateral upper urinary tract stones (OR=4.550, 95% CI: 2.237-9.252, P<0.001). Diabetes was a probable risk factor for secondary ipsilateral upper urinary tract stones after partial nephrectomy (OR=2.419, 95% CI: 0.973-6.012, P=0.057). CONCLUSIONS The incidence of ipsilateral upper urinary tract stones after partial nephrectomy is higher than that of contralateral and bilateral stones. Intraoperative renal collecting system damage is a risk factor for secondary ipsilateral upper urinary tract stones after partial nephrectomy.
Humans ; Nephrectomy/methods* ; Retrospective Studies ; Risk Factors ; Male ; Female ; Case-Control Studies ; Middle Aged ; Aged ; Kidney Neoplasms/surgery* ; Adult ; Intraoperative Complications ; Kidney Tubules, Collecting/injuries* ; Propensity Score ; Incidence ; Kidney Calculi/etiology* ; Urinary Calculi/epidemiology*

OBJECTIVES: To conduct a comprehensive analysis of the global burden of diarrheal diseases in children under 5 years. METHODS: The data from the Global Burden of Disease (GBD) 2021 were analyzed to assess the incidence, mortality rates and average annual percentage changes (AAPC) of diarrhea among children under 5 years across nations(regions) and GBD regions from 1990 to 2021 using joinpoint regression. Smoothed curve regression was employed to explore the correlation of diarrheal disease burden with the Social Development Index (SDI) and for analyzing the burden of specific diarrheal pathogens. The Slope and Concentration Indices quantified disparities across SDI levels and the future trend were projected by the Bayesian Age-Period-Cohort (BAPC) model. RESULTS: From 1990 to 2021, the global incidence (AAPC: -3.65) and mortality (AAPC: -5.15) rates of diarrheal diseases declined steadily in children below 5 years. In 2021, neonates (<28 days) were the most affected, with an incidence rate of 138 058.74 per 100 000 and a mortality rate of 251.14 per 100 000. Rotavirus was the leading cause of death. The incidence rate of diarrheal diseases was negatively correlated with SDI, and the Concentration Index decreased from -0.293 in 1990 to -0.314 in 2021 without a significant gender difference. The BAPC model suggested that the global incidence rate of diarrheal diseases tends to decrease progressively from 2022 to 2050, with a predicted rate of 23 448.04 per 100 000 for male and 29 932.59 per 100 000 for female by 2050. CONCLUSIONS Despite the reduction in the global burden of diarrhea and the projection of its further decline, diarrheal diseases disproportionately affect neonates and low-SDI regions. While rotavirus remains the primary etiological agent worldwide, the predominant pathogens vary by nations (regions) and GBD regions, and strengthened interventions targeting vulnerable populations are needed.
Humans ; Child, Preschool ; Diarrhea/mortality* ; Infant ; Incidence ; Infant, Newborn ; Global Burden of Disease/trends* ; Global Health ; Male ; Bayes Theorem ; Female

OBJECTIVES: To analyze the changes in disease burden and risk factors of atrial fibrillation/atrial flutter (AF/AFL) in China and globally from 1990 to 2021 to provide epidemiological evidence for developing effective preventive measures for AF/AFL in China. METHODS: Based on data from the Global Burden of Disease Study 2021, we analyzed sex- and age-specific AF/AFL burden metrics across 204 countries or territories. Age-standardized incidence rate (ASIR), prevalence, mortality rate (ASMR), and disability-adjusted life-years (DALYs) rate (ASDR) were calculated. Joinpoint regression was employed to compute average annual percentage changes (AAPC) in trends. The risk factors were systematically evaluated and further validated using Mendelian randomization analysis. RESULTS: From 1990 to 2021, China experienced an increase in ASIR of AF/AFL (from 42.63 to 44.93 per 100 000), contrasting with the global decline. While China's ASMR decreased (from 4.93 to 4.33 per 100 000), global ASMR rose slightly (from 4.24 to 4.36 per 100 000). China's ASDR remained stable at 93.29 per 100 000, whereas global ASDR increased marginally (100.81 to 101.40 per 100 000). Significant sex disparities were observed: males showed higher ASIR and ASDR, while females exhibited greater ASMR and ASDR. China had higher incidence and prevalence but lower mortality and DALY rates compared to global averages. In 2021, the key risk factors for AF/AFL included elevated systolic blood pressure, high BMI, smoking, alcohol use, high-sodium diet, and low temperature. Gender-specific patterns emerged: smoking was predominant in males, whereas high BMI disproportionately affected females. CONCLUSIONS AF/AFL incidence and prevalence keep increasing in China, and its large population base and demographic aging pose significant public health challenges. Maintaining healthy lifestyle habits, including smoking cessation, alcohol moderation, and a low-sodium diet can help to lower AF/AFL incidence, and regular screenings is crucial for its early detection and treatment.
Humans ; China/epidemiology* ; Risk Factors ; Atrial Flutter/epidemiology* ; Atrial Fibrillation/epidemiology* ; Mendelian Randomization Analysis ; Male ; Female ; Global Burden of Disease ; Incidence ; Prevalence ; Middle Aged ; Disability-Adjusted Life Years ; Aged

