Objective:To determine the stroke predictors for the 10-year of follow-up in Bogor City,Indonesia.Methods:The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of&q...Objective:To determine the stroke predictors for the 10-year of follow-up in Bogor City,Indonesia.Methods:The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of"the Bogor Cohort Study on Non-Communicable Disease Risk Factors".Data were collected by interview method with structured questionnaires,physical measurements three times a year,and laboratory examination every two years during a 10-year follow-up(2011-2021,without examination in 2020).The incidence of stroke is based on anamnesis results and examination by a neurologist.Other stroke predictor variables include characteristics,biological conditions,and risk behavior.We analysed 4445 stroke-free samples with Cox proportional hazard regression test.Results:During the 10-year observation,stroke incidence was 440 person-years per 100000 population(95%CI 370-530).During the follow-up of ten years,the main predictor of stroke was mental-emotional disorders with HR 4.2(95%CI 2.8-6.3)after adjustment by age,hypertension,obesity,abdominal obesity,and high LDL-cholesterol levels.Conclusions:Mental-emotional disorders are the strongest predictor of stroke incidence.Hence,psychological factors must be controlled in a stroke prevention program.展开更多
BACKGROUND Infective endocarditis(IE)is a life-threatening infection with an annual mortality of 40%.Embolic events reported in up to 80%of patients.Vegetations of>10 mm size are associated with increased embolic e...BACKGROUND Infective endocarditis(IE)is a life-threatening infection with an annual mortality of 40%.Embolic events reported in up to 80%of patients.Vegetations of>10 mm size are associated with increased embolic events and poor prognosis.There is a paucity of literature on the association of multiple vegetations with outcome.AIM To study the echocardiographic(ECHO)features and outcomes associated with the presence of multiple vegetations.METHODS In this retrospective,single-center,cohort study patients diagnosed with IE were recruited from June 2017 to June 2019.A total of 84 patients were diagnosed to have IE,of whom 67 with vegetation were identified.Baseline demographic,clinical,laboratory,and ECHO parameters were reviewed.Outcomes that were studied included recurrent admission,embolic phenomenon,and mortality.RESULTS Twenty-three(34%)patients were noted to have multiple vegetations,13(56.5%)were male and 10(43.5%)were female.The mean age of these patients was 50.Eight(35%)had a prior episode of IE.ECHO features of moderate to severe valvular regurgitation[odds ratio(OR)=4],presence of pacemaker lead(OR=4.8),impaired left ventricle(LV)relaxation(OR=4),and elevated pulmonary artery systolic pressure(PASP)(OR=2.2)are associated with higher odds of multiple vegetations.Of these moderate to severe valvular regurgitation(P=0.028),pacemaker lead(P=0.039)and impaired relaxation(P=0.028)were statistically significant.These patients were noted to have an increased association of recurrent admissions(OR=3.6),recurrent bacteremia(OR=2.4),embolic phenomenon(OR=2.5),intensive care unit stay(OR=2.8),hypotension(OR=2.1),surgical intervention(OR=2.8)and device removal(OR=4.8).Of this device removal(P=0.039)and recurrent admissions(P=0.017)were statistically significant.CONCLUSION This study highlights the associations of ECHO predictors and outcomes in patients with IE having multiple vegetations.ECHO features of moderate to severe regurgitation,presence of pacemaker lead,impaired LV relaxation,and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations.展开更多
BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts p...BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.展开更多
Background: An abnormal vaginal discharge is a common complaint among women of reproductive age, and it can indicate serious conditions like pelvic inflammatory disease and cervical cancer. This study aimed to assess ...Background: An abnormal vaginal discharge is a common complaint among women of reproductive age, and it can indicate serious conditions like pelvic inflammatory disease and cervical cancer. This study aimed to assess the predictors of abnormal vaginal discharge in women of reproductive age group in Imo State, Southeast Nigeria. Methods: A cross-sectional study was conducted among 368 women of reproductive age group attending the clinic at Federal University Teaching Hospital Owerri, in Imo State, Nigeria. Respondents were recruited using a systematic sampling technique. Data were collected using a pre-tested interviewer-administered questionnaire. Multivariable analysis was performed to determine predictors of abnormal vaginal discharge. Statistical significance was set at p Results: The mean age of the respondents was 30 ± 4.5 years. Predictors of abnormal vaginal discharge were: age 36 - 45 years (OR: 4.5;95% C.I: 1.023 - 8.967, p = 0.041), being a student (OR: 2.4: 95% C.I: 1.496 - 7.336, p = 0.003), use of oral contraceptives (OR: 3.4;95% C.I: 1.068 - 6.932, p = 0.010), use of water cistern (OR: 4.7;C.I: 1.654 - 5.210, p = 0.028) anal hygiene practices (OR: 2.7;95% C.I: 1.142 - 4.809, p Conclusion: These findings suggest that targeted sexual and reproductive health interventions should be provided to reduce the risk of abnormal vaginal discharge in women of reproductive age group.展开更多
BACKGROUND The lack of specific predictors for type-2 diabetes mellitus(T2DM)severely impacts early intervention/prevention efforts.Elevated branched-chain amino acids(BCAAs:Isoleucine,leucine,valine)and aromatic amin...BACKGROUND The lack of specific predictors for type-2 diabetes mellitus(T2DM)severely impacts early intervention/prevention efforts.Elevated branched-chain amino acids(BCAAs:Isoleucine,leucine,valine)and aromatic amino acids(AAAs:Tyrosine,tryptophan,phenylalanine)show high sensitivity and specificity in predicting diabetes in animals and predict T2DM 10-19 years before T2DM onset in clinical studies.However,improvement is needed to support its clinical utility.AIM To evaluate the effects of body mass index(BMI)and sex on BCAAs/AAAs in new-onset T2DM individuals with varying body weight.METHODS Ninety-seven new-onset T2DM patients(<12 mo)differing in BMI[normal weight(NW),n=33,BMI=22.23±1.60;overweight,n=42,BMI=25.9±1.07;obesity(OB),n=22,BMI=31.23±2.31]from the First People’s Hospital of Yunnan Province,Kunming,China,were studied.One-way and 2-way ANOVAs were conducted to determine the effects of BMI and sex on BCAAs/AAAs.RESULTS Fasting serum AAAs,BCAAs,glutamate,and alanine were greater and high-density lipoprotein(HDL)was lower(P<0.05,each)in OB-T2DM patients than in NW-T2DM patients,especially in male OB-T2DM patients.Arginine,histidine,leucine,methionine,and lysine were greater in male patients than in female patients.Moreover,histidine,alanine,glutamate,lysine,valine,methionine,leucine,isoleucine,tyrosine,phenylalanine,and tryptophan were significantly correlated with abdominal adiposity,body weight and BMI,whereas isoleucine,leucine and phenylalanine were negatively correlated with HDL.CONCLUSION Heterogeneously elevated amino acids,especially BCAAs/AAAs,across new-onset T2DM patients in differing BMI categories revealed a potentially skewed prediction of T2DM development.The higher BCAA/AAA levels in obese T2DM patients would support T2DM prediction in obese individuals,whereas the lower levels of BCAAs/AAAs in NW-T2DM individuals may underestimate T2DM risk in NW individuals.This potentially skewed T2DM prediction should be considered when BCAAs/AAAs are to be used as the T2DM predictor.展开更多
