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Objective: To investigate the association between sarcopenia, short-term efficacy, and long-term survival in patients with extensive small-cell lung cancer (SCLC) treated with standard first-line immunochemotherapy. Methods: A total of 63 patients initially diagnosed with extensive-stage small cell lung cancer were enrolled in the prospective study from December 1, 2020 to December 31, 2022. The clinical characteristics, body composition, blood test results, and image data were obtained before treatment. Patients were divided into sarcopenia and non-sarcopenia groups according to the diagnostic criteria of the Asian Sarcopenia Working Group 2019. The primary outcome was overall survival (OS) and comprehensive survival analyses were performed. Secondary outcomes included short-term efficacy and adverse events associated with first-line immunochemotherapy. Results: The median age of the 63 patients enrolled in our study was 63.0 years (40–80 years). The incidence of sarcopenia was 19.0% (12/63) in patients with extensive SCLC. Compared with non-sarcopenia patients, extensive-stage SCLC patients with sarcopenia were significantly older (69.0 vs. 62.0, P = 0.017), and had lower body mass index (BMI) (20.29 vs. 24.27, P < 0.001), hand grip strength (HGS) (20.42 vs. 30.75, P < 0.001), and albumin (35.9 vs. 41.40, P < 0.001). The objective response rate after two cycles of standard first-line immunochemotherapy in the sarcopenia group was lower than in the non-sarcopenia group (30.0 vs. 78.9%, P = 0.012). There was no significant difference in chemotherapy-related hematological toxicity between the two groups. During a median follow-up of 15 months (3–33 months), patients with extensive SCLC had a median OS of 24 months, with 1-year survival of 75% and 2-year survival of 52%, respectively. Compared to non-sarcopenia patients, the median OS in the sarcopenia group was significantly shorter (9 vs. 24 months, P = 0.0014). Multivariate Cox analysis showed that sarcopenia was an independent risk factor for OS in patients with extensive SCLC (HR = 4.993, 95%CI = 1.106–22.538, P = 0.037). Conclusions: Patients with Extensive SCLC and sarcopenia had worse clinical outcomes and shorter OS. Sarcopenia is a prognostic factor affecting first-line treatment efficacy and long-term survival of patients with SCLC in the era of immunotherapy. [ABSTRACT FROM AUTHOR]

To investigate the relationships between inflammatory parameters, including neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and systemic immune-inflammation index (SII), and quantitative flow ratio (QFR) in stable coronary artery disease (CAD) patients (n = 450) enrolled in this cross-sectional study. Logistic regression was performed to evaluate the associations of NLR, PLR, MLR, and SII evaluated as continuous and binary variables with QFR ≤0.80. When treated as continuous variables, lnNLR was associated with QFR ≤0.80 with borderline significance in univariable (odds ratio (OR) = 1.60, p =.05) and multivariable analysis (OR = 1.72, p =.05), while lnMLR was associated with QFR ≤0.80 significantly in univariable analysis (OR = 1.87, p =.03) and with borderline significance in multivariable analysis (OR = 1.91, p =.05). When treated as binary variables, high levels of MLR and SII were significantly associated with QFR ≤0.80 in univariable (MLR: OR = 1.91, p =.02; SII: OR = 2.42, p =.006) and multivariable analysis (MLR: OR = 1.83, p =.04; SII: OR = 2.19, p =.02). NLR, MLR, and SII, but not PLR, were significantly associated with the severity of coronary physiology in stable CAD patients. [ABSTRACT FROM AUTHOR]

Background Despite rising hepatitis C virus (HCV) prevalence among pregnant individuals in the United States, HCV testing among exposed infants remains low. Although recent guidelines recommend early ribonucleic acid (RNA) testing for HCV-exposed children to help improve testing rates, national studies describing factors associated with HCV testing and the type of testing completed are lacking. Methods In this retrospective national study, we characterized HCV testing and care among HCV-exposed infants born between 2010 and 2020 captured in the electronic health record-based TriNetX Research Network. We analyzed factors associated with appropriate HCV testing completion (negative or positive HCV RNA testing or negative HCV antibody testing at any age through study end in 2022) and with RNA compared with antibody testing using univariable and multivariable logistic regression with clustered standard errors by healthcare organization. Results Of 8516 HCV-exposed children, 45.8% completed any HCV testing and 42.1% completed appropriate testing (25% of whom had RNA testing only). A total of 182 (5.1% of appropriately tested children) had evidence of HCV infection. Of 104 treatment-eligible children, 14.4% were treated. Black (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.26–0.55), Asian/Pacific Islander (OR: 0.06, 95% CI: 0.03–0.11), and Hispanic/Latinx (OR: 0.56, 95% CI: 0.36–0.88) children had lower odds of appropriate testing compared with White and non-Hispanic/Latinx children. Conclusions Fewer than half of HCV-exposed children in this national sample were tested for HCV, with lower testing odds among Black, Asian/Pacific Islander, and Hispanic/Latinx children. Substantial work to increase testing and treatment and decrease disparities in testing among HCV-exposed children is needed to help reach US HCV elimination goals. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze the association between environmental and occupational organochlorine pesticides (OCPs) exposure and Parkinson's disease (PD) risk. Systematic review and meta-analysis. A comprehensive search of articles before March 18, 2024, was conducted through PubMed, Cochrane, Embase, Medlin and Web of Science databases, and the relevant data were expressed as odds ratios (OR) and 95 % confidence intervals (CI). Newcastle-Ottawa Scale (NOS) was used to evaluate literature quality. STATA (Version 11.0) was used for analysis. This meta-analysis included 17 case-control studies. The results showed that OCPs exposure increased PD risk, including seven blood sample assessment exposure (BOCPs) studies (OR = 1.54, 95 % CI = 1.32–1.79) and 10 indirect assessment exposure (IOCPs) studies (OR = 1.19, 95 % CI = 1.04–1.35). Location subgroup analysis showed that OCPs was positively associated with PD risk in Asia, while there was no statistical significance in North America and Europe. The IOCPs functional subclasses subgroup results suggested that organochlorine insecticides were significantly associated with PD risk (OR = 1.18, 95%CI = 1.03–1.37). Study time may be a factor of high heterogeneity in BOCPs. In addition, BOCPs (OR = 1.49, 95%CI = 1.28–1.74) and IOCPs (OR = 1.10, 95%CI = 0.95–1.26) showed different results with PD risk. Study suggests that OCPs exposure may be a risk factor for PD, but there may be location and OCPs type differences. [ABSTRACT FROM AUTHOR]

Objective: Upper gastrointestinal bleeding (UGIB) has been identified as a potential adverse drug reaction associated with the use of low-dose aspirin (LDA). This study aimed to investigate the relationship between variants in the TBXA2R gene, which is involved in platelet aggregation, and the risk of UGIB in patients with cardiovascular diseases treated with LDA. Methods: A case-control study was conducted at a Brazilian hospital complex. Three groups were defined: (1) case group (n = 50): patients with cardiovascular disease who used LDA and were diagnosed with UGIB of non-variceal etiology, (2) LDA control group (n = 50): patients with cardiovascular disease who used LDA without developing UGIB, and (3) healthy control group (n = 189). Data were collected through face-to-face interviews, and blood samples were collected for the analysis of Helicobacter pylori infection and genotyping of 3 genetic variants [rs2238631 (C > T), rs4807491 (A > G), and rs1131882 (A > G)]. Results: The case group had a significantly higher frequency of carriers of the rs4807491.G allele compared to the control group of LDA users (P -value =.004). No significant difference was observed in the proportion of carriers of the rs2238631.T and 1131882.G variants between the studied groups. Carriers of rs2238631.T (OR: 4.515, 95% CI: 1.37-14.89) and rs4807491.G allele (OR: 3.232, 95% CI: 1.12-9.37) exhibited a higher risk of UGIB. Conclusion: These findings suggest that the presence of the rs2238631 and rs4807491 variant alleles is associates with a 3- to 4-fold increased risk of UGIB in patients with cardiovascular diseases treated with LDA. Future studies with larger sample sizes should confirm these results and to better identify individuals who may benefit from chronic LDA use. [ABSTRACT FROM AUTHOR]

Background and Aims: Meningitis in immunocompromised patients is a significant cause of mortality and morbidity. In HIV-infected cases, it is majorly of infectious origin, with Cryptococcus neoformans and Mycobacterium tuberculosis being two opportunistic pathogens together accounting for about 75% of meningitis cases. However, other variants like bacterial, aseptic, fungal or acanthamoeba meningitis can also occur in patients with HIV. The present study aimed to observe the clinical profile and aetiology of different types of meningitis in HIV-infected patients. Methods: A cross-sectional observational study included HIV-infected patients with symptoms and signs suggestive of meningitis. Patients were then assessed according to clinical, blood and CSF biochemical, blood and CSF microbiological and/special test parameter and/or radiological parameters. Data was statistically analysed. Results: Of 120 patients included, a majority belonged to the age group 26–49 years. Common presenting features included headache, fever, photophobia, neck stiffness and altered mental status. Various aetiologies of the cases included 55% cases of cryptococcal meningitis, 38.33% cases of tubercular meningitis, 3.33% cases of tubercular/cryptococcal co-infection meningitis and 1.66% cases of syphilis and pyogenic infection each. CSF findings suggested elevated opening pressure in 64.16% cases, followed by positive serum CrAg in 63.33% cases. CSF CrAg and India ink were positive, and budding yeast cell was seen in 58.33% cases. Conclusion: Tuberculosis and cryptococcal meningitis continue to be the prevailing culprits of meningitis in individuals with HIV. As treatment is readily available for these infections, early suspicion and prompt diagnosis coupled with effective early initiation of treatment can improve the lifespan of these patients. [ABSTRACT FROM AUTHOR]

