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Background: Among female patients’ breast cancer are a growing threat for over a century. In women, breast cancer is the most common malignancy universally such as 154 of 185 nations. Breast self-examination (BSE) is a simple, very low-cost, non-invasive early detection method used to detect early breast cancer, which involves the woman herself looking at and feeling for any change in their breast as early as possible, which yields a better survival rate. BSE should be done for all women older than 20 years. This study intended to determine knowledge, attitude, and practice (KAP) of breast cancer among medical and non-medical undergraduate students. Material & Methods: A descriptive cross‑sectional study was conducted from October to November 2019 to assess the knowledge, attitude, and practice of BSE. The target population consisted of undergraduate female medical and non‑medical students. A total of 154 (N=154) undergraduate female students participated in this study. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 25.0. Results: Among the study population (N=154) with an early familiar diagnosis of breast cancer ”breast self-examination, the mean age of them was 20.434±4.38. Of seventy-eight respondents (n=78), breast cancer screening test was heard by around half of the medical students (42, 53.8%) & of seventy-six non-medical respondents (n=76), around three-fifth of them (46, 60.5%) did not hear about breast cancer screening test. There was no significant relationship between them (p=0.394). Forty medical students (40, 51.3% and twenty-five non-medical students (25, 32.9%) had no idea, twenty-four medical students (24, 30.8%) & forty-three (43, 56.6%) non-medical students had monthly BSE done. Conclusion: Initial diagnosis and treatment of breast cancer have a definite survival benefit. So early detection is an issue of necessity to be uplifted. The results of the present study suggested that knowledge regarding breast cancer, its risk factors, sign symptoms, prevention measures, and performance of BSE is insufficient.

Background: A limited number of studies have exclusively assessed fatigue among post-COVID patients. Our study aimed to assess the persistence and associations of fatigue among COVID-19 survivors after two months of recovery from their primary illness. Methods: During hospital admission from August to September, 2020, a total of 400 patients were diagnosed to be suffering from fatigue using Chalder fatigue scale. After obtaining informed written consent, patients were followed up two months later over telephone. A total of 332 participants participated in the interview (63 patients could not be traced and another 5 patient died within two months). Patients were asked to categorize their present fatigue condition based on a simplified questionnaire developed for telephone interview. Results: Among study participants, 62.9% (n=207) were found to be still suffering from fatigue two months after their hospital discharge. A significant association of fatigue was found with age (p=0.000), hypertension (RR: 1.51; CI: 1.15-1.99; p=0.002), diabetes mellitus (RR: 1.45; CI: 1.08-1.95; p=0.010), ischemic heart disease (RR: 2.04; CI: 1.15-3.64; p=0.011), on admission SpO2 (p=0.000), on admission serum ferritin (p=0.000), d-dimer (p=0.000), CRP (p=0.000), and Hb% (p=0.019). Binary logistic regression model revealed significant association of age and onadmission SpO2 with persistence of fatigue. Conclusions: Fatigue is a highly prevalent symptom among the COVID-19 survivors with significant association between fatigue and patients clinical and laboratory markers. Bangladesh J Medicine July 2022; 33(1) : 57-63

To evaluate the persistence and factors associated with sleep disturbances among COVID-19 patients with a history of sleep disturbances 2 months after discharge from the hospital. A total of 400 patients admitted at Dhaka Medical College Hospital during July and August were diagnosed as suffering from sleep disturbances during their hospital stay using a standardized scale. They were followed up 2 months later through telephone, and a total of 322 participants were interviewed (excluding 63 nonresponders and five deceased) regarding the persistence of disturbances in sleep through a structured questionnaire. Patient demographic, clinical, and epidemiological data including history regarding in-hospital sleep disturbance were retrieved from hospital treatment sheets. Results revealed, 35% of study participants (n = 113) were still experiencing symptoms of sleep disturbances during the interview by telephone. Age (p = 0.015), diabetes mellitus (relative risk [RR]: 1.21; confidence interval [CI]: 1.02-1.42, p = 0.022), on admission SPO2 (p = 0.009), C-reactive protein (CRP) (p = 0.025), serum ferritin (p = 0.014), and d-dimer (p = 0.030) were independently associated with sleep disturbances among participants (p < 0.05). Binary and fitting logistic regression through repeated K folds cross-validation revealed 1.65 (CI: 1.02-2.66), 1.07 (CI: 1.01-1.14), and 1.07 (CI: 1.00-1.15) times higher odds of persistence of sleep disturbances among patients with diabetes mellitus, increased neutrophil, and lymphocyte percentages, respectively. Findings of this study need to be validated and patients should be further followed up with more in-depth studies conducted 6 or 12 months after initial infection, possibly with the help of higher sample size and in-person interview.