BACKGROUND Portal vein thrombosis(PVT)is a commonthsn complication after splenectomy in patients with cirrhosis.However,the predictors of postoperative PVT are not known.AIM To investigate the predictors of PVT after ...BACKGROUND Portal vein thrombosis(PVT)is a commonthsn complication after splenectomy in patients with cirrhosis.However,the predictors of postoperative PVT are not known.AIM To investigate the predictors of PVT after splenectomy in patient with cirrhosis.METHODS A total of 45 patients with cirrhosis who underwent splenectomy were consecutively enrolled from January 2017 to December 2018.The incidence of PVT at 1 months,3 months,and 12 months after splenectomy in patients with cirrhosis was observed.The hematological indicators,biochemical and coagulation parameters,and imaging features were recorded at baseline and at each observation point.The univariable,multivariable,receiver operating characteristic curve and timedependent curve analyses were performed.RESULTS The cumulative incidence of PVT was 40.0%,46.6%,and 48.9%at 1 months,3 months,and 12 months after splenectomy.Multivariable analysis showed that portal vein diameter(PVD)≥14.5 mm and monthsdel end-stage liver disease(MELD)score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy(P<0.05).Time-dependent curve showed that the cumulative incidence of PVT was significantly different between patients with MELD score≤10 and>10(P<0.05).In addition,the cumulative incidence of PVT in the PVD≥14.5 mm group was significantly higher than that in the PVD<14.5 mm group(P<0.05).CONCLUSION Wider PVD and MELD score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy in patient with cirrhosis.展开更多
This article documents socio-demographic predictors of anxiety and depression among Maasai women in resource poor settings in Northern Kenya.These findings emerged from the findings of a dissertation research that aim...This article documents socio-demographic predictors of anxiety and depression among Maasai women in resource poor settings in Northern Kenya.These findings emerged from the findings of a dissertation research that aimed to establish the treatment effectiveness of an eclectic model of psychoeducation(PE)in treating depressive and anxiety symptoms among the women.The study adopted a quasi-experimental research design which had an experimental group(EG)and control group(CG).The population for the study was 686 female members of Conservation Enterprise Groups(CEG)in Laikipia County,from which a sample of 200 were recruited for the study(EG,n=100 and CG,n=100),at 80%power and 30%effective size.The Beck’s Depression Inventory(BDI)and Beck’s Anxiety Inventory(BAI)tools were used to assess the symptoms of depression and anxiety,respectively.The PE was provided as an intervention treatment to the EG at the middle and end of the study,after which the respondents were tested for symptoms of depression.The study established the prevalence of depression as 26.7%and 31.3%for anxiety and disorders,among women in the region.Data was analyzed using SPSS Version 21.0.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is a reliable method to resect early esophageal cancer.Esophageal stricture is one of the major complications after ESD of the esophagus.Steroid prophylaxis for esophage...BACKGROUND Endoscopic submucosal dissection(ESD)is a reliable method to resect early esophageal cancer.Esophageal stricture is one of the major complications after ESD of the esophagus.Steroid prophylaxis for esophageal strictures,particularly local injection of triamcinolone acetonide(TA),is a relatively effective method to prevent esophageal strictures.However,even with steroid prophylaxis,stenosis still occurs in up to 45%of patients.Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients.AIM To identify the predictors of esophageal strictures after steroids application.METHODS Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion-and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study.The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis.RESULTS A total of 120 patients were included in the analysis.In the oral prednisone and oral prednisone combined with local tretinoin injection groups,the stenosis rates were 44/53(83.0%)and 56/67(83.6%),respectively.Among them,univariate analysis showed that the lesion circumference(P=0.01)and submucosal injection solution(P=0.04)showed significant correlation with the risk of stenosis formation.Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports,such as additional chemoradiotherapy and tumor location.We identified a lesion circumference<5/6(OR=0.19;P=0.02)and submucosal injection of sodium hyaluronate(OR=0.15;P=0.03)as independent predictors of on esophageal stricture formation.CONCLUSION Steroid prophylaxis effectively prevents stenosis.Moreover,the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures.Additional interventions should be considered in high-risk patients.展开更多
Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Sahara...Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.展开更多
Objective:Despite trials and programs for the prevention of childhood mortality due to pneumonia,Ethiopia is among the top five countries with the highest number of deaths due to pneumonia.Although the prevalence of p...Objective:Despite trials and programs for the prevention of childhood mortality due to pneumonia,Ethiopia is among the top five countries with the highest number of deaths due to pneumonia.Although the prevalence of pneumonia has increased in the abovementioned trials,little is known about the recovery time from severe pneumonia and its predictors in the study area.Therefore,this study aimed to assess the time to recovery from severe pneumonia and its predictors among pediatric patients admitted to Mizan-Tepi University Teaching Hospital,Ethiopia,in 2022.Methods:A total of 591 children admitted for severe pneumonia were selected using simple random sampling.Data were entered into Epi-data version 4.4.2.1 and expor ted to STATA version 14 for analysis,and the assumptions of Cox propor tional hazard models and goodness of fit were assessed through Shoenfeld residual and Cox-Snell residual,respectively.Bivariate and multivariable Cox regression models were used to identify the predictors of mor tality.Results:This study revealed that 91.54%(95%confidence interval[CI]:89.00–93.53)of participants recovered with an incidence rate of 24.10(95%CI:22.15–26.21)per 100 person-day–observations.The hmedian recovery time of children was 4 days(95%CI:2–6).Children who were not exclusively breastfed(AHR=1.3;95%CI:1.03–1.66),who had a history of inability to suck/feed(AHR=0.81;95%CI:0.65–0.99)were independent predictors of the time to recovery.Conclusions:Children with severe pneumonia who had not exclusively breastfed and who had a history of inability to suck/feed were independent predictors of time to recovery.Therefore,all stakeholders and concerned health care providers should focus more on early diagnosis and management and hasten early recovery based on the identified factors.展开更多
The energy norm convergence rate of the finite element solution of the heat equation is reduced by the time-regularity of the exact solution. This paper presents an adaptive finite element treatment of time-dependent ...The energy norm convergence rate of the finite element solution of the heat equation is reduced by the time-regularity of the exact solution. This paper presents an adaptive finite element treatment of time-dependent singularities on the one-dimensional heat equation. The method is based on a Fourier decomposition of the solution and an extraction formula of the coefficients of the singularities coupled with a predictor-corrector algorithm. The method recovers the optimal convergence rate of the finite element method on a quasi-uniform mesh refinement. Numerical results are carried out to show the efficiency of the method.展开更多
Hepatocellular carcinoma(HCC)is the most frequent liver neoplasm,and its incidence rates are constantly increasing.Despite the availability of potentially curative treatments(liver transplantation,surgical resection,t...Hepatocellular carcinoma(HCC)is the most frequent liver neoplasm,and its incidence rates are constantly increasing.Despite the availability of potentially curative treatments(liver transplantation,surgical resection,thermal ablation),long-term outcomes are affected by a high recurrence rate(up to 70%of cases 5 years after treatment).HCC recurrence within 2 years of treatment is defined as“early”and is generally caused by the occult intrahepatic spread of the primary neoplasm and related to the tumor burden.A recurrence that occurs after 2 years of treatment is defined as“late”and is related to de novo HCC,independent of the primary neoplasm.Early HCC recurrence has a significantly poorer prognosis and outcome than late recurrence.Different pathogenesis corresponds to different predictors of the risk of early or late recurrence.An adequate knowledge of predictive factors and recurrence risk stratification guides the therapeutic strategy and post-treatment surveillance.Patients at high risk of HCC recurrence should be referred to treatments with the lowest recurrence rate and when standardized to combined or adjuvant therapy regimens.This review aimed to expose the recurrence predictors and examine the differences between predictors of early and late recurrence.展开更多