Analyse the association between the use of diagnostic tests and the characteristics of older patients 65 years of age or more who consult the emergency department (ED). We performed an analysis of the EDEN cohort that includes patients who consulted 52 Spanish EDs. The association of age, sex, and ageing characteristics with the use of diagnostic tests (blood tests, electrocardiogram (ECG), microbiological cultures, X-ray, computed tomography, ultrasound, invasive techniques) was studied. The association was analysed by calculating the adjusted odds ratios (aOR) and their 95 % confidence intervals (CI) using a logistic regression model. A total of 25,557 patients were analysed. There was an increase in the use of diagnostic tests based on age, with an aOR for blood test of 1.805 (95 %CI 1.671 – 1.950), ECG 1.793 (95 %CI 1.664 – 1.932) and X-ray 1.707 (95 %CI 1.583 – 1.840) in the group of 85 years or more. The use of diagnostic tests is lower in the female population. Most ageing characteristics (cognitive impairment, previous falls, polypharmacy, dependence, and comorbidity) were independently associated with increased use of diagnostic tests. Age, and the characteristics of ageing itself are generally associated with a greater use of diagnostic tests in the ED. [ABSTRACT FROM AUTHOR]

Objective: This study aims to determine the association between anthropometric values and laboratory tests with parasitosis diagnosis and identify diagnostic models for parasitosis without relying on copro-parasitological examinations. Methods: Data were collected from 1894 children aged 0–14 who attended a medical center for low-income children in Lima, Peru, between 2021 and 2022. Anthropometric data (BMI, weight, height), laboratory data (red blood cells, hemoglobin, platelets, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, eosinophils), and parasitological examination results were analyzed. Prevalence ratios for the association between parasitosis and each anthropometric and laboratory variable were estimated using multivariable Poisson regression. Regression models were developed for each type of parasite found, and the diagnostic value was assessed using ROC curves. Results: A high prevalence of parasitosis was identified (41.9%), including Blastocystis hominis (29.1%), Endolimax nana (7.76%), Entamoeba coli (5.97%), Giardia duodenalis (6.44%), and Enterobius vermicularis (1.85%). It was found that the male sex (PRa 1.18), the age group of 2–5 years (PRa 4.83) and >5 years (PRa 4.59), the percentage of eosinophils (PRa 1.02 for every 1% increase), and height/age with −5 SD (PRa 1.34) were associated with a greater risk of parasitosis. Satisfactory values were only shown for diagnostic models associating Enterobius vermicularis and BMI, with a diagnostic value of 70.9% and 70.2% for a BMI < 12 and hematocrit > 29.8%, and BMI < 12 and hemoglobin < 10.6 g/L, respectively. Conclusions: Satisfactory diagnostic value models were only found for parasitosis by Enterobius vermicularis, suggesting the potential for reducing reliance on copro-parasitological exams in resource-limited settings. [ABSTRACT FROM AUTHOR]

Introduction: The British HIV Association (BHIVA) guidelines were amended during the coronavirus (COVID‐19) pandemic, allowing for less frequent monitoring of routine bloods. We assessed the impact of this on patient outcomes. Methods: Between April 2020 and March 2021, routine blood appointments at our HIV clinic were replaced by virtual consultations in 'stable' people living with HIV (PLWH), defined using standard operating procedure (SOP) criteria. All had an undetectable HIV viral load (VL) (<50 copies/mL). Demographic, HIV clinical information, and antiretroviral treatment (ART) data were collated using the electronic patient record (EPR). Blood results from before (baseline) and after (follow‐up) the omitted appointment were analysed for each parameter. Results: In all, 791/2395 PLWH were scheduled to have blood tests omitted; 381 were excluded for reasons including not fitting the SOP criteria or presenting to clinic early, and 410 were included in analysis. The demographics of the group were consistent with our whole HIV cohort. HIV VL became detectable in 8/410 individuals (1.95%, range 51–730 copies/mL). VL resuppressed in 6/8 after a median of 29 days. VL remained detectable in two individuals, both of whom remain in care. Routine blood monitoring revealed baseline and follow‐up blood parameters that were largely within normal range. Four out of 12 parameters had statistically significant changes but were not considered clinically significant; 59/410 (14.4%) changed ART, most commonly for simplification. Conclusion: For the majority of stable PLWH included in our evaluation, the omission of routine blood monitoring during the pandemic did not have a negative impact on HIV suppression or blood monitoring outcomes. ART switch was uncommon. [ABSTRACT FROM AUTHOR]

The article discusses a study aimed at understanding the dynamics of neutralizing antibodies (NAb) and S-receptor binding protein (SRBD) antibodies in individuals receiving the BNT162b2 mRNA COVID-19 vaccine. Topics include the study's objective to examine factors influencing antibody levels after vaccination, the methods used in the study, including a cohort of 243 healthcare workers, and the importance of identifying strategies for antibody assay testing to improve clinical practices.

This study aimed to assess hemoglobin concentration and its association with oral contraceptive (OC) use, food insecurity (FI) and dietary iron availability (DIA) in adult women of reproductive age (20–44 years). This is a population-based cross-sectional study that analysed 505 women living in favelas and urban communities in a capital city in northeastern Brazil. Hemoglobin concentration was determined using capillary blood samples. FI and DIA were assessed using the Brazilian Food Insecurity Scale and the 24-h food recall, respectively. Association analysis was carried out using logistic regression. A directed acyclic graph (DAG) was designed to illustrate the causal paths between hemoglobin concentration and DIA. A significance level of 5 % was adopted. Low hemoglobin concentrations (11·2 g/dl: (1·79)) and a high prevalence of anaemia (64·0 %) were observed; 28·7 % used OC (28·7 %) and 76·4 % were in FI. An average energetic intake of 1495 kcal/d (482·0) and 0·46 mg/d (0·27) of DIA were also observed. In the DAG-guided multivariable analysis, it was observed that hemoglobin concentrations ≥ 12 mg/dl were directly associated with higher DIA (OR: 1·67; 95 % CI (1. 08, 2·59)) and OC use (OR: 1·67; 95 % CI (1·10, 2·55)) and inversely associated with mild FI (OR: 0·60; 95 % CI (0·37, 0·96)) or severe FI (OR: 0·37; 95 % CI: (0·18, 0·76)). Women taking OC and with a higher DIA were less likely to have low hemoglobin concentrations, while those in the context of FI were in the opposite situation. [ABSTRACT FROM AUTHOR]

Context Histidine-containing dipeptides (carnosine, anserine, beta-alanine and others) are found in human muscle tissue and other organs like the brain. Data in rodents and humans indicate that administration of exogenous carnosine improved cognitive performance. However, RCTs results vary. Objectives To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of histidine-containing dipeptide (HCD) supplementation on cognitive performance in humans to assess its utility as a cognitive stabiliser. Data Sources OVID Medline, Medline, EBM Reviews, Embase, and Cumulative Index to Nursing and Allied Health Literature databases from 1/1/1965 to 1/6/2022 for all RCT of HCDs were searched. Data Extraction 2653 abstracts were screened, identifying 94 full-text articles which were assessed for eligibility. Ten articles reporting the use of HCD supplementation were meta-analysed. Data Analysis The random effects model has been applied using the DerSimonian-Laird method. HCD treatment significantly increased performance on Wechsler Memory Scale (WMS) −2 Delayed recall (Weighted mean difference (WMD) (95% CI (CI)) = 1.5 (0.6, 2.5), P < .01). Treatment with HCDs had no effect on Alzheimer's Disease Assessment Scale-Cognitive (WMD (95% CI) = −0.2 (−1.1, 0.7), P = .65, I2 = 0%), Mini-Mental State Examination (WMD (95% CI) = 0.7 (−0.2, 1.5), P = .14, I2 = 42%), The Wechsler Adult Intelligence Scale (WAIS) Digit span Backward (WMD (95% CI) = 0.1 (−0.3, 0.5), P = .51, I2 = 0%), WAIS digit span Forward (WMD (95% CI) = 0.0 (−0.3, 0.4), P = .85, I2 = 33%) and the WMS-1 Immediate recall (WMD (95% CI) = .7 (−.2, 1.5), P = .11, I2 = 0%). The effect on delayed recall remained in subgroup meta-analysis performed on studies of patients without mild cognitive impairment (MCI), and in those without MCI where average age in the study was above 65. Conclusion HCD, supplementation improved scores on the Delayed recall examination, a neuropsychological test affected early in Alzheimer's disease. Further studies are needed in people with early cognitive impairment with longer follow-up duration and standardization of carnosine doses to delineate the true effect. Systematic Review Registration PROSPERO registration no. CRD42017075354. [ABSTRACT FROM AUTHOR]