Microbial agents including periodontal pathogens have recently appeared as important actors in Alzheimer’s disease (AD) pathology. We examined associations of clinical periodontal and bacterial parameters with incident all-cause and AD dementia as well as AD mortality among US middle-aged and older adults. Clinical [Attachment Loss (AL); probing pocket depth (PPD)] and bacterial [pathogen immunoglobulin G (IgG)] periodontal markers were investigated in relation to AD and all-cause dementia incidence and to AD mortality, using data from the third National Health and Nutrition Examination Surveys (NHANES III, 1988–1994) linked longitudinally with National Death Index and Medicare data through January 1, 2014, with up to 26 years of follow-up. Sex- and age-specific multivariable-adjusted Cox proportional hazards models were conducted. Among those ≥65 years, AD incidence and mortality were consistently associated with PPD, two factors and one cluster comprised of IgG titers against Porphyromonas gingivalis (P. gingivalis), Prevotella melaninogenica (P. melaninogenica) and Campylobacter rectus (C. rectus) among others. Specifically, AD incidence was linked to a composite of C. rectus and P. gingivalis titers (per SD, aHR = 1.22; 95% CI, 1.04–1.43, p = 0.012), while AD mortality risk was increased with another composite (per SD, aHR = 1.46; 95% CI, 1.09–1.96, p = 0.017) loading highly on IgG for P. gingivalis, Prevotella intermedia, Prevotella nigrescens, Fusobacterium nucleatum, C. rectus, Streptococcus intermedius, Capnocylophaga Ochracea, and P. melaninogenica. This study provides evidence for an association between periodontal pathogens and AD, which was stronger for older adults. Effectiveness of periodontal pathogen treatment on reducing sequelae of neurodegeneration should be tested in randomized controlled trials.

Background: The coronavirus disease 19 (COVID-19) was declared a global pandemic on 11 March 2020. To date, a limited number of studies have examined the impact of this pandemic on healthcare-seeking behaviors of older populations. This longitudinal study examined personal characteristics linked to COVID-19 outcomes as predictors of self-reported delayed healthcare services attributed to this pandemic, among U.S. adults, ≥50 years of age. Methods: Secondary analyses were performed using cross-sectional data (1413 participants) and longitudinal data (2881 participants) from Health and Retirement Study (HRS) (2006–2018) linked to the 2020 HRS COVID-19 Project (57% female, mean age: 68 years). Demographic, socioeconomic, lifestyle and health characteristics were evaluated in relation to delayed overall, surgical and non-surgical healthcare services (“Since March 2020, was there any time when you needed medical or dental care, but delayed getting it, or did not get it at all?” and “What type of care did you delay”) using logistic regression and Ensemble machine learning for cross-sectional data as well as mixed-effects logistic modeling for longitudinal data. Results: Nearly 32.7% delayed healthcare services, 5.8% delayed surgical services and 31.4% delayed non-surgical services. Being female, having a college degree or higher and 1-unit increase in depression score were key predictors of delayed healthcare services. In fully adjusted logistic models, a history of 1 or 2 cardiovascular and/or metabolic conditions (vs. none) was associated with 60–70% greater odds of delays in non-surgical services, with distinct findings for histories of hypertension, cardiovascular disease, diabetes and stroke. Ensemble machine learning predicted surgical better than overall and non-surgical healthcare delays. Conclusion: Among older adults, sex, education and depressive symptoms are key predictors of delayed healthcare services attributed to the COVID-19 pandemic. Delays in surgical and non-surgical healthcare services may have distinct predictors, with non-surgical delays more frequently observed among individuals with a history of 1 or 2 cardiovascular and/or metabolic conditions.