Tumor necrosis factor-α(TNF-α)antagonists,the first biologics approved for treating patients with inflammatory bowel disease(IBD),are effective for the induction and maintenance of remission and significantly improv...Tumor necrosis factor-α(TNF-α)antagonists,the first biologics approved for treating patients with inflammatory bowel disease(IBD),are effective for the induction and maintenance of remission and significantly improving prognosis.However,up to one-third of treated patients show primary nonresponse(PNR)to anti-TNF-αtherapies,and 23%-50%of IBD patients experience loss of response(LOR)to these biologics during subsequent treatment.There is still no recognized predictor for evaluating the efficacy of anti-TNF drugs.This review summarizes the existing predictors of PNR and LOR to anti-TNF in IBD patients.Most predictors remain controversial,and only previous surgical history,disease manifestations,drug concentrations,antidrug antibodies,serum albumin,some biologic markers,and some genetic markers may be potentially predictive.In addition,we also discuss the next steps of treatment for patients with PNR or LOR to TNF antagonists.Therapeutic drug monitoring plays an important role in treatment selection.Dose escalation,combination therapy,switching to a different anti-TNF drug,or switching to a biologic with a different mechanism of action can be selected based on the concentration of the drug and/or antidrug antibodies.展开更多
Convolutional neural networks(CNNs) have been widely studied and found to obtain favorable results in statistical downscaling to derive high-resolution climate variables from large-scale coarse general circulation mod...Convolutional neural networks(CNNs) have been widely studied and found to obtain favorable results in statistical downscaling to derive high-resolution climate variables from large-scale coarse general circulation models(GCMs).However, there is a lack of research exploring the predictor selection for CNN modeling. This paper presents an effective and efficient greedy elimination algorithm to address this problem. The algorithm has three main steps: predictor importance attribution, predictor removal, and CNN retraining, which are performed sequentially and iteratively. The importance of individual predictors is measured by a gradient-based importance metric computed by a CNN backpropagation technique, which was initially proposed for CNN interpretation. The algorithm is tested on the CNN-based statistical downscaling of monthly precipitation with 20 candidate predictors and compared with a correlation analysisbased approach. Linear models are implemented as benchmarks. The experiments illustrate that the predictor selection solution can reduce the number of input predictors by more than half, improve the accuracy of both linear and CNN models,and outperform the correlation analysis method. Although the RMSE(root-mean-square error) is reduced by only 0.8%,only 9 out of 20 predictors are used to build the CNN, and the FLOPs(Floating Point Operations) decrease by 20.4%. The results imply that the algorithm can find subset predictors that correlate more to the monthly precipitation of the target area and seasons in a nonlinear way. It is worth mentioning that the algorithm is compatible with other CNN models with stacked variables as input and has the potential for nonlinear correlation predictor selection.展开更多
Coronavirus disease 2019(COVID-19)has affected patients with pre-existing chronic liver disease(CLD)in various ways.The maximum impact was seen on patients with underlying cirrhosis who have shown to have poor clinica...Coronavirus disease 2019(COVID-19)has affected patients with pre-existing chronic liver disease(CLD)in various ways.The maximum impact was seen on patients with underlying cirrhosis who have shown to have poor clinical outcomes in the form of increased risk of hepatic decompensation,acute-onchronic liver failure,and even mortality.It is of paramount importance to identify various factors which are associated with unfavorable outcomes for prognostication and making informed management strategy.Many factors have been evaluated in different studies in patients with underlying CLD.Some of these factors include the severity of underlying chronic liver disease,comorbid conditions,age,and severity of COVID-19.Overall,the outcomes are not favorable in patients with cirrhosis as evidenced by data from various studies.The main purpose of this review is to identify the predictors of adverse clinical outcomes including mortality in patients with CLD for risk stratification,prognostication,and appropriate clinical management.展开更多
The robust stability study of the classic Smith predictor-based control system for uncertain fractional-order plants with interval time delays and interval coefficients is the emphasis of this work.Interval uncertaint...The robust stability study of the classic Smith predictor-based control system for uncertain fractional-order plants with interval time delays and interval coefficients is the emphasis of this work.Interval uncertainties are a type of parametric uncertainties that cannot be avoided when modeling real-world plants.Also,in the considered Smith predictor control structure it is supposed that the controller is a fractional-order proportional integral derivative(FOPID)controller.To the best of the authors'knowledge,no method has been developed until now to analyze the robust stability of a Smith predictor based fractional-order control system in the presence of the simultaneous uncertainties in gain,time-constants,and time delay.The three primary contributions of this study are as follows:ⅰ)a set of necessary and sufficient conditions is constructed using a graphical method to examine the robust stability of a Smith predictor-based fractionalorder control system—the proposed method explicitly determines whether or not the FOPID controller can robustly stabilize the Smith predictor-based fractional-order control system;ⅱ)an auxiliary function as a robust stability testing function is presented to reduce the computational complexity of the robust stability analysis;andⅲ)two auxiliary functions are proposed to achieve the control requirements on the disturbance rejection and the noise reduction.Finally,four numerical examples and an experimental verification are presented in this study to demonstrate the efficacy and significance of the suggested technique.展开更多