BACKGROUND: Folic acid (FA) supplementation may attenuate the associations between gestational exposure to certain chemicals and autism or autistic-like behaviors, but to our knowledge, this has not been assessed for lead. OBJECTIVES: We examined whether the relationship between gestational blood-lead levels (BLLs) and autistic-like behaviors was modified by gestational plasma total folate concentrations, FA supplementation, and maternal methylenetetrahydrofolate reductase (MTHFR) 677C>T genotype. METHODS: We used data from the Maternal–Infant Research on Environmental Chemicals study (2008–2011), a Canadian pregnancy and birth cohort study. Childhood autistic-like behaviors were documented in 601 children 3–4 y of age with the Social Responsiveness Scale-2 (SRS-2), where higher scores denote more autistic-like behaviors. We measured BLLs and plasma total folate concentrations during the first and third trimesters of pregnancy. We also estimated gestational FA supplementation via surveys and genotyped the maternal MTHFR 677C>T single nucleotide polymorphism (SNP). We estimated the confounder-adjusted associations between log2-transformed BLLs and SRS-2 scores by two indicators of folate exposure and maternal MTHFR 677C>T genotype using linear regression. RESULTS: Third-trimester BLLs were associated with increased SRS-2 scores [β[sub 푎푑푗] = 3.3; 95% confidence interval (CI): 1.1, 5.5] among participants with low (<10th percentile), third-trimester, plasma total folate concentrations, but BLL-SRS-2 associations were null (β[sub 푎푑푗] = -0.3; 95% CI: -1.2, 0.5) among those in the middle category (≥10th and <80th percentiles) (푝-interaction <0.001). FA supplementation also attenuated these associations. Both folate indicators modified first-trimester BLL-SRS-2 associations, but to a lesser extent. Third-trimester BLL-SRS-2 associations were slightly stronger among participants who were homozygous for the T (minor) allele of the MTHFR 677C>T SNP (β[sub 푎푑푗]= 0.9; 95% CI: -1.2, 3.1) than those without the T allele (β[sub 푎푑푗] = -0.3; 95% CI: -1.3, 0.7), but the difference was not statistically significant (푝-interaction = 0.28). DISCUSSION: Folate may modify the associations between gestational lead exposure and childhood autistic-like behaviors, suggesting that it mitigates the neurotoxic effects of prenatal lead exposure. [ABSTRACT FROM AUTHOR]

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significant global health burden without established curative therapies. Early detection and preventive strategies are crucial for effective MASLD management. This study aimed to develop and validate machine-learning (ML) algorithms for accurate MASLD screening in a geographically diverse, large-scale population. Methods: Data from the prospective Fasa Cohort Study, initiated in rural Fars province, Iran (March 2014), were employed for this purpose. The required data were collected using blood tests, questionnaires, liver ultrasonography, and physical examinations. A two-step approach identified key predictors from over 100 variables: (1) statistical selection using mean decrease Gini in random forest and (2) incorporation of clinical expertise for alignment with known MASLD risk factors. The hold-out validation approach (with a 70/30 train/validation split) was utilized, along with 5-fold cross-validation on the validation set. Logistic regression, Naïve Bayes, support vector machine, and light gradient-boosting machine (LightGBM) algorithms were compared for model construction with the same input variables based on area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Results: A total of 6,180 adults (52.7% female) were included in the study, categorized into 4816 non-MASLD and 1364 MASLD cases with a mean age (± standard deviation [SD]) of 48.12 (± 9.61) and 49.47 (± 9.15) years, respectively. Logistic regression outperformed other ML algorithms, achieving an accuracy of 0.88 (95% confidence interval [CI]: 0.86-0.89) and an AUC of 0.92 (95% CI: 0.90-0.93). Among more than 100 variables, the key predictors included waist circumference, body mass index (BMI), hip circumference, wrist circumference, alanine aminotransferase levels, cholesterol, glucose, high-density lipoprotein, and blood pressure. Conclusion: Integration of ML in MASLD management holds significant promise, particularly in resource-limited rural settings. Additionally, the relative importance assigned to each predictor, particularly prominent contributors such as waist circumference and BMI, offers valuable insights into MASLD prevention, diagnosis, and treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: In 2018, the Australasian College for Emergency Medicine (ACEM) and the Royal College of Pathologists of Australasia (RCPA) produced a guideline to encourage appropriate pathology requesting in the Emergency Department (ED). Objective: To assess adherence to the ACEM/RCPA pathology testing guideline in a regional ED. Methods, Design, Setting and Participants: This was a retrospective observational study conducted at a regional Australian ED over 7 days. Adults with a presenting complaint encompassed by the guideline were included. All blood tests were audited against the guideline recommendations and classified as indicated or non‐indicated. Chi‐squared analyses were performed to explore the association between presenting complaint and non‐indicated testing. Main Outcome Measure: The primary outcome was the number of non‐indicated blood tests. Results: Forty percent of tests ordered were not clinically indicated, with non‐indicated testing occurring during 87% of encounters. The C‐reactive protein (CRP) was the test most frequently ordered outside of guidelines (94% non‐indicated). Patients presenting with lower abdominal pain accounted for nearly one‐quarter of all non‐indicated tests. Conclusions: Blood tests were commonly requested outside of the guideline recommendations and interventions to improve pathology stewardship are required. [ABSTRACT FROM AUTHOR]

Background and Aims: The natural history of untreated patients with type 1 Gaucher disease (GD1) is not well documented, and there is controversy over when and how to treat such patients, especially if they are only mildly symptomatic. Treatment of GD1 is inconvenient, very costly, and may result in undesirable side effects. We documented the clinical history of 31 untreated patients with GD1 followed in our clinic for 4–26 (median 15) years. Methods: This was a retrospective, observational study of the progress of untreated adult patients with GD1 followed by blood tests (haemoglobin, platelet counts, ferritin and chitotriosidase), organ volumes (spleen and liver), bone manifestations (through magnetic resonance imaging and dual X‐ray absorptiometry scans) and neurological and quality of life issues. Statistical analyses were performed with the use of the Student paired t test and the modified Wald test for 95% confidence intervals. Results: We found that the above parameters remained stable in most patients over a period of 4–26 (median 15) years. Five patients progressed from normal bone density to osteopenia and two from osteopenia to osteofibrosis; six were peri‐ or post‐menopausal females. The DS‐3 was stable over time. Only four of the 31 patients were started on enzyme or substrate reduction therapy. Conclusions: Our results demonstrate that many patients with GD1, provided with close follow‐up by a specialist centre, can be followed for many years without requiring treatment and with no or minimal worsening of their GD1 manifestations. [ABSTRACT FROM AUTHOR]

Background: Patients with gastric cancer (GC) who underwent radical surgery require long-term follow-up (usually 5 years). The purpose of this study was to explore individualized follow-up strategies for patients with GC. Methods: This is a retrospective cohort study that established a clinicopathologic database of patients who underwent gastrectomy from January 2010 to December 2020 at Ningbo No. 2 Hospital. Follow-up was performed until March 2023. The rate of new-onset recurrence of patients with GC was explored annually according to different pTNM stages, defining a recurrence rate of less than 1% as adequate follow-up time. Results: Of the 1606 patients who were eligible, the total number of patients who completed the 5- and 10-year follow-up was 1107 and 586, respectively. A total of 444 cases were diagnosed with recurrence. The recurrence rate for stage IA patients was consistently less than 1% during the follow-up time. The adequate follow-up time (the rate of new-onset recurrence less than 1%) was 5 years for stage IB and IIA patients, and 8 years for stage IIB and IIIA patients, respectively. In contrast, stage IIIB patients were always at risk of recurrence during the follow-up time (>1%). Time to a new recurrence rate for stage IIIC patients was 6 years. Conclusion: Among patients who underwent radical gastrectomy, the rate of new-onset recurrence varied among patients with different pTNM stages. This study suggests that the follow-up of GC can be individualized and refer to pTNM stage. [ABSTRACT FROM AUTHOR]

Purpose: Dyslipidemia is a major health issue worldwide. There is growing interest in understanding the potential role of kimchi consumption on serum lipid profiles. However, there are limited epidemiological studies available on this topic. Therefore, this study aims to investigate the association between kimchi intake and serum lipid profiles. Methods: We conducted an epidemiological study on participants (aged 40–69 years old) selected from the Health Examinees (HEXA) cohort study (n = 61,761). Four types of kimchi, including Baechu kimchi (cabbage kimchi), Kkakdugi (radish kimchi), Nabak kimchi/Dongchimi (a type of water kimchi made with fermented vegetables), and other kimchi, were assessed by a 106-food item semi-quantitative validated food frequency questionnaire (FFQ). Each kimchi intake is the average value calculated from the FFQ of the baseline and follow-up surveys. Fasting blood data were obtained at baseline and follow-up visits. Linear regression was used to examine the relationship between the intake of kimchi and the change in serum lipid profiles. Results: The mean years between the baseline survey and a follow-up survey was 4.97 years. In this study, compared to the lowest category (< 1 serving/day), Baechu kimchi intake (2− < 3 servings/day) had more negative correlations with the change in values of total cholesterol (β: −1.600, 95% confidence interval [CI, −2.744, −0.456]), triglycerides (β: −3.372, 95% CI [−5.414, −1.330]), and low-density lipoprotein cholesterol (β: −1.155, 95% CI [−2.214, −0.095]) in women. In men, Baechu kimchi intake (2− < 3 servings/day) had a more positive correlation associated with the changes in values of high-density lipoprotein cholesterol (β: 0.049, 95% CI [0.031, 0.907]) compared to the lowest intake category (< 1 serving/day). Conclusions: Among Korean adults, consumption of kimchi, particularly Baechu kimchi, was found to be associated with improvements in serum lipid profiles. Further studies are required to conduct additional interventions to confirm the association between kimchi and serum lipid profiles. [ABSTRACT FROM AUTHOR]

The article presents letter to the editor focuses on comparing blood cell counts in leukemoid reaction (LR) and chronic myeloid leukemia (CML) using Scopio blood cell counter and statistical analysis. Topics include the diagnostic challenges between LR and CML, the morphological and statistical differences in white blood cell counts, and the study's implications for clinical practice, highlighting its contribution to medical literature and the need for further multi-institutional studies.