OBJECTIVES: To investigate the effect of intubation with electromyographic (EMG) endotracheal tubes versus conventional wire-reinforced (CWR) tubes on the incidence of postoperative sore throat (POST) in patients undergoing thyroidectomy under general anesthesia and identify the risk factors for POST. METHODS: We retrospectively collected the clinical data from a cohort of 245 patients undergoing elective thyroid surgery under general anesthesia at the Sixth Affiliated Hospital of Sun Yat-sen University between October, 2024 and March, 2025. Patients received intubation with either EMG endotracheal tubes (n=100) or CWR tubes (n=145) during the operation, and the incidences of POST and other postoperative complications were compared between the two groups. Propensity score matching (PSM) was applied to adjust for the baseline differences, and multivariate logistic regression analysis was used to identify independent risk factors for POST. RESULTS: Comparisons of the baseline data revealed significant differences between the two groups (P<0.05). After PSM, 90 patients in EMG group and 75 in CWR group were included in the final analysis with matching baseline characteristics (P>0.05). Post-matching analysis showed that the EMG group had a shorter operative time (P=0.002) but a higher incidence of POST (P=0.001). Multivariate logistic regression identified the use of EMG tubes (OR=17.50, 95% CI: 2.25-136.03, P<0.01) as an independent risk factor for POST. CONCLUSIONS Intubation with EMG endotracheal tubes can shorten the operative time and allow recurrent laryngeal nerve monitoring during thyroidectomy under general anesthesia, but their structural design may increase the risk of POST. Clinical decisions should be made to balance nerve protection and postoperative patient comfort by selecting appropriate tube types and optimizing intubation strategies to enhance perioperative outcomes.
Humans ; Retrospective Studies ; Intubation, Intratracheal/instrumentation* ; Thyroidectomy/adverse effects* ; Anesthesia, General ; Postoperative Complications/epidemiology* ; Pharyngitis/epidemiology* ; Electromyography ; Risk Factors ; Female ; Male ; Middle Aged ; Adult ; Incidence

Congenital musculoskeletal and limb deformities (CMLD) seriously affect the physical and mental health of patients, and pose great challenges to healthcare systems worldwide. We explored the specific situation and changes of incidence, prevalence, disability-adjusted life years rates, and mortality of CMLD in under-5 children from 1990 to 2021 in different groups, including different regions, periods, genders and socio-demographic indices (SDI), through corresponding analytical models. Overall, the global disease burden of CMLD in under-5 children has decreased from 1990 to 2021. The disease burden of CMLD in under-5 children varied significantly among different regions and countries, and there was a strong correlation between the corresponding burden of disease and the level of SDI. In addition, cross-country inequality analysis showed that while absolute inequalities in the disease burden of CMLD in under-5 children have improved, relative inequalities have worsened. It is essential to reduce the global health impact of CMLD by implementing targeted interventions to improve health care in underdeveloped areas.
Humans ; Global Burden of Disease/trends* ; Child, Preschool ; Global Health/statistics & numerical data* ; Infant ; Male ; Prevalence ; Limb Deformities, Congenital/mortality* ; Musculoskeletal Abnormalities/mortality* ; Female ; Disability-Adjusted Life Years ; Incidence ; Infant, Newborn ; Cost of Illness ; Socioeconomic Factors