Background: Cancer patients frequently suffer from mental health problems because of their reactions to their cancer diagnosis, cancer type, treatment effects, recurrence, fear of the end-of-life, survival, and financ...Background: Cancer patients frequently suffer from mental health problems because of their reactions to their cancer diagnosis, cancer type, treatment effects, recurrence, fear of the end-of-life, survival, and financial burden. Some hospitals have integrated mental health assessments into cancer care, but our centre has little experience with this practice. Aim and Objectives: To ascertain the prevalence and predictors of anxiety and depression in patients with gynaecological cancer at a tertiary health facility in southern Nigeria. Materials and Methods: This was a facility-based cross-sectional descriptive study of 75 women with histologically confirmed gynaecological cancer managed at the University of Port Harcourt Teaching Hospital, Port Harcourt, from January 1, 2022, to December 31, 2022. Individuals having a history of drug addiction, severe cognitive impairment, non-consenting patients, and those with communication difficulties were excluded from the study. A data collection form was used to obtain socio-demographic, reproductive, and clinical characteristics, while the Hospital Anxiety and Depression Scale (HADS) was used to assess for anxiety and depression. Data was analyzed using descriptive statistics to determine the association of variables with anxiety and depression. Results: Most 27 (36.0%) of the respondents were in 40 - 49 age group with a mean age of 50.4 ± 12.3 years. The study showed that 39 (52.0%) of the respondents exhibited symptoms of anxiety, of which 14 (35.9%) were mild, 20 (51.3%) had moderate anxiety and 5 (12.8%) experienced severe anxiety. In addition, 46 (61.3%) of them showed symptoms of depression, of which 17 (37.0%) were mild, 15 (32.6%) were moderate and 14 (30.4%) experienced severe depression. The ratio of respondents who showed anxiety to those that showed symptoms of depression was 5: 6. The factors associated with anxiety were partner’s educational level (X<sup>2</sup> = 4.745, p = 0.029), parity (X<sup>2</sup> = 6.651, p = 0.036) and duration of diagnosis (X<sup>2</sup> = 8.321, p = 0.004), while partner’s educational level (X<sup>2</sup> = 6.810, p = 0.009), parity (X<sup>2</sup> = 7.129, p = 0.028), age of coitarche (X<sup>2</sup> = 6.512, p = 0.039) and duration of diagnosis (X<sup>2</sup> = 4.955, p = 0.026) were significantly associated with depression. Conclusion: More than half of the respondents experienced anxiety, while about two-thirds experienced depression. There is a need to incorporate psychological evaluation into the care of gynaecological cancer patients.展开更多
Background: Type 2 diabetes mellitus (T2DM) is currently a major global public health burden associated with elevated blood glucose. The use of herbal medicine in the management of type 2 diabetes is currently on the ...Background: Type 2 diabetes mellitus (T2DM) is currently a major global public health burden associated with elevated blood glucose. The use of herbal medicine in the management of type 2 diabetes is currently on the rise both in developed and developing countries. This study sets out to determine the prevalence of herbal medicine use and to identify the factors associated with herbal medicine use amongst type 2 diabetes patients. Methods: A community based cross-sectional study involves 123 adults living with type 2 diabetes (90 males and 30 females), mean age 58.7 ± 9.5 years in the Bamenda III health district of the North West Region of Cameroon. Data on the different types of herbs used, frequency and mode of herbal medicine use as well as reasons for using herbal medicines in the management of T2DM were assessed using a structured questionnaire. Anthropometric and diabetes related measurements were carried out following standard procedures. Logistic regression analysis was used to identify the independent predictors of herbal medicine use. Results: The prevalence of herbal medicine use was 24.4% (n = 30) amongst which 37.4 % used both herbs and orthodox medicine. A higher proportion of diabetic males used herbal medicines compared to females and this difference was significant (X<sup>2</sup> = 5.243, p X<sup>2</sup> = 10.75, p = 0.005). The most commonly used herbs were Vernonia amygdalina leaves (19.10%), Aloe vera (13.48%), Mangifera indica leaves (11.24%) including its bark and Carica papaya leaves (8.99%). Bivariate analysis indicated that being male (OR 2.8, 95% CI, 1.14 -6.79) and having attained secondary/tertiary education (OR 13.2, 95% CI, 1.6 - 29.9) were significantly (p 0.05) associated with herbal medicine use. Multivariate analysis revealed that having attained secondary /tertiary education (OR 10.5, 95% CI, 1.30 - 35.23) was an independent predictor of herbal medicine use in the study population. Conclusion: This study has demonstrated that amongst T2DM patients in Cameroon having attained secondary/tertiary education positively influences the use of herbal medicine in the management of T2DM.展开更多
Background: Obesity, especially central obesity, is a major risk factor for cardiovascular diseases and type-2 diabetes, known for their significant morbidity and mortality. University students are at increased risk o...Background: Obesity, especially central obesity, is a major risk factor for cardiovascular diseases and type-2 diabetes, known for their significant morbidity and mortality. University students are at increased risk of obesity due to adoption of unhealthy lifestyles and school-related stress. However, there is scant information regarding the prevalence and risk factors of obesity among university students in Kenya. The study aimed to determine the prevalence and factors associated with general and abdominal obesity among undergraduate students of The Catholic University of Eastern Africa, Kenya. Methods: A cross-sectional study design was employed among undergraduate students (n = 245) of The Catholic University of Eastern Africa, Nairobi. A systematic random sampling method was used to select the study participants. Lifestyle risk factors associated with obesity were collected using a structured questionnaire adopted from the WHO STEP-wise approach to non-communicable disease risk factor surveillance. Anthropometric measures of weight, height, and waist circumference were appropriately measured. The data were analyzed using SPSS software (ver: 22). The chi-square test of independence and binary logistic regression was used to establish an association between dependent and independent variables. Results: The prevalence of general and abdominal obesity was 19.6% and 27.8%, respectively. Risk factors of general obesity were age ≥ 20 years (OR, 9.95;95% CI, 3.09 - 32.08, p < 0.001), sedentary lifestyle (OR, 11.36;95% CI, 2.08 - 61.96, p = 0.005), staying with parents (OR, 3.22;95% CI, 1.09 - 9.58, p = 0.035), consumption of fast/processed foods (OR, 7.83;95% CI, 1.90 - 32.21, p = 0.004). Risk factors for abdominal obesity were being female (OR, 38.76;95% CI, 5.07 - 296.54, p < 0.001), staying with parents (OR, 3.02;95% CI, 1.14 - 7.99, p = 0.026) and sedentary lifestyle (OR, 6.55;95% CI, 1.80 - 23.81, p = 0.004). Conclusion: Being female, sedentary lifestyle, and consumption of fast/processed foods were found as predictors of obesity. Behavioural intervention is required to mitigate the burden of obesity among university students in Kenya. This can be achieved through promoting intervention programmes that lead to changing the built environment, counseling, and behavioral-lifestyle modification of students.展开更多
Objective:The present study aimed to identify predictive factors for mortality among elderly individuals infected with COVID-19.Methods and Materials:This historical cohort study was conducted from July to December 20...Objective:The present study aimed to identify predictive factors for mortality among elderly individuals infected with COVID-19.Methods and Materials:This historical cohort study was conducted from July to December 2021 in the specialized departments for COVID-19 patients at one of the hospitals in Mashhad,Iran.Data were collected from the medical records of 404 elderly patients.Sampling was conducted using the convenience sampling method.Data were gathered through a demographic and clinical checklist developed by the researcher.Univariate and multivariate Cox regression were used to analyze the data.Results:The mortality rate among elderly individuals was 25%(n=101).Multiple regression analysis revealed significant associations between mortality and age(hazard ratio[HR]=0.58,95%confidence interval[CI]:0.38,0.88;P=0.011),level of consciousness(HR=0.31,95%CI:0.19,0.50;P<0.001),and SpO2(HR=0.58,95%CI:0.37,0.92;P=0.022).The probability of survival after the 19th day of hospitalization was 50%.Conclusions:Determining predictors of death allows for early identification of elderly individuals at risk and enables the health-care team to provide more effective care,ultimately saving the lives of elderly individuals by allocating appropriate facilities and equipment.展开更多
基金supported by National Institute of Health Research and Development,Ministry of Health(No.024-11-416176).