Objective To evaluate the longitudinal relationship in insomnia symptoms over time with incident memory problems and dementia diagnoses among U.S. adults aged 65 years and older. Methods Secondary analyses were performed on 9518 elderly participants (≥65 years) who completed the 2006 wave of the Health and Retirement Study (HRS) and were followed-up to determine if insomnia symptom scores (2006–2014) were associated with time-to-onset of [1] physician-diagnosed “memory-related disease”, “Alzheimer's disease” and/or “dementia, senility or any other serious memory impairment” and [2] diagnosis of dementia based on HRS-specific criteria. Cox proportional hazards models were constructed adjusting for socio-demographic, lifestyle, and health characteristics. Results In fully adjusted models, severe insomnia symptoms were associated with increased risk of physician-diagnosed memory problems. Individuals reporting any change (increase or decrease) in insomnia symptoms during the 2006–2010 period were more likely to be diagnosed with dementia based on HRS criteria. Finally, those who experienced an increase in the severity of insomnia symptoms over time exhibited 41–72% increased risks of physician-diagnosed memory problems and 45–58% increased risks of dementia diagnosis based on HRS criteria. Conclusions When severe insomnia symptoms increased over time, physician-diagnosed memory problems and dementia diagnoses also increased among U.S. elderly people over a 10-year follow-up period. More studies are required to confirm these findings using large prospective cohort designs and validated tools.

Importance: Hypokalemia is a neglected common manifestation in COVID-19 patients admitted in hospital though it has serious consequences. Coronavirus may cause hypokalemia through disruptions of rennin-angiotensin system, gastrointestinal loss or other unknown mechanisms. Objective: To investigate the prevalence of hypokalemia among patients with moderate to severe COVID-19 and its association with other clinical and laboratory parameters. Design, Setting, and Participants: This was cross sectional observational study conducted at Dhaka medical College Hospital of Bangladesh from June, 2020, to August 2020. Participants were included who were positive for rt-PCR for COVID-19 according to the national guideline. The patients were classified as having severe hypokalemia (plasma potassium 3.5 mmol/L). Results: Prevalence of hypokalemia among patients with COVID-19 was 20.2%, severe hypokalemia (2 patients [1.5%]) and hypokalemia (25 patients [18.7%]). One thirty four (134) patients with positive COVID-19 were included. The mean [SD] age of these 134 patients according to different potassium levels appear to be : 68 [2.83] years for severe hypokalemia , 51.93[11.68] years for hypokalemia and 50.73[14.7] years for normokalemia. Among them, 46 patients were females [34.32%]) and rest were males [65.68%]. Within the total sum of 134 patients, 107 were identified having normokalemia, [79.9%]. 25 patients [18. 7%] had hypokalemia and only two patients [1.5%] were found having normokalemia. Among 134 patients, three commonest symptoms were fever (132 patients [98.5%]), dry cough (123 patients (91.79%) and shortness of breath (122 patients [91.04%]), followed by less common symptoms like fatigue (89 patients [66.410%]), sore throat (60 patients [44.77%]), and diarrhea (44 patients, [32.83%]). Shortness of breath was associated with grades of hypokalemia (P=0.022). Only 26 patients (19.4%) manifested having vomiting/Nausea. The predominant comorbidities found among these 134 participants were Hypertension (68 patients [64.2%]), Diabetes (54 patients [52.9%]), Ischemic heart disease (37 patients [38.1%]) and Asthma (27 patients [31.0%]). The prevalence of comorbidities was not associated with Hypokalemia. Conclusions Prevalence of hypokalemia among patients with COVID-19 is high (20.2%) and appropriate treatment is highly required. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 131-137