Purpose: This study investigated the associations between intermediate hyperglycemia (IH) and increased body mass index (BMI), abdominal obesity (AO), high-sensitivity C-reactive protein (hs-CRP), and leptin levels in Korean adults. Methods: The participants were 248 adults (≥ 19 years) who understood the purpose of the study, had no cognitive impairment, and were able to communicate. Physical examinations, BMI, AO measurements, and blood tests were performed. Data were analyzed using the t-test, chi-square test, Pearson correlation coefficients, and multiple logistic regression analyses. The risk factors for IH were predicted after adjusting for BMI, waist circumference (WC), age, hs-CRP and leptin levels, education, and economic status. Results: WC, hs-CRP and leptin levels, and age were higher in the IH group than in the non-IH group. According to the multiple logistic regression analysis, the factors affecting IH prevalence were WC, hs-CRP, leptin, and age. AO (male, WC ≥ 90 cm; female, WC ≥ 85 cm) exhibited an adjusted odds ratio of 5.45 for IH. IH was 2.43 times higher in those with hs-CRP > 3 mg than in those with hs-CRP < 1 mg. As leptin levels increased, the odds ratio for IH increased by 3.05 times. IH was 8.07, 8.79, 18.42, and 35.33 times more common for those in their 30s, 40s, 50s, and ≥ 60 years of age, respectively, than those 19-29 years old. Conclusion: This study provides evidence that interventions for AO should be included in IH management programs. Identifying the predictive factors for IH may contribute to the early detection of type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study was conducted to identify factors associated with repeated suicide attempts by analyzing the electronic medical records of suicide attempters who visited emergency medical centers due to drug intoxication. Methods: Data from January 1, 2020 to December 31, 2021 were collected for this study and analyzed using SPSS/WIN 25.0. Results: In this study, the factors affecting repeated suicide attempts among individuals who visited the emergency medical center due to acute drug intoxication were the presence or absence of psychiatric diseases, the season of drug intoxication, and age. In order to identify the factors affecting repeated suicide attempts in those who presented with acute drug intoxication, logistic regression analysis was performed by inputting psychiatric diseases, season of drug intoxication, and age, all of which exhibited significant differences between those who did and did not attempt suicide again. The presence of psychiatric diseases (odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.04~3.80), intoxication occurring in the fall (vs. spring; OR = 3.35, 95% CI = 1.28~8.75), and age ≥ 65 (vs. those under the age of 18; OR = 12.96, 95% CI = 2.02~83.17). The regression model was found to be statistically significant (F = 30.01, p < .001), and the coefficient of determination of Cox and Snell, which represents the explanatory power of the model, was 12.0%. Conclusion: This study suggests that to prevent repeated suicide attempts, it is necessary to develop a tool to evaluate the risk of suicide, use it to evaluate the risk of suicide, and then manage individuals accordingly. [ABSTRACT FROM AUTHOR]

Background: A serious complication after knee arthroscopy is venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). However, asymptomatic VTE is frequently undetected. Purpose: To (1) report the incidence of VTE after knee arthroscopy using ultrasound examination and computed tomography pulmonary angiography (CTPA) and (2) discover the independent risk factors of VTE after knee arthroscopy and determine the corresponding cutoff values of these indicators. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 222 patients (115 male) who underwent arthroscopic knee procedures between October 2022 and January 2023. Baseline characteristics, blood test results, and VTE assessments were collected. During the 2-week follow-up, routine lower extremity vascular ultrasound was applied for DVT measurement, with CTPA evaluation for suspected PE. Patients were allocated into VTE and no-VTE groups, and descriptive statistics were used to analyze baseline data. Logistic regression analysis was used to determine the correlation between binary variables and the presence of postoperative VTE. Multivariate logistic regression analysis was further performed to determine the independent risk factors of VTE. Results: Of the 222 patients, 37 (16.7%) had DVT and 1 (0.5%) had both DVT and PE. Compared to the no-VTE group, the VTE group was significantly older, with more female patients; higher body mass index (BMI) and postoperative D-dimer level; and higher rates of hypertension, hyperlipidemia, varicose veins of the lower extremity, and abnormal postoperative fibrin degradation product level (P ≤.043 for all). Notably, operative time >20 minutes was not significantly associated with postoperative VTE (P =.513). The independent risk factors for VTE included age >32 years (odds ratio [OR], 20.71 [95% CI, 4.40-97.47]; P <.001), BMI >23 kg/m2 (OR, 3.52 [95% CI, 1.11-11.14]; P =.032), hyperlipidemia (OR, 6.81 [95% CI, 1.86-24.88]; P =.004), and postoperative D-dimer level >0.63 mg/L (OR, 34.01 [95% CI, 7.36-157.07]; P <.001). Conclusion: The incidence of VTE after knee arthroscopy was 16.7% at the 2-week follow-up. Age >32 years, BMI >23 kg/m2, hyperlipidemia, and postoperative D-dimer >0.63 mg/L were independent risk factors of postoperative VTE within 2 weeks after knee arthroscopy. For patients with knee arthroscopy, the cutoff value of postoperative D-dimer for VTE was found to be 0.63 mg/L for timely intervention. [ABSTRACT FROM AUTHOR]

Introduction: Osteoarthritis of the knee (OA knee) is a common geriatric disease that require total knee arthroplasty. Periprosthetic fracture is one of the common complications, which is strongly related to metabolic bone disease. Materials and methods: We conducted a prospective study on 291 outpatients with OA knee between November 2020 and April 2021. Baseline characteristics, dual-energy X-ray absorptiometry and blood test results were analysed using logistic regression analysis and expressed as odds ratio, 95% confidence intervals and P -values. Results: Overall metabolic bone diseases were found in 82.91% of patients. Vitamin D insufficiency (53.38%) was the most prevalent, followed by osteopenia (44.38%), impaired renal function (26.69%), and osteoporosis (17.45%). Risk factors of vitamin D insufficiency are age ≥71 years (OR 0.33, P = 0.003) and bilateral affected side (OR 1.99, P = 0.007). For osteopenia and osteoporosis, risk factors were age, body mass index, affected side, and chronic kidney disease (P < 0.05). Discussion: In the aspect of Vit D insufficiency, age>70 and bilateral OA knee were significantly related in many ways, such as reduction in cutaneous synthesis and daily exposure to sunlight and various diseases, including CKD and GI malabsorption. The risk factors of osteopenia and osteoporosis can be explained throughout several mechanisms. For instance, abnormality in hormone and cytokines metabolism will lead to the increase in adipocyte differentiation and fat accumulation. And that situation may lead to the decrease in osteoblast differentiation and increased osteoclast activity which could lead to negative impact on bone strength. Conclusions: Metabolic bone diseases were common in most patients with OA knee, and the insufficiency in amount of vitamin D(serum 25-hydroxyvitamin D), osteoporosis, and osteopenia conditions were mainly identified. These preventable conditions have risk factors that are mostly correctable These preventable conditions have risk factors that are mostly correctable, for example gain more outdoor activities, consume vitamin D supplement or start osteoporosis treatment program. Further analysis is necessary to establish solid evidence in the comparison of risk factors between the OA and non-OA groups. [ABSTRACT FROM AUTHOR]

Background: Children's urinary system stones may develop from environmental, metabolic, anatomical, and other causes. Our objective is to determine the recurrence and prognosis, demographic, clinical, and etiological characteristics of children with urolithiasis. Methods: Medical records of patients were evaluated retrospectively. Patients' demographic data and medical history, serum/urine biochemical and metabolic analysis, blood gas analysis, stone analysis, imaging findings, and medical/surgical treatments were recorded. Results: The study included 364 patients (male 187). Median age at diagnosis was 2.83 (IQR 0.83–8.08) years. The most common complaints were urinary tract infection (23%) and urine discoloration (12%). Sixty-two percent had a family history of stone disease. At least one metabolic disorder was found in 120 (88%) of 137 patients having all metabolic analyses: hypercalciuria was found in 45%, hypocitraturia in 39%, and hyperoxaluria in 37%. Anatomical abnormalities were detected in 18% of patients. Of 58 stones analyzed, 65.5% were calcium and 20.6% were cystine stones. Stone recurrence rate was 15% (55/364). Older age (> 5 years), family history of stone disease, stone size (≥ 5 mm), and urinary system anatomical abnormalities were significantly associated with stone recurrence (p = 0.027, p = 0.031, p < 0.001, and p < 0.001, respectively). In adjusted logistic regression analysis, stone size ≥ 5 mm (OR 4.85, 95% CI 2.53–9.3), presence of urinary system anatomical abnormalities (OR 2.89, 95% CI 1.44–5.78), and family history of stone disease (OR 2.41, 95% CI 1.19–4.86) had increased recurrence rate. Conclusions: All children with urolithiasis should be evaluated for factors affecting stone recurrence. Children at higher risk of recurrence need to be followed carefully. [ABSTRACT FROM AUTHOR]