OBJECTIVE: To investigate the incidence of sepsis in Xinjiang Uygur Autonomous Region and the compliance with sepsis diagnosis and treatment guidelines in intensive care unit (ICU) at different levels of hospitals, and to identify the risk factors associated with poor prognosis in patients with sepsis in this region. METHODS: A prospective cross-sectional survey was conducted in ICU of Xinjiang Uygur Autonomous Region Critical Care Medicine Alliance. The survey period was from 10:00 on January 31, 2024, to 09:59 on February 1, 2024. The patients diagnosed with sepsis admitted to the ICU during the study period were included in the analysis. Data on patient demographics, physiology, microbiology, and treatment protocols were collected, with follow-up until the 28th day after ICU admission or death. Baseline characteristics and treatment information of septic patients across different hospital levels were compared, as well as clinical data of septic patients with different 28-day outcomes. Multivariate Cox proportional hazards model was used to identify risk factors for 28-day death in septic patients. RESULTS: A total of 77 units of Xinjiang Uygur Autonomous Region Critical Care Medicine Alliance from 14 prefectures/cities in Xinjiang participated in the survey. On the survey day, 727 patients were admitted to ICU, of whom 179 (24.6%) were diagnosed with sepsis, and 64 (35.8%) died within 28 days, 115 (64.2%) survived. Among the participating institutions, 33 were tertiary hospitals (42.9%), managing 97 septic cases (54.2%), and 44 were secondary hospitals (57.1%), managing 82 septic cases (45.8%). The lactic acid monitoring rate and continuous renal replacement therapy (CRRT) rate for septic patients in tertiary hospitals were significantly higher than those in secondary hospitals [lactic acid monitoring rate: 92.8% (90/97) vs. 82.9% (68/82), CRRT rate: 17.5% (17/97) vs. 3.7% (3/82), both P < 0.05]. No statistically significant differences were observed between tertiary and secondary hospitals in length of ICU stay or 28-day mortality [length of ICU stay (days): 11.0 (16.0) vs. 10.0 (22.0), 28-day mortality: 35.1% (34/97) vs. 36.6% (30/82), both P > 0.05]. Compared with survivors, non-survivors had higher acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, Charlson comorbidity index (CCI) score and lower Glasgow coma scale (GCS) score. Significant differences were noted in vital signs [heart rate, blood pressure, body temperature, pulse oxygen saturation (SpO₂)], laboratory markers [red blood cell count (RBC), white blood cell count (WBC), lymphocyte ratio (LYM%), blood urea nitrogen (BUN), total protein (TP), albumin (Alb), pH value, base excess (BE)], and monitoring, diagnosis and treatment information (invasive blood pressure monitoring, mechanical ventilation, CRRT, usage of norepinephrine). Multivariate Cox proportional hazards model indicated that body temperature [hazard ratio (HR) = 1.416, 95% confidence interval (95%CI) was 1.022-1.961, P = 0.037] and WBC (HR = 1.040, 95%CI was 1.010-1.071, P = 0.009) were independent risk factors for 28-day death in patients with sepsis. CONCLUSIONS Sepsis in Xinjiang Uygur Autonomous Region is characterized by a high mortality. In this region, tertiary hospitals demonstrate better compliance with bundled treatment strategies such as lactic acid monitoring and the usage of CRRT compared to secondary hospitals, yet they do not show significant advantages in clinical outcomes. Body temperature and WBC are independent risk factors for 28-day death in patients with sepsis in this region. However, clinicians should still consider the actual situation of patients, along with more optimal early warning indicators and comprehensive system assessments, to identify and prevent risk factors for adverse outcomes in patients.
Humans ; Sepsis/diagnosis* ; Cross-Sectional Studies ; Prospective Studies ; Risk Factors ; Intensive Care Units ; Prognosis ; China/epidemiology* ; Male ; Female ; Middle Aged ; Aged ; Proportional Hazards Models ; Incidence