文摘Objective:To determine the stroke predictors for the 10-year of follow-up in Bogor City,Indonesia.Methods:The prospective study analyzed the data of 4445 stroke-free subjects aged 25 years and above that was part of"the Bogor Cohort Study on Non-Communicable Disease Risk Factors".Data were collected by interview method with structured questionnaires,physical measurements three times a year,and laboratory examination every two years during a 10-year follow-up(2011-2021,without examination in 2020).The incidence of stroke is based on anamnesis results and examination by a neurologist.Other stroke predictor variables include characteristics,biological conditions,and risk behavior.We analysed 4445 stroke-free samples with Cox proportional hazard regression test.Results:During the 10-year observation,stroke incidence was 440 person-years per 100000 population(95%CI 370-530).During the follow-up of ten years,the main predictor of stroke was mental-emotional disorders with HR 4.2(95%CI 2.8-6.3)after adjustment by age,hypertension,obesity,abdominal obesity,and high LDL-cholesterol levels.Conclusions:Mental-emotional disorders are the strongest predictor of stroke incidence.Hence,psychological factors must be controlled in a stroke prevention program.
文摘BACKGROUND Infective endocarditis(IE)is a life-threatening infection with an annual mortality of 40%.Embolic events reported in up to 80%of patients.Vegetations of>10 mm size are associated with increased embolic events and poor prognosis.There is a paucity of literature on the association of multiple vegetations with outcome.AIM To study the echocardiographic(ECHO)features and outcomes associated with the presence of multiple vegetations.METHODS In this retrospective,single-center,cohort study patients diagnosed with IE were recruited from June 2017 to June 2019.A total of 84 patients were diagnosed to have IE,of whom 67 with vegetation were identified.Baseline demographic,clinical,laboratory,and ECHO parameters were reviewed.Outcomes that were studied included recurrent admission,embolic phenomenon,and mortality.RESULTS Twenty-three(34%)patients were noted to have multiple vegetations,13(56.5%)were male and 10(43.5%)were female.The mean age of these patients was 50.Eight(35%)had a prior episode of IE.ECHO features of moderate to severe valvular regurgitation[odds ratio(OR)=4],presence of pacemaker lead(OR=4.8),impaired left ventricle(LV)relaxation(OR=4),and elevated pulmonary artery systolic pressure(PASP)(OR=2.2)are associated with higher odds of multiple vegetations.Of these moderate to severe valvular regurgitation(P=0.028),pacemaker lead(P=0.039)and impaired relaxation(P=0.028)were statistically significant.These patients were noted to have an increased association of recurrent admissions(OR=3.6),recurrent bacteremia(OR=2.4),embolic phenomenon(OR=2.5),intensive care unit stay(OR=2.8),hypotension(OR=2.1),surgical intervention(OR=2.8)and device removal(OR=4.8).Of this device removal(P=0.039)and recurrent admissions(P=0.017)were statistically significant.CONCLUSION This study highlights the associations of ECHO predictors and outcomes in patients with IE having multiple vegetations.ECHO features of moderate to severe regurgitation,presence of pacemaker lead,impaired LV relaxation,and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations.
文摘BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.
文摘Background: An abnormal vaginal discharge is a common complaint among women of reproductive age, and it can indicate serious conditions like pelvic inflammatory disease and cervical cancer. This study aimed to assess the predictors of abnormal vaginal discharge in women of reproductive age group in Imo State, Southeast Nigeria. Methods: A cross-sectional study was conducted among 368 women of reproductive age group attending the clinic at Federal University Teaching Hospital Owerri, in Imo State, Nigeria. Respondents were recruited using a systematic sampling technique. Data were collected using a pre-tested interviewer-administered questionnaire. Multivariable analysis was performed to determine predictors of abnormal vaginal discharge. Statistical significance was set at p Results: The mean age of the respondents was 30 ± 4.5 years. Predictors of abnormal vaginal discharge were: age 36 - 45 years (OR: 4.5;95% C.I: 1.023 - 8.967, p = 0.041), being a student (OR: 2.4: 95% C.I: 1.496 - 7.336, p = 0.003), use of oral contraceptives (OR: 3.4;95% C.I: 1.068 - 6.932, p = 0.010), use of water cistern (OR: 4.7;C.I: 1.654 - 5.210, p = 0.028) anal hygiene practices (OR: 2.7;95% C.I: 1.142 - 4.809, p Conclusion: These findings suggest that targeted sexual and reproductive health interventions should be provided to reduce the risk of abnormal vaginal discharge in women of reproductive age group.
基金Supported by the Open Project Grant for Clinical Medical Center of Yunnan Province,No.2019LCZXKF-NM03Medical Leader Training Grant,No.L-201624and Yunnan Province Ten Thousand Talents:“Medical Expert”grant,No.YNWR-MY-2019-020.
文摘BACKGROUND The lack of specific predictors for type-2 diabetes mellitus(T2DM)severely impacts early intervention/prevention efforts.Elevated branched-chain amino acids(BCAAs:Isoleucine,leucine,valine)and aromatic amino acids(AAAs:Tyrosine,tryptophan,phenylalanine)show high sensitivity and specificity in predicting diabetes in animals and predict T2DM 10-19 years before T2DM onset in clinical studies.However,improvement is needed to support its clinical utility.AIM To evaluate the effects of body mass index(BMI)and sex on BCAAs/AAAs in new-onset T2DM individuals with varying body weight.METHODS Ninety-seven new-onset T2DM patients(<12 mo)differing in BMI[normal weight(NW),n=33,BMI=22.23±1.60;overweight,n=42,BMI=25.9±1.07;obesity(OB),n=22,BMI=31.23±2.31]from the First People’s Hospital of Yunnan Province,Kunming,China,were studied.One-way and 2-way ANOVAs were conducted to determine the effects of BMI and sex on BCAAs/AAAs.RESULTS Fasting serum AAAs,BCAAs,glutamate,and alanine were greater and high-density lipoprotein(HDL)was lower(P<0.05,each)in OB-T2DM patients than in NW-T2DM patients,especially in male OB-T2DM patients.Arginine,histidine,leucine,methionine,and lysine were greater in male patients than in female patients.Moreover,histidine,alanine,glutamate,lysine,valine,methionine,leucine,isoleucine,tyrosine,phenylalanine,and tryptophan were significantly correlated with abdominal adiposity,body weight and BMI,whereas isoleucine,leucine and phenylalanine were negatively correlated with HDL.CONCLUSION Heterogeneously elevated amino acids,especially BCAAs/AAAs,across new-onset T2DM patients in differing BMI categories revealed a potentially skewed prediction of T2DM development.The higher BCAA/AAA levels in obese T2DM patients would support T2DM prediction in obese individuals,whereas the lower levels of BCAAs/AAAs in NW-T2DM individuals may underestimate T2DM risk in NW individuals.This potentially skewed T2DM prediction should be considered when BCAAs/AAAs are to be used as the T2DM predictor.