Using pesticides in the An Giang province is widespread. However, studies on the health effect of organophosphate pesticide have not been updated within the past 12 years. This study aimed to assess exposure to organophosphate pesticides and their effects on sperm quality among farmers in the An Giang Province, Mekong Delta, Vietnam. During the winter – spring crop season of December 2021 to February 2022, a cross-sectional study was conducted on farmers aged 18 to 60 years-old based on seven communes' health checkup programs. The pesticide spray group included farmers who had sprayed pesticides in the previous week and had a history of working in agriculture for more than 2 years. The control group was defined as those who lived in the same community, had not worked in agriculture, and had never sprayed pesticides. Demographic characteristics and blood, urine, and semen samples were collected and analyzed. Data for 184 eligible participants were analyzed, including 116 farmers in the pesticide spray group and 68 non-farmers in the control group. Pesticide spray contributed to a decrease in the sperm quality index of 6.253 units (95% CI, 4.472–8.749). Increasing each pseudocholinesterase (PChE) unit (kIU/L) was associated with an increase of 1.181 units in the sperm quality index (95% CI, 0.757–0.947). Preventive methods for organophosphate pesticide exposure, such as administrative controls, engineering controls, substitution, and personal protective equipment should be applied to control health risks. In the An Giang setting, personal protective equipment is feasible, but most types of equipment are not used. The immediate priority is to determine the cause of personal protective equipment not being used and to find solutions to encourage people to use them. [ABSTRACT FROM AUTHOR]

Purpose: Malaria is one of the febrile illnesses and the most common fatal disease in the world caused by one or more species of Plasmodium. Because malaria and typhoid fever usually display similar symptoms, malaria patients are likely to be suspected of typhoid fever, especially when they do not respond to the malaria first line medication. To determine the prevalence of malaria infection among patients suspected of typhoid fever in the Bamenda and Bafousam regional hospitals. Methodology: This study was a descriptive cross sectional study in which participants were recruited by convenience. The population for this study was volunteer patients suspected of typhoid fever by the respective hospital physicians. Blood samples were collected and Rapid Diagnostic Test was carried out, as well as thin and thick blood films. Data was analyzed using SPSS V20.0. Chi-square test was used to assess the association between results with a p-value of 0.05 considered significant at 95% confidence interval. Results: A total of 356 patients suspected of typhoid fever were contacted for the study of which 337 signed the consent form and took part in the study from the two targetted Regional Hospitals giving a participation rate of 94.66%. Among the participants, 195[57.9%] were from the Bamenda regional hospital while 142[42.1%] were from the Bafoussam regional hospital. Majority 65.9% of the participants were females recorded in both hospitals. An overall prevalence of 37.4% was recorded in both the Bafoussam and Bamenda regional hospital there was thus no statistical significant difference between the result gotten from the two Regional Hospitals [p=0.3]. The age group with the highest prevalence was that of 10-29 years. More than 90% of infections were caused by Plasmodium falciparum while about 3% of the infections were due to Plasmodium vivax. The prevalence of malaria infections in patients suspected of typhoid fever in the Bamenda and Bafoussam Regional Hospitals is 37.4%, and more women were infected than males. Unique Contribution to Theory, Practice and Policy: We advocated that proper malaria investigation of suspected cases should be carried out before embarking into typhoid fever treatment. This study have saved as an eye opener to medical practitioners to test both typhoid and malaria for all patients presenting with such signs and symptoms. [ABSTRACT FROM AUTHOR]

BACKGROUND: Thalassemia is an inherited disorder that is also called mediterranean anemia and is described by a lack of hemoglobin synthesis. β-thalassemia is more common in people of certain origins, particularly those from the Mediterranean region and Arabian Peninsula. The NRAMP1 protein in membranes catalyzes the exit of divalent metal ions from phagolysosomes and their entry into the cytoplasm, including iron and manganese. AIMS: To investigate the possible link between beta-thalassemia major (β-TM) illness and the single-nucleotide polymorphism (3′ untranslated region) rs3 of the NRAMP1 gene. MATERIALS AND METHODS: To investigate the relationship between the condition β-TM and the NRAMP1 gene, the study used restriction fragment length polymorphisms-polymerase chain reaction. The enzyme-linked fluorescent assay was used to quantify the ferritin level. A hematology analyzer was used to quantify hemoglobin concentration. A spectrophotometer technique was used to assess the serum iron, serum total iron-binding capacity (TIBC), and serum unsaturated iron-binding capacity. RESULTS: The results showed a difference in hemoglobin and serum iron levels, serum unbound iron-binding capacity, serum TIBC, and ferritin concentration between individuals suffering from β-thalassemia and healthy groups. In NRAMP1 gene polymorphism, a highly significant difference was observed between the distribution of two alleles (TG− 244 bp, and TG+ 211 bp). CONCLUSION: During an investigation of NRAMP1 gene polymorphism, a significant variance was observed between β-thalassemia and control groups. Those who carried the (244 bp −TG) allele were found to have a 3.6 times higher risk of developing complications of β-TM than those who carried the (211 bp −TG+) allele. [ABSTRACT FROM AUTHOR]

Background and Design: Hematological parameters have been used as laboratory markers to evaluate the systemic inflammation in several rheumatic disease. The aim of this study is to determine the difference of hematological parameters between the patients who have been just fulfilled the Behçet's disease (BD) criteria and patients with recurrent aphthous stomatitis (RAS). Materials and Methods: Twenty patients with newly diagnosed BD and 47 patients with RAS whose oral ulcerations appeared at least three times a year were enrolled in this cross-sectional study. Demographic and clinical characteristics of patients, complete blood count, C-reactive protein (CRP) and erythrocyte sedimentation rate were recorded. Results: Patients' characteristics including gender, age, duration, and frequency of oral aphthous ulcerations in both study groups were comparable (p>0.05). CRP was significantly higher in newly diagnosed BD group when compared to the RAS group (p=0.001). CRP value higher than 2.7 g/dL, mean platelet volume (MPV) value higher than 7.58 fL and lymphocyte count higher than 2.85 103/μL were found to be the markers for distinguishing patients with BD from patients with RAS [odds ratio (OR): 12.76 (95% confidence interval (CI): 2.86-56.88), OR: 5.61 (95% CI: 1.11-28.42), OR: 15.24 (95% CI: 1.77-131.31), respectively]. Conclusion: The elevated CRP, MPV and lymphocyte count were associated with patients with newly diagnosed BD rather than patients with RAS. Further large prospective studies with the healthy control group are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives: The triglyceride-glucose (TyG) index is a sign of atherosclerosis in cardiovascular diseases. The TyG index is thought to have clinical significance for the assessment of vascular damage. In this study we aimed to demonstrate the connection between the TyG index and retinal vein occlusion (RVO). Materials and Methods: This case-control observational study involved 492 participants aged 40-90, admitted to the ophthalmology outpatient clinic of our hospital. TyG index was calculated using the formula: ln(fasting TG [mg/dL] ´ fasting plasma glucose [mg/dL]/2). Results: The RVO group included 387 patients (181 women and 206 men) and the control group included 115 patients (61 women and 54 men). The average patient age was 62.9±11.1 years in the RVO group and 56.7±8.7 years in the control group. The TyG index was higher in the RVO group (8.9±0.7) than in the control group (8.8±0.6). This difference was statistically significant (p=0.04). The correlation was statistically significant when evaluated according to age and sex by multivariate logistic regression analysis (odds ratio: 1.45, confidence interval: 1.03-2.02, p=0.03). Conclusion: The TyG index is a novel atherogenicity index that is derived from routine blood tests and can be used to determine the risk of RVO in at-risk individuals with a simple calculation. Therefore, the TyG index could help as a reliable guide to identify individuals at RVO with high risk and initiate early intervention. [ABSTRACT FROM AUTHOR]

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The article presents a study which explored the extent to which anaphylaxis events are missed by algorithms that require the presence of an anaphylaxis diagnosis code. Topics include indicators based on procedure codes and concepts extracted from unstructured clinical notes using natural language processing, findings on uncoded anaphylaxis events, and characteristics of emergency department encounters in the electronic health records of a midsized healthcare system in the Pacific Northwest.