Background and ObjectivesSerum antioxidant vitamins and carotenoids may protect against neurodegeneration with age. We examined associations of these nutritional biomarkers with incident all-cause and Alzheimer disease (AD) dementia among US middle-aged and older adults.MethodsUsing data from the third National Health and Nutrition Examination Surveys (1988–1994), linked with Centers for Medicare & Medicaid follow-up data, we tested associations and interactions of serum vitamins A, C, and E and total and individual serum carotenoids and interactions with incident AD and all-cause dementia. Cox proportional hazards regression models were conducted.ResultsAfter ≤26 years follow-up (mean 16–17 years, 7,283 participants aged 45–90 years at baseline), serum lutein+zeaxanthin was associated with reduced risk of all-cause dementia (65+ age group), even in the lifestyle-adjusted model (per SD: hazard ratio [HR] 0.93, 95% CI 0.87–0.99;p= 0.037), but attenuated in comparison with a socioeconomic status (SES)–adjusted model (HR 0.92, 95% CI 0.86–0.93;p= 0.013). An inverse relationship was detected between serum β-cryptoxanthin (per SD increase) and all-cause dementia (45+ and 65+) for age- and sex-adjusted models (HR 0.86, 95% CI 0.80–0.93;p< 0.001 for 45+; HR 0.86, 95% CI 0.80–0.93;p= 0.001 for 65+), a relationship remaining strong in SES-adjusted models (HR 0.89, 95% CI 0.82–0.96;p= 0.006 for 45+; HR 0.88, 95% CI 0.81–0.96;p= 0.007 for 65+), but attenuated in subsequent models. Antagonistic interactions indicate putative protective effects of 1 carotenoid may be observed at lower levels other carotenoids or antioxidant vitamin.DiscussionIncident all-cause dementia was inversely associated with serum lutein+zeaxanthin and β-cryptoxanthin levels. Further studies with time-dependent exposures and randomized trials are needed to test neuroprotective effects of supplementing the diet with select carotenoids.Classification of EvidenceThis study provides Class II evidence that incident all-cause dementia was inversely associated with serum lutein+zeaxanthin and β-cryptoxanthin levels.

The purpose of the study was to measure the prevalence of hyponatremia and its association with clinical and laboratory characteristics of hospitalized coronavirus disease 2019 (COVID-19) patients at Dhaka Medical College and Hospital (DMCH).This retrospective study was conducted in COVID-19 dedicated wards at DMCH from June to August 2020. Demographic, clinical, and laboratory data were collected from patient treatment sheets. Two groups of COVID-19 patients were retrospectively screened on the basis of plasma sodium level at admission: hyponatremic (sodium 135 mM,A total of 132 patients were included in the study, with a mean age of 51.41 (±14.13) years. Hyponatremia was found in 84 patients (63.6%) and the remaining 48 patients (36.4%) had normal plasma NaThe authors suggest that patients' serum electrolytes be measured during initial hospital admission and then monitored throughout the hospital stay to predict the probability for referral for invasive ventilation and for better management.

BACKGROUND It is relatively unknown as to how dietary bioactive compound sulforaphane (SFN) and vitamin D regulate gene expression in colorectal cancer. We hypothesized that a combination of SFN with vitamin D would prove beneficial in colorectal cancer. A combinatorial chemo-preventive strategy was employed to investigate the impact of SFN on chromatin remodeling in colorectal carcinoma. To understand the epigenetics-mediated changes in gene expression in response to SFN and vitamin D, Caco-2 cells were exposed for 24 h to vitamin D (100 nmol L-1 ) either alone or in combination with SFN and trichostatin A (20 and 1 μmol L-1 , respectively) at 70% confluency (proliferating) and after 13 days post-confluency (fully differentiated). Changes to VDR, CYP24A1, CYP27B1 and TRPV6 gene expressions were quantified using real-time PCR-based assays. Histone deacetylase (HDAC) inhibitor activity was assessed using HDAC I/II assay that measured global changes in acetylation status. RESULTS In differentiated Caco-2 cells, none of the genes had significant changes from D alone group. D + SFN (P = 0.99) demonstrated an opposing effect from D alone and decreased VDR expression. However, in proliferating Caco-2 cells, D + SFN (P