基金Supported by the National Natural Science Foundation of China,No.81800528Natural Science Foundation of Gansu Province,No.20JR5RA364Key Research and Development Project of Gansu Province,No.20YF2FA011。
文摘BACKGROUND Portal vein thrombosis(PVT)is a commonthsn complication after splenectomy in patients with cirrhosis.However,the predictors of postoperative PVT are not known.AIM To investigate the predictors of PVT after splenectomy in patient with cirrhosis.METHODS A total of 45 patients with cirrhosis who underwent splenectomy were consecutively enrolled from January 2017 to December 2018.The incidence of PVT at 1 months,3 months,and 12 months after splenectomy in patients with cirrhosis was observed.The hematological indicators,biochemical and coagulation parameters,and imaging features were recorded at baseline and at each observation point.The univariable,multivariable,receiver operating characteristic curve and timedependent curve analyses were performed.RESULTS The cumulative incidence of PVT was 40.0%,46.6%,and 48.9%at 1 months,3 months,and 12 months after splenectomy.Multivariable analysis showed that portal vein diameter(PVD)≥14.5 mm and monthsdel end-stage liver disease(MELD)score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy(P<0.05).Time-dependent curve showed that the cumulative incidence of PVT was significantly different between patients with MELD score≤10 and>10(P<0.05).In addition,the cumulative incidence of PVT in the PVD≥14.5 mm group was significantly higher than that in the PVD<14.5 mm group(P<0.05).CONCLUSION Wider PVD and MELD score>10 were independent predictors of PVT at 1 months,3 months,and 12 months after splenectomy in patient with cirrhosis.
文摘This article documents socio-demographic predictors of anxiety and depression among Maasai women in resource poor settings in Northern Kenya.These findings emerged from the findings of a dissertation research that aimed to establish the treatment effectiveness of an eclectic model of psychoeducation(PE)in treating depressive and anxiety symptoms among the women.The study adopted a quasi-experimental research design which had an experimental group(EG)and control group(CG).The population for the study was 686 female members of Conservation Enterprise Groups(CEG)in Laikipia County,from which a sample of 200 were recruited for the study(EG,n=100 and CG,n=100),at 80%power and 30%effective size.The Beck’s Depression Inventory(BDI)and Beck’s Anxiety Inventory(BAI)tools were used to assess the symptoms of depression and anxiety,respectively.The PE was provided as an intervention treatment to the EG at the middle and end of the study,after which the respondents were tested for symptoms of depression.The study established the prevalence of depression as 26.7%and 31.3%for anxiety and disorders,among women in the region.Data was analyzed using SPSS Version 21.0.
基金Supported by Jiangsu Province Chinese Medicine Science and Technology Development Program,No.ZT202119.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is a reliable method to resect early esophageal cancer.Esophageal stricture is one of the major complications after ESD of the esophagus.Steroid prophylaxis for esophageal strictures,particularly local injection of triamcinolone acetonide(TA),is a relatively effective method to prevent esophageal strictures.However,even with steroid prophylaxis,stenosis still occurs in up to 45%of patients.Predicting the risk of stenosis formation after local TA injection would enable additional interventions in risky patients.AIM To identify the predictors of esophageal strictures after steroids application.METHODS Patients who underwent esophageal ESD and steroid prophylaxis and who were comprehensively assessed for lesion-and ESD-related factors at Southeast University Affiliated Zhongda Hospital between February 2018 and March 2023 were included in the study.The univariate and multivariate regression analyses were conducted to identify the predictors of stricture among patients undergoing steroid prophylaxis.RESULTS A total of 120 patients were included in the analysis.In the oral prednisone and oral prednisone combined with local tretinoin injection groups,the stenosis rates were 44/53(83.0%)and 56/67(83.6%),respectively.Among them,univariate analysis showed that the lesion circumference(P=0.01)and submucosal injection solution(P=0.04)showed significant correlation with the risk of stenosis formation.Logistic regression analyses were then performed using predictors that were significant in the univariate analyses and combined with known predictors from previous reports,such as additional chemoradiotherapy and tumor location.We identified a lesion circumference<5/6(OR=0.19;P=0.02)and submucosal injection of sodium hyaluronate(OR=0.15;P=0.03)as independent predictors of on esophageal stricture formation.CONCLUSION Steroid prophylaxis effectively prevents stenosis.Moreover,the lesion circumference and submucosal injection of sodium hyaluronate were independent predictors of esophageal strictures.Additional interventions should be considered in high-risk patients.
文摘Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.
文摘Objective:Despite trials and programs for the prevention of childhood mortality due to pneumonia,Ethiopia is among the top five countries with the highest number of deaths due to pneumonia.Although the prevalence of pneumonia has increased in the abovementioned trials,little is known about the recovery time from severe pneumonia and its predictors in the study area.Therefore,this study aimed to assess the time to recovery from severe pneumonia and its predictors among pediatric patients admitted to Mizan-Tepi University Teaching Hospital,Ethiopia,in 2022.Methods:A total of 591 children admitted for severe pneumonia were selected using simple random sampling.Data were entered into Epi-data version 4.4.2.1 and expor ted to STATA version 14 for analysis,and the assumptions of Cox propor tional hazard models and goodness of fit were assessed through Shoenfeld residual and Cox-Snell residual,respectively.Bivariate and multivariable Cox regression models were used to identify the predictors of mor tality.Results:This study revealed that 91.54%(95%confidence interval[CI]:89.00–93.53)of participants recovered with an incidence rate of 24.10(95%CI:22.15–26.21)per 100 person-day–observations.The hmedian recovery time of children was 4 days(95%CI:2–6).Children who were not exclusively breastfed(AHR=1.3;95%CI:1.03–1.66),who had a history of inability to suck/feed(AHR=0.81;95%CI:0.65–0.99)were independent predictors of the time to recovery.Conclusions:Children with severe pneumonia who had not exclusively breastfed and who had a history of inability to suck/feed were independent predictors of time to recovery.Therefore,all stakeholders and concerned health care providers should focus more on early diagnosis and management and hasten early recovery based on the identified factors.