Simple Summary: Despite the promising evidence of the Royal Marsden Hospital (RMH) score as a readily available prognostic biomarker in patients with cancer, the wide scale implementation in clinical practice as well as the true benefit in clinical decision-making is lacking. Therefore, we systematically reviewed the available evidence on the association between the RMH score and prognosis in patients with cancer. This comprehensive meta-analysis, encompassing over a hundred thousand patients, revealed a negative association between a higher RMH score and survival in cancer patients. The available evidence demonstrates that the RMH score is not only a selective biomarker for patients enrolled in clinical trials, but also a useful prognostic biomarker in a real-world setting. Future research should aim to validate and refine this score, ensuring its optimal application in clinical practice and decision-making. Background: Cancer remains a leading cause of death globally, necessitating the identification of prognostic biomarkers to guide treatment decisions. The Royal Marsden Hospital (RMH) score, based on readily available blood tests and clinical features, has emerged as a prognostic tool, although its performance across variable clinical scenarios is not thoroughly delineated. Therefore, we aimed to systematically assess the association between RMH score and survival in cancer patients. Methods: We conducted a systematic literature search across Pubmed, Scopus, and Web of Science databases for studies published up to 15 February 2024. We performed a meta-analysis with the generic inverse variance method with a random-effects model and reported hazard ratios (HR) with 95% confidence intervals (CI). Results: Nineteen studies encompassing 127,230 patients were included. A higher RMH score was significantly associated with worse overall survival (OS) (HR: 2.09, 95% CI: 1.87–2.33, p < 0.001) and progression-free survival (PFS) (HR: 1.80, 95% CI: 1.48–2.18, p < 0.001). This association was consistent across various subgroups, including study population (clinical trial vs. real-world cohort), geographic region, and tumor type. Conclusion: This meta-analysis, including over a hundred thousand patients, demonstrates a negative association between a higher RMH score and survival in cancer patients. The RMH score holds promise as a readily available prognostic tool across diverse cancer types and clinical settings. Future research should focus on validating and refining this score to aid clinical decision-making. [ABSTRACT FROM AUTHOR]

Ventilator-associated pneumonia (VAP) is common in Pediatric Intensive Care Units. Although early detection is crucial, current diagnostic methods are not definitive. This study aimed to identify lung ultrasound (LUS) findings and procalcitonin (PCT) values in pediatric patients with VAP to create a new early diagnosis score combined with the Clinical Pulmonary Infection Score (CPIS), the CPIS-PLUS score. Prospective longitudinal and interventional study. Pediatric patients with suspected VAP were included and classified into VAP or non-VAP groups, based on Centers of Disease Control (CDC) criteria for the final diagnosis. A chest-X-ray (CXR), LUS, and blood test were performed within the first 12 h of admission. CPIS score was calculated. A total of 108 patients with VAP suspicion were included, and VAP was finally diagnosed in 51 (47%) patients. CPIS-PLUS showed high accuracy in VAP diagnosis with a sensitivity (Sn) of 80% (95% CI 65–89%) and specificity (Sp) of 73% (95% CI 54–86%). The area under the curve (AUC) resulted in 0.86 for CPIS-PLUS vs. 0.61 for CPIS. In conclusion, this pilot study showed that CPIS-PLUS could be a potential and reliable tool for VAP early diagnosis in pediatric patients. Internal and external validations are needed to confirm the potential value of this score to facilitate VAP diagnosis in pediatric patients. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is an alternative method for patients with reversible causes of cardiac arrest (CA) after conventional cardiopulmonary resuscitation (CCPR). However, cardiopulmonary resuscitation (CPR) duration during ECPR can vary due to multiple factors. Healthcare providers need to understand these factors to optimize the resuscitation process and improve outcomes. The aim of this study was to examine the different variables impacting the duration of CPR in patients undergoing ECPR. Methods: This retrospective, single-center, observational study was conducted on adult patients who underwent ECPR due to in-hospital CA (IHCA) or out-of-hospital CA (OHCA) at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. Univariate and multivariate binary logistic regression analyses were performed to identify the prognostic factors associated with CPR duration, including demographic and clinical variables, as well as laboratory tests. Results: The mean ± standard division age of the 48 participants who underwent ECPR was 41.50 ± 13.15 years, and 75% being male. OHCA and IHCA were reported in 77.1% and 22.9% of the cases, respectively. The multivariate analysis revealed that several factors were significantly associated with an increased CPR duration: higher age (OR: 1.981, 95%CI: 1.021–3.364, P = 0.025), SOFA score (OR: 3.389, 95%CI: 1.289–4.911, P = 0.013), presence of comorbidities (OR: 3.715, 95%CI: 1.907–5.219, P = 0.026), OHCA (OR: 3.715, 95%CI: 1.907–5.219, P = 0.026), and prolonged collapse-to-CPR time (OR: 1.446, 95%CI:1.092–3.014, P = 0.001). Additionally, the study found that the initial shockable rhythm was inversely associated with the duration of CPR (OR: 0.271, 95%CI: 0.161–0.922, P = 0.045). However, no significant associations were found between laboratory tests and CPR duration. Conclusion: These findings suggest that age, SOFA score, comorbidities, OHCA, collapse-to-CPR time, and initial shockable rhythm are important factors influencing the duration of CPR in patients undergoing ECPR. Understanding these factors can help healthcare providers better predict and manage CPR duration, potentially improving patient outcomes. Further research is warranted to validate these findings and explore additional factors that may impact CPR duration in this population. [ABSTRACT FROM AUTHOR]

Objective: A prospective experiment was designed to explore all possible SNPs in the promoter region of fibrinogen B β (FGB) and reveal the influence of these SNPs on susceptibility of pulmonary embolism. Methods: In this 2-year randomized prospective study, we had totally recruited 203 volunteers. 58 PE patients (58 out of 145 VTE patients) and 114 healthy people were taken as case and control objects, respectively. FGB promoter was detected by gene sequencing. Results: There were 6 SNPs in FGB promoter, which were β-1420G/A, β-993C/T, β-854G/A, β-455G/A, β-249C/T, and β-148C/T. Genotype frequencies of individual SNPs between the cases and controls were not statistically significant, all p >.05. After excluding subjects of COVID-19 infection within 6 months, the statistical results (35 PE patients vs 66 healthy people) were consistent. Conclusion: The susceptibility to pulmonary embolism may not be affected by any SNP in the FGB promoter region. [ABSTRACT FROM AUTHOR]

Uric acid (UA) to albumin ratio (UAR) is an emerging marker to predict coronary artery disease (CAD)-related events. There is limited data on the relationship between UAR and the severity of the disease in chronic CAD patients. We aimed to evaluate UAR as an indicator for CAD severity using the Syntax score (SS). We retrospectively enrolled 558 patients with stable angina pectoris and underwent coronary angiography (CAG). Patients were divided into 2 groups, according to CAD severity: low SS (≤22) and intermediate-high SS (>22) groups. UA levels were higher and albumin levels were lower in the intermediate-high SS score group (P <.001). UAR levels were significantly higher in the intermediate-high SS group (P <.001). Also, there was a significant correlation between UAR levels and SS (r =.55, 95% confidence interval (CI):.49–.60, P <.001). In multivariable analysis, UAR >1.34 (Odds ratio, 3.8 [2.3–6.2]; P <.001) was an independent predictor of intermediate-high SS while albumin and UA levels were not. In conclusion, UAR predicted disease burden in chronic CAD patients. It may prove useful as a simple and readily available marker to select patients for further evaluation. [ABSTRACT FROM AUTHOR]

Severe hypercholesterolemia/possible familial hypercholesterolemia (FH) is relatively common but underdiagnosed and undertreated. We investigated whether implementing clinical decision support (CDS) was associated with lower low-density lipoprotein cholesterol (LDL-C) in patients with severe hypercholesterolemia/possible FH (LDL-C ≥ 190 mg/dL). As part of a pre-post implementation study, a CDS alert was deployed in the electronic health record (EHR) in a large health system comprising 3 main sites, 16 hospitals and 53 clinics. Data were collected for 3 months before ('silent mode') and after ('active mode') its implementation. Clinicians were only able to view the alert in the EHR during active mode. We matched individuals 1:1 in both modes, based on age, sex, and baseline lipid lowering therapy (LLT). The primary outcome was difference in LDL-C between the two groups and the secondary outcome was initiation/intensification of LLT after alert trigger. We identified 800 matched patients in each mode (mean ± SD age 56.1 ± 11.8 y vs. 55.9 ± 11.8 y; 36.0% male in both groups; mean ± SD initial LDL-C 211.3 ± 27.4 mg/dL vs. 209.8 ± 23.9 mg/dL; 11.2% on LLT at baseline in each group). LDL-C levels were 6.6 mg/dL lower (95% CI, −10.7 to −2.5; P = 0.002) in active vs. silent mode. The odds of high-intensity statin use (OR, 1.78; 95% CI, 1.41–2.23; P < 0.001) and LLT initiation/intensification (OR, 1.30, 95% CI, 1.06–1.58, P = 0.01) were higher in active vs. silent mode. Implementation of a CDS was associated with lowering of LDL-C levels in patients with severe hypercholesterolemia/possible FH, likely due to higher rates of clinician led LLT initiation/intensification. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac organ damage like left ventricular (LV) hypertrophy and left atrial (LA) enlargement is more prevalent in women than men with hypertension, but the mechanisms underlying this gender difference remain unclear. Methods: We tested the association of drug nonadherence with the presence of LV hypertrophy and LA enlargement by echocardiography in 186 women and 337 men with uncontrolled hypertension defined as daytime systolic blood pressure (BP) ≥ 135mmHg despite the prescription of at least two antihypertensive drugs. Drug adherence was assessed by measurements of serum drug concentrations interpreted by an experienced pharmacologist. Aldosterone-renin-ratio (ARR) was measured on actual medication. Results: Women had a higher prevalence of LV hypertrophy (46% vs. 33%) and LA enlargement (79% vs 65%, both p < 0.05) than men, while drug nonadherence (8% vs. 9%, p > 0.514) did not differ. Women were older and had lower serum renin concentration and higher ARR than men, while 24-h systolic BP (141 ± 9 mmHg vs. 142 ± 9 mmHg), and the prevalences of obesity (43% vs. 50%) did not differ (all p > 0.10). In multivariable analyses, female gender was independently associated with a two-fold increased risk of LV hypertrophy (OR 2.01[95% CI 1.30–3.10], p = 0.002) and LA enlargement (OR 1.90 [95% CI 1.17–3.10], p = 0.010), while no association with drug nonadherence was found. Higher ARR was independently associated with LV hypertrophy in men only (OR 2.12 [95% CI 1.12–4.00] p = 0.02). Conclusions: Among patients with uncontrolled hypertension, the higher prevalence of LV hypertrophy and LA enlargement in women was not explained by differences in drug nonadherence. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03209154. [ABSTRACT FROM AUTHOR]

The Low Energy Availability in Females Questionnaire (LEAF-Q) was validated to identify risk of the female athlete triad (triad) in female endurance athletes. This study explored the ability of the LEAF-Q to detect conditions related to low energy availability (LEA) in a mixed sport cohort of female athletes. Data included the LEAF-Q, SCOFF Questionnaire for disordered eating, dual-energy X-ray absorptiometry-derived body composition and bone mineral density, Mini International Neuropsychiatric Interview, blood pressure, and blood metabolic and reproductive hormones. Participants were grouped according to LEAF-Q score (≥8 or <8), and a comparison of means was undertaken. Sensitivity, specificity, and predictive values of the overall score and subscale scores were calculated in relation to the triad and biomarkers relevant to LEA. Fisher's exact test explored differences in prevalence of these conditions between groups. Seventy-five athletes (18–32 years) participated. Mean LEAF-Q score was 8.0 ± 4.2 (55% scored ≥8). Injury and menstrual function subscale scores identified low bone mineral density (100% sensitivity, 95% confidence interval [15.8%, 100%]) and menstrual dysfunction (80.0% sensitivity, 95% confidence interval [28.4%, 99.5%]), respectively. The gastrointestinal subscale did not detect surrogate markers of LEA. LEAF-Q score cannot be used to classify athletes as "high risk" of conditions related to LEA, nor can it be used as a surrogate diagnostic tool for LEA given the low specificity identified. Our study supports its use as a screening tool to rule out risk of LEA-related conditions or to create selective low-risk groups that do not need management as there were generally high negative predictive values (range 76.5–100%) for conditions related to LEA. [ABSTRACT FROM AUTHOR]

Background: Artemisinin-based combination therapy (ACT) has been effective in the supervised treatment of uncomplicated malaria in Ghana. Since ACT usage is primarily unsupervised, this study aimed to determine the effectiveness of artemether–lumefantrine (AL) for treating malaria patients in two transmission settings in Ghana. Methods: Eighty-four individuals with uncomplicated Plasmodium falciparum malaria were recruited from Lekma Hospital (LH) in Accra (low-transmission area; N = 28), southern Ghana, and King's Medical Centre (KMC) in Kumbungu (high-transmission area; N = 56), northern Ghana. Participants were followed up for 28 days after unsupervised treatment with AL. The presence of asexual parasites was determined by microscopic examination of Giemsa-stained blood smears. Plasmodium species identification was confirmed using species-specific primers targeting the 18S rRNA gene. Parasite recrudescence or reinfection was determined by genotyping the Pfmsp 1 and Pfmsp 2 genes. Results: After AL treatment, 3.6% (2/56) of the patients from KMC were parasitaemic on day 3 compared to none from the LH patients. One patient from KMC with delayed parasite clearance on day 3 remained parasite-positive by microscopy on day 7 but was parasite-free by day 14. While none of the patients from LH experienced parasite recurrence during the 28-day follow-up, three and two patients from KMC had recurrent parasitaemia on days 21 and 28, respectively. Percentage reduction in parasite densities from day 1, 2, and 3 for participants from the KMC was 63.2%, 89.5%, and 84.5%. Parasite densities for participants from the LH reduced from 98.2%, 99.8% on day 1, and 2 to 100% on day 3. The 28-day cumulative incidence rate of treatment failure for KMC was 12.8% (95% confidence interval: 1.9–23.7%), while the per-protocol effectiveness of AL in KMC was 89.47%. All recurrent cases were assigned to recrudescence after parasite genotyping by Pfmsp 1 and Pfmsp 2. Conclusion: While AL is efficacious in treating uncomplicated malaria in Ghana, when taken under unsupervised conditions, it showed an 89.4% PCR-corrected cure rate in northern Ghana, which is slightly below the WHO-defined threshold. [ABSTRACT FROM AUTHOR]

Objective Disease activity monitoring in SLE includes serial measurement of anti-double stranded-DNA (dsDNA) antibodies, but in patients who are persistently anti-dsDNA positive, the utility of repeated measurement is unclear. We investigated the usefulness of serial anti-dsDNA testing in predicting flare in SLE patients who are persistently anti-dsDNA positive. Methods Data were analysed from patients in a multinational longitudinal cohort with known anti-dsDNA results from 2013 to 2021. Patients were categorized based on their anti-dsDNA results as persistently negative, fluctuating or persistently positive. Cox regression models were used to examine longitudinal associations of anti-dsDNA results with flare. Results Data from 37 582 visits of 3484 patients were analysed. Of the patients 1029 (29.5%) had persistently positive anti-dsDNA and 1195 (34.3%) had fluctuating results. Anti-dsDNA expressed as a ratio to the normal cut-off was associated with the risk of subsequent flare, including in the persistently positive cohort (adjusted hazard ratio [HR] 1.56; 95% CI: 1.30, 1.87; P  < 0.001) and fluctuating cohort (adjusted HR 1.46; 95% CI: 1.28, 1.66), both for a ratio >3. Both increases and decreases in anti-dsDNA more than 2-fold compared with the previous visit were associated with increased risk of flare in the fluctuating cohort (adjusted HR 1.33; 95% CI: 1.08, 1.65; P  = 0.008) and the persistently positive cohort (adjusted HR 1.36; 95% CI: 1.08, 1.71; P  = 0.009). Conclusion Absolute value and change in anti-dsDNA titres predict flares, including in persistently anti-dsDNA positive patients. This indicates that repeat monitoring of dsDNA has value in routine testing. [ABSTRACT FROM AUTHOR]

Background: Low birth weight, post-partum haemorrhage still births and maternal deaths are associated with anaemia in pregnancy. If prevalence of anemia will be reduced then there will be improvement in maternal and child health and its outcome. Aim & Objectives: To evaluate the changes in the hematological profile of the study subjects and to determine the impact of intensive health education intervention on anemia status of pregnant women. Methodology: A Community based interventional study was conducted among 200 Pregnant women of selected villages in rural area of Etawah district (100 women in each interventional and non-interventional group) using a selfdeveloped, pre designed, pretested, structured and validated questionnaire. statistical package for social sciences (SPSS) software was used to analyse the data. Result: After health education intervention there is significant increase in the haematological profile of study participants of interventional group (p<0.05) as before intervention values of mean Hb was 10.58±1.79 gm/dl which became 11.72±1.48 gm/dl There were 34 (73.9%) participants in the interventional group that were originally anaemic before the study, but after the intervention, they became non-anaemic. Conclusion: Health education sessions helped the pregnant women to improve their knowledge regarding anemia in pregnancy, as well as improve their ability to select iron rich foods, increase compliance with iron supplementation, and raise their haemoglobin levels [ABSTRACT FROM AUTHOR]

Background: The appropriate reference value of the urinary protein‐to‐creatinine ratio (PCR) for proteinuria may change when the urinary pyrogallol red (PR) protein assay method is changed to the benzethonium chloride method (BC). This study aimed to evaluate the difference between BC‐based PCR (BC‐PCR) and PR‐based PCR (PR‐PCR) values in children. Methods: We compared the BC‐PCR and PR‐PCR values in the same first‐morning urine samples without significant proteinuria in school urine screening settings. The upper limit of the reference values was set at the 97.5th percentile. Results: Notably, 133 samples from 124 individuals (female: 62%, age: median 12.3 years, range 6.3–16.9 years) were collected between August 2020 and October 2022. The diagnoses included 34 normal individuals and 99 with asymptomatic hematuria. The urinary protein (UP) concentrations measured using the BC (BC‐UP) and PR (PR‐UP) methods were in a linear relationship; however, the BC‐UP concentrations were higher than the PR‐UP concentrations (mean of differences: 11.2, 95% confidence interval (CI): 11.0–13.4 mg/dL). Also, the BC‐PCR values were higher than the PR‐PCR values (mean of differences: 0.090, 95% CI: 0.082–0.098 g/gCr). The BC‐PCR showed a body‐size‐related decrease, reflecting a body‐size‐related urinary creatinine increase. The suggested BC‐PCR reference values for proteinuria were 0.25 and 0.17 g/gCr for elementary (6–12.4 years) and junior high school students (12.5–16 years), respectively. These values were higher than those of the PR‐PCR and need further studies. Conclusions: When evaluating PCR results, the urinary protein assay should be stated. [ABSTRACT FROM AUTHOR]