文摘The energy norm convergence rate of the finite element solution of the heat equation is reduced by the time-regularity of the exact solution. This paper presents an adaptive finite element treatment of time-dependent singularities on the one-dimensional heat equation. The method is based on a Fourier decomposition of the solution and an extraction formula of the coefficients of the singularities coupled with a predictor-corrector algorithm. The method recovers the optimal convergence rate of the finite element method on a quasi-uniform mesh refinement. Numerical results are carried out to show the efficiency of the method.
文摘Hepatocellular carcinoma(HCC)is the most frequent liver neoplasm,and its incidence rates are constantly increasing.Despite the availability of potentially curative treatments(liver transplantation,surgical resection,thermal ablation),long-term outcomes are affected by a high recurrence rate(up to 70%of cases 5 years after treatment).HCC recurrence within 2 years of treatment is defined as“early”and is generally caused by the occult intrahepatic spread of the primary neoplasm and related to the tumor burden.A recurrence that occurs after 2 years of treatment is defined as“late”and is related to de novo HCC,independent of the primary neoplasm.Early HCC recurrence has a significantly poorer prognosis and outcome than late recurrence.Different pathogenesis corresponds to different predictors of the risk of early or late recurrence.An adequate knowledge of predictive factors and recurrence risk stratification guides the therapeutic strategy and post-treatment surveillance.Patients at high risk of HCC recurrence should be referred to treatments with the lowest recurrence rate and when standardized to combined or adjuvant therapy regimens.This review aimed to expose the recurrence predictors and examine the differences between predictors of early and late recurrence.
文摘Tumor necrosis factor-α(TNF-α)antagonists,the first biologics approved for treating patients with inflammatory bowel disease(IBD),are effective for the induction and maintenance of remission and significantly improving prognosis.However,up to one-third of treated patients show primary nonresponse(PNR)to anti-TNF-αtherapies,and 23%-50%of IBD patients experience loss of response(LOR)to these biologics during subsequent treatment.There is still no recognized predictor for evaluating the efficacy of anti-TNF drugs.This review summarizes the existing predictors of PNR and LOR to anti-TNF in IBD patients.Most predictors remain controversial,and only previous surgical history,disease manifestations,drug concentrations,antidrug antibodies,serum albumin,some biologic markers,and some genetic markers may be potentially predictive.In addition,we also discuss the next steps of treatment for patients with PNR or LOR to TNF antagonists.Therapeutic drug monitoring plays an important role in treatment selection.Dose escalation,combination therapy,switching to a different anti-TNF drug,or switching to a biologic with a different mechanism of action can be selected based on the concentration of the drug and/or antidrug antibodies.
基金supported by the following grants: National Basic R&D Program of China (2018YFA0606203)Strategic Priority Research Program of Chinese Academy of Sciences (XDA23090102 and XDA20060501)+2 种基金Guangdong Major Project of Basic and Applied Basic Research (2020B0301030004)Special Fund of China Meteorological Administration for Innovation and Development (CXFZ2021J026)Special Fund for Forecasters of China Meteorological Administration (CMAYBY2020094)。
文摘Convolutional neural networks(CNNs) have been widely studied and found to obtain favorable results in statistical downscaling to derive high-resolution climate variables from large-scale coarse general circulation models(GCMs).However, there is a lack of research exploring the predictor selection for CNN modeling. This paper presents an effective and efficient greedy elimination algorithm to address this problem. The algorithm has three main steps: predictor importance attribution, predictor removal, and CNN retraining, which are performed sequentially and iteratively. The importance of individual predictors is measured by a gradient-based importance metric computed by a CNN backpropagation technique, which was initially proposed for CNN interpretation. The algorithm is tested on the CNN-based statistical downscaling of monthly precipitation with 20 candidate predictors and compared with a correlation analysisbased approach. Linear models are implemented as benchmarks. The experiments illustrate that the predictor selection solution can reduce the number of input predictors by more than half, improve the accuracy of both linear and CNN models,and outperform the correlation analysis method. Although the RMSE(root-mean-square error) is reduced by only 0.8%,only 9 out of 20 predictors are used to build the CNN, and the FLOPs(Floating Point Operations) decrease by 20.4%. The results imply that the algorithm can find subset predictors that correlate more to the monthly precipitation of the target area and seasons in a nonlinear way. It is worth mentioning that the algorithm is compatible with other CNN models with stacked variables as input and has the potential for nonlinear correlation predictor selection.
文摘Coronavirus disease 2019(COVID-19)has affected patients with pre-existing chronic liver disease(CLD)in various ways.The maximum impact was seen on patients with underlying cirrhosis who have shown to have poor clinical outcomes in the form of increased risk of hepatic decompensation,acute-onchronic liver failure,and even mortality.It is of paramount importance to identify various factors which are associated with unfavorable outcomes for prognostication and making informed management strategy.Many factors have been evaluated in different studies in patients with underlying CLD.Some of these factors include the severity of underlying chronic liver disease,comorbid conditions,age,and severity of COVID-19.Overall,the outcomes are not favorable in patients with cirrhosis as evidenced by data from various studies.The main purpose of this review is to identify the predictors of adverse clinical outcomes including mortality in patients with CLD for risk stratification,prognostication,and appropriate clinical management.
基金supported by the Estonian Research Council(PRG658)。
文摘The robust stability study of the classic Smith predictor-based control system for uncertain fractional-order plants with interval time delays and interval coefficients is the emphasis of this work.Interval uncertainties are a type of parametric uncertainties that cannot be avoided when modeling real-world plants.Also,in the considered Smith predictor control structure it is supposed that the controller is a fractional-order proportional integral derivative(FOPID)controller.To the best of the authors'knowledge,no method has been developed until now to analyze the robust stability of a Smith predictor based fractional-order control system in the presence of the simultaneous uncertainties in gain,time-constants,and time delay.The three primary contributions of this study are as follows:ⅰ)a set of necessary and sufficient conditions is constructed using a graphical method to examine the robust stability of a Smith predictor-based fractionalorder control system—the proposed method explicitly determines whether or not the FOPID controller can robustly stabilize the Smith predictor-based fractional-order control system;ⅱ)an auxiliary function as a robust stability testing function is presented to reduce the computational complexity of the robust stability analysis;andⅲ)two auxiliary functions are proposed to achieve the control requirements on the disturbance rejection and the noise reduction.Finally,four numerical examples and an experimental verification are presented in this study to demonstrate the efficacy and significance of the suggested technique.