Background Olfactory dysfunction has been suggested to be associated with all-cause mortality. Yet, there is a lack of large-scale cohorts to study this relationship. Methods Using data from the Kailuan cohort, we assessed 97327 Chinese adults for perceived olfactory dysfunction at baseline and gathered mortality data from government records. We used Cox proportional hazards regression models to analyse the risk of all-cause mortality associated with perceived olfactory dysfunction, yielding hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for multiple potential confounders. Results Over a median follow-up of 6.4-year, we recorded a total of 3903 deaths. Individuals reporting perceived olfactory dysfunction had a higher risk of mortality (adjusted HR=1.42; 95% CI=1.02–2.00) compared to those without the dysfunction. In sensitivity analyses, we found similar results after excluding participants with pre-existing obesity, cardiovascular diseases, those younger than 50 years old, individuals diagnosed with cancer or stroke during follow-up, and those who died within two years of follow-up. Conclusions Perceived olfactory dysfunction was associated with a high risk of all-cause mortality among Chinese adults. Our study is limited by failure to include a national-representative sample and misclassification of exposure assessment due to use of a subjective question to assess olfactory dysfunction. Further studies with objective are warranted to replicate our findings and understand the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Objectives: Our research aimed to examine the characteristics of palliative oncology patients hospitalised through an emergency to look for the symptom profile, characteristics of dyselectrolytemia and blood investigations, and possible associations with mortality. Materials and Methods: After institutional review board approval, a retrospective, observational study of patients hospitalised in our tertiary care specialty oncology hospital was undertaken. Records of hospitalised cancer patients admitted from the emergency department under palliative care from January 2019 to October 2021 were examined. As all admissions during this period were through emergency due to institution COVID-19 protocols, all elective admissions were excluded from the study. Data collected included patient characteristics, blood investigations, and comorbid history of systemic diseases and factors that could be associated with electrolyte imbalance. Results: There were 157 emergency admissions during the study period. A majority were patients with solid tumours (92.4%). Pain was the most frequent cardinal symptom, along with other symptoms (68/157) or in isolation (33/157), followed by reduced oral intake (32/157) and altered sensorium (24/157). sixty-six patients died within the hospitalisation period. On long-term follow-up, only 8 (5.1%) were surviving. Hyponatraemia (43%), Hypoalbuminaemia (66%), and altered renal function (33.1%) were prevalent. We observed a weak positive correlation between sodium levels and outcome (r = 0.199, P = 0.016) and a strong positive correlation between albumin levels and survival outcomes (r = 0.329, P = 0.000). Patients with normal albumin had a higher chance of survival (odds ratio: 33.1225, 95% confidence interval: 3.415–321.20, P = 0.003). Conclusion: Pain-reduced oral intake and altered sensorium are common emergency symptoms in oncology palliative care. Mortality is high in these patients. Hyponatraemia, hypoalbuminaemia, and deranged renal functions were commonly seen. Normal sodium and albumin levels were associated with higher chances of survival, and the association was strong for serum albumin levels. This may have prognostic utility. [ABSTRACT FROM AUTHOR]

Mumps is an acute contagious viral disease caused by paramyxovirus characterized by complications that include orchitis, oophoritis, aseptic meningitis, and spontaneous abortion among many others. This study reports high mumps IgG seropositivity among school-aged children in rural areas of the Mbeya region, information that might be useful in understanding the epidemiology of mumps and instituting appropriate control measures including vaccination. Between May and July 2023, a cross-sectional study involving 196 enrolled children aged 5–13 years was conducted. Sociodemographic information and other relevant information were collected using a structured data collection tool. Blood samples were collected and used to detect mumps immunoglobulin G antibodies using indirect enzyme-linked immunosorbent assay (ELISA). A descriptive analysis was performed using STATA version 15. The median age of the enrolled children was 13 (interquartile range (IQR): 8–13) years. The seropositivity of mumps IgG antibodies was 88.8% (174/196, 95% CI: 83.5–92.5). By multivariable logistic regression analysis, history of fever (OR: 5.36, 95% CI: 1.02–28.22, p = 0.047) and sharing utensils (OR: 8.05, 95% CI: 1.99–32.65, p = 0.003) independently predicted mumps IgG seropositivity. More than three-quarters of school-aged children in rural areas of the Mbeya region are mumps IgG-seropositive, which is significantly associated with the sharing of utensils and history of fever. This suggests that the virus is endemic in this region, which calls for further studies across the country so as to institute evidence-based, appropriate control measures including a vaccination program. [ABSTRACT FROM AUTHOR]

Modifiable risk factors play an important role in the premature mortality among patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to examine the factors that influence the early death of patients who had CABG. We conducted a prospective cohort study and followed 2863 patients after their CABG, and collected data on their characteristics and blood tests. We used the Cox proportional hazards regression model in Stata, version 16, to identify the predictors of early mortality. Out of 2863 patients, 162 died during the follow-up period. The survival rate was 99.2% within the first three days after the surgery, 96.2% from the fourth day to the end of the first year, 94.9% at the end of the second year, and 93.6% at the end of the third year. After adjusting for confounding factors, we found that older age (hazard ratio [HR] 1.05, 95% CI 1.02, 1.08 for one year increase in age), obesity (HR 2.16, 95% CI 1.25, 3.72), ejection fraction < 50% (HR 1.61, 95% CI 1.06, 2.44), number of rehospitalizations (HR 2.63, 95% CI 1.35, 5.12 for two or more readmissions), history of stroke (HR 2.91, 95% CI 1.63, 5.21), living in rural areas (HR 1.58, 95% CI 1.06, 2.34), opium use (HR 2.08, 95% CI 1.40, 3.09), and impaired glomerular filtration rate increased the risk of early death after CABG, while taking a beta-blocker (HR 0.59, 95% CI 0.38, 0.91) reduced the risk. We conclude that modifiable risk factors such as excess body mass, high blood glucose, opium use, and kidney dysfunction should be monitored and managed in patients who had CABG to improve their survival outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Volume indices and count of platelets through sickle cell anemia (SCA) steady state are modified by chronic hemolysis, red blood cell sickling, and vaso-occlusion induced by this structural hemoglobinopathy. The bone pain crises additionally change these parameters. The recognition of the modification in platelet indices has a significant impact on understanding the pathogenesis and outcome of sickle cell disease patients. OBJECTIVES: This study objective is to compare volume indices and count of platelets of SCA patients in steady and through bone pain crisis states. PATIENTS AND METHODS: This is a retrospective cohort study that included 82 SCA patients who received care between October 2022 and October 2023 at the Hereditary Blood Disease Center, Basra, Iraq Written consent was obtained from all the participants and legal guardians. The criteria of inclusion involved SCA patients of 13 years old and older who presented to the center at the period of the stdy. They had their platelet count and volume indices measured during the crises of bone pain and in the steady state later on. Platelet count, platelet distribution width (PDW), plateletcrit (PCT), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were measured by the automatic analyzer. RESULTS: Through bone pain crises as well as steady state, patients had a normal mean platelet count in comparison to the reference values of non-SCA population. It was found that MPV, PDW, PCT, and P-LCR were different in a significant way between the steady and bone pain crisis states, with P ≤ 0.001 with the mean values of 9.69 ± 1.25 versus 11.09 ± 0.99 for MPV, 13.27 ± 0.46 versus 15.78 ± 0.65 for PDW, 0.31 ± 0.03 versus 0.36 ± 0.01 for PCT, and 0.16 ± 0.01 versus 0.18 ± 0 for P-LCR, respectively. CONCLUSIONS: Through the steady state as well as bone pain crisis, the platelet count of SCA patients showed a normal value according to the range of reference for the normal population with no SCA. The P-LCR, MPV, PCT, and PDW were different significantly between SCA two clinical states as they became higher through the state of bone pain crises. This finding reflects the increment in the activation of platelets and the existence of large platelets in circulation at the time of vaso-occlusive crises. [ABSTRACT FROM AUTHOR]

Introduction: Defining accurate age‐ and sex‐specific reference intervals (RIs) for hematology parameters, especially for the pediatric population, is important for making an appropriate clinical diagnosis. To address gaps, we established age‐specific RIs for 11 hematologic parameters in Iranian children younger than 30 months for the first time. Methods: Fresh whole blood samples collected from a total of 344 participants (males: 158 and females: 186) ages 3 days to 30 months, with a mean age of 12.91 ± 7.15 months, were recruited from healthcare centers in Mashhad, Iran. Hematologic parameters, including complete blood count (CBC), were analyzed on the Sysmex auto‐analyzer system (KX‐21 N). RIs were calculated with 90% confidence intervals using the direct method based on CLSI Ep28‐A3 and C28‐A3 guidelines. Results: None of the CBC parameters required sex partitioning. Of 11 CBC parameters, six required age partitions of 3 days–<4 months, 4–<10, 10–<15, and 4–<30 months. Five parameters (i.e., white blood cell count, mean corpuscular hemoglobin concentration, mean platelet volume, red cell distribution width, and platelet distribution width) did not demonstrate age‐specific changes. RIs of red blood cell count and hematocrit, as well as hemoglobin, increased with age, while mean corpuscular volume, mean corpuscular hemoglobin, and platelet count, decreased with age. Conclusion: In this study, we established RIs for 11 hematology parameters in young children. Age partitioning was required for six parameters demonstrating marked changes during the early period of growth and development and necessitating the use of pediatric‐specific reference standards. [ABSTRACT FROM AUTHOR]