文摘Background: Cancer patients frequently suffer from mental health problems because of their reactions to their cancer diagnosis, cancer type, treatment effects, recurrence, fear of the end-of-life, survival, and financial burden. Some hospitals have integrated mental health assessments into cancer care, but our centre has little experience with this practice. Aim and Objectives: To ascertain the prevalence and predictors of anxiety and depression in patients with gynaecological cancer at a tertiary health facility in southern Nigeria. Materials and Methods: This was a facility-based cross-sectional descriptive study of 75 women with histologically confirmed gynaecological cancer managed at the University of Port Harcourt Teaching Hospital, Port Harcourt, from January 1, 2022, to December 31, 2022. Individuals having a history of drug addiction, severe cognitive impairment, non-consenting patients, and those with communication difficulties were excluded from the study. A data collection form was used to obtain socio-demographic, reproductive, and clinical characteristics, while the Hospital Anxiety and Depression Scale (HADS) was used to assess for anxiety and depression. Data was analyzed using descriptive statistics to determine the association of variables with anxiety and depression. Results: Most 27 (36.0%) of the respondents were in 40 - 49 age group with a mean age of 50.4 ± 12.3 years. The study showed that 39 (52.0%) of the respondents exhibited symptoms of anxiety, of which 14 (35.9%) were mild, 20 (51.3%) had moderate anxiety and 5 (12.8%) experienced severe anxiety. In addition, 46 (61.3%) of them showed symptoms of depression, of which 17 (37.0%) were mild, 15 (32.6%) were moderate and 14 (30.4%) experienced severe depression. The ratio of respondents who showed anxiety to those that showed symptoms of depression was 5: 6. The factors associated with anxiety were partner’s educational level (X<sup>2</sup> = 4.745, p = 0.029), parity (X<sup>2</sup> = 6.651, p = 0.036) and duration of diagnosis (X<sup>2</sup> = 8.321, p = 0.004), while partner’s educational level (X<sup>2</sup> = 6.810, p = 0.009), parity (X<sup>2</sup> = 7.129, p = 0.028), age of coitarche (X<sup>2</sup> = 6.512, p = 0.039) and duration of diagnosis (X<sup>2</sup> = 4.955, p = 0.026) were significantly associated with depression. Conclusion: More than half of the respondents experienced anxiety, while about two-thirds experienced depression. There is a need to incorporate psychological evaluation into the care of gynaecological cancer patients.
文摘Background: Type 2 diabetes mellitus (T2DM) is currently a major global public health burden associated with elevated blood glucose. The use of herbal medicine in the management of type 2 diabetes is currently on the rise both in developed and developing countries. This study sets out to determine the prevalence of herbal medicine use and to identify the factors associated with herbal medicine use amongst type 2 diabetes patients. Methods: A community based cross-sectional study involves 123 adults living with type 2 diabetes (90 males and 30 females), mean age 58.7 ± 9.5 years in the Bamenda III health district of the North West Region of Cameroon. Data on the different types of herbs used, frequency and mode of herbal medicine use as well as reasons for using herbal medicines in the management of T2DM were assessed using a structured questionnaire. Anthropometric and diabetes related measurements were carried out following standard procedures. Logistic regression analysis was used to identify the independent predictors of herbal medicine use. Results: The prevalence of herbal medicine use was 24.4% (n = 30) amongst which 37.4 % used both herbs and orthodox medicine. A higher proportion of diabetic males used herbal medicines compared to females and this difference was significant (X<sup>2</sup> = 5.243, p X<sup>2</sup> = 10.75, p = 0.005). The most commonly used herbs were Vernonia amygdalina leaves (19.10%), Aloe vera (13.48%), Mangifera indica leaves (11.24%) including its bark and Carica papaya leaves (8.99%). Bivariate analysis indicated that being male (OR 2.8, 95% CI, 1.14 -6.79) and having attained secondary/tertiary education (OR 13.2, 95% CI, 1.6 - 29.9) were significantly (p 0.05) associated with herbal medicine use. Multivariate analysis revealed that having attained secondary /tertiary education (OR 10.5, 95% CI, 1.30 - 35.23) was an independent predictor of herbal medicine use in the study population. Conclusion: This study has demonstrated that amongst T2DM patients in Cameroon having attained secondary/tertiary education positively influences the use of herbal medicine in the management of T2DM.
文摘Background: Obesity, especially central obesity, is a major risk factor for cardiovascular diseases and type-2 diabetes, known for their significant morbidity and mortality. University students are at increased risk of obesity due to adoption of unhealthy lifestyles and school-related stress. However, there is scant information regarding the prevalence and risk factors of obesity among university students in Kenya. The study aimed to determine the prevalence and factors associated with general and abdominal obesity among undergraduate students of The Catholic University of Eastern Africa, Kenya. Methods: A cross-sectional study design was employed among undergraduate students (n = 245) of The Catholic University of Eastern Africa, Nairobi. A systematic random sampling method was used to select the study participants. Lifestyle risk factors associated with obesity were collected using a structured questionnaire adopted from the WHO STEP-wise approach to non-communicable disease risk factor surveillance. Anthropometric measures of weight, height, and waist circumference were appropriately measured. The data were analyzed using SPSS software (ver: 22). The chi-square test of independence and binary logistic regression was used to establish an association between dependent and independent variables. Results: The prevalence of general and abdominal obesity was 19.6% and 27.8%, respectively. Risk factors of general obesity were age ≥ 20 years (OR, 9.95;95% CI, 3.09 - 32.08, p < 0.001), sedentary lifestyle (OR, 11.36;95% CI, 2.08 - 61.96, p = 0.005), staying with parents (OR, 3.22;95% CI, 1.09 - 9.58, p = 0.035), consumption of fast/processed foods (OR, 7.83;95% CI, 1.90 - 32.21, p = 0.004). Risk factors for abdominal obesity were being female (OR, 38.76;95% CI, 5.07 - 296.54, p < 0.001), staying with parents (OR, 3.02;95% CI, 1.14 - 7.99, p = 0.026) and sedentary lifestyle (OR, 6.55;95% CI, 1.80 - 23.81, p = 0.004). Conclusion: Being female, sedentary lifestyle, and consumption of fast/processed foods were found as predictors of obesity. Behavioural intervention is required to mitigate the burden of obesity among university students in Kenya. This can be achieved through promoting intervention programmes that lead to changing the built environment, counseling, and behavioral-lifestyle modification of students.
文摘Objective:The present study aimed to identify predictive factors for mortality among elderly individuals infected with COVID-19.Methods and Materials:This historical cohort study was conducted from July to December 2021 in the specialized departments for COVID-19 patients at one of the hospitals in Mashhad,Iran.Data were collected from the medical records of 404 elderly patients.Sampling was conducted using the convenience sampling method.Data were gathered through a demographic and clinical checklist developed by the researcher.Univariate and multivariate Cox regression were used to analyze the data.Results:The mortality rate among elderly individuals was 25%(n=101).Multiple regression analysis revealed significant associations between mortality and age(hazard ratio[HR]=0.58,95%confidence interval[CI]:0.38,0.88;P=0.011),level of consciousness(HR=0.31,95%CI:0.19,0.50;P<0.001),and SpO2(HR=0.58,95%CI:0.37,0.92;P=0.022).The probability of survival after the 19th day of hospitalization was 50%.Conclusions:Determining predictors of death allows for early identification of elderly individuals at risk and enables the health-care team to provide more effective care,ultimately saving the lives of elderly individuals by allocating appropriate facilities and equipment.