Co-infection between Helicobacter pylori (Hp) and groups of periodontal pathogens may alter the onset of Alzheimer's disease (AD) and all-cause dementia. We examined the interactive associations among Hp sero-positivity, periodontal disease (Pd), and infections with incident AD and all-cause dementia, among older adults (≥65 years at baseline). Up to 1431 participants from phase 1 of the National Health and Nutrition Survey III (1988-1991) had complete data till January 1st, 2014 on Hp sero-positivity with a mean follow-up of 10-11 years for AD and all-cause dementia incidence. Exposures consisted of 19 periodontal pathogens, constructed factors and clusters, and two Pd markers- probing depth and clinical attachment loss (CAL). Cox proportional hazards models were performed. Around 55% of the selected sample was Hp+. We found that Prevotella intermedia, Campylobacter Rectus, Factor 2 (Pi/Prevotella nigrescens/Prevotella melaninogenica), and the Orange-Red cluster interacted synergistically with Hp sero-positivity, particularly with respect to AD incidence. The presence of higher levels of Actinomyces Naeslundii (An) enhanced the effect of being Hp+ on both AD and all-cause dementia incidence. In contrast, Fusobacterim nucleatum (Fn), and Factor 1 (which included Fn), exhibited an antagonistic interaction with Hp in relation to all-cause dementia. Both probing depth and CAL had direct associations with all-cause dementia among Hp+ individuals, despite nonsignificant interaction. Selected periodontal pathogen titers, factors, and clusters interacted mostly synergistically, with Hp sero-positivity, to alter the risk of AD and all-cause dementia. Ultimately, a randomized controlled trial is needed, examining effects of co-eradication of Hp and select periodontal pathogens on neurodegenerative disease.

Poor diet quality (DQ) is associated with poor cognition and increased neurodegeneration, including Alzheimer’s disease (AD). We are interested in the role of DQ on cognitive functioning (by sex and increasing genetic risk for AD), in a sample of African American (AA) middle-aged adults. We analysed a sub-group of participants (about 55 % women; mean follow-up time of about 4·7 years) from the Healthy Aging in Neighborhoods of Diversity across the Life Span study with a genetic risk score for AD (hAlzScore). The Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension and the mean adequacy ratio computed at baseline (2004–2009) and follow-up visits (2009–2013) were used to assess initial DQ and change over time. Linear mixed-effects regression models were utilised, adjusting for select covariates, selection bias and multiple testing. DQ change (ΔDQ) was associated with California Verbal Learning Test-List A – overall (0·15 (se 0·06), P = 0·008) and in women (0·21 (se 0·08), P = 0·006), at highest AD risk, indicating protective effects over time. Greater AD risk was longitudinally associated with poorer Clock Command Test scores in men. Poor DQ was positively and cross-sectionally associated with Trails B scores, but in women only. Better-quality diet was associated with a slower decline in verbal memory among AA women, with greater AD risk. Insufficient clinical evidence and/or mixed findings dictate that more studies are needed to investigate brain morphology and volume changes in relation to DQ in an at-risk population for AD, over time.

Background: To examine patterns and outcomes of bariatric surgeries, including Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB), among women diagnosed with polycystic ovarian syndrome (PCOS). Materials and Methods: Retrospective cohort study using 1998–2011 Nationwide Inpatient Sample data. A total of 52,668 hospital discharge records met eligibility criteria among PCOS women, 18–49 years. Of those, 17,759 had an obesity/overweight diagnosis and 4310 underwent bariatric surgery. Furthermore, 3086 underwent RYGB (n = 2411), LSG (n = 126), or LAGB (n = 549), and were compared to 78,931 non-PCOS controls. Multiple regression models were constructed to examine patient- and hospital-level predictors of obesity/overweight and bariatric surgery, as well as type of bariatric surgery (RYGB, LSG, or LAGB) as a predictor of in-hospital outcomes and PCOS status. Results: The prevalence of obesity/overweight (≈34%) among women diagnosed with PCOS, and of bariatric surgery (≈24%) among women diagnosed with PCOS and obese/overweight varied by patient- and hospital-level characteristics. Women having PCOS and overweight/obesity, who underwent LSG or LAGB, had shorter hospital stay, reduced hospital charges, and better disposition at discharge compared to those who underwent RYGB. PCOS cases and non-PCOS controls experienced similar treatment selection and in-hospital outcomes after bariatric surgery. Also, PCOS cases and non-PCOS controls experienced similar in-hospital outcomes after undergoing RYGB, LSG, or LAGB. Conclusions: Compared to RYGB, LSG and LAGB resulted in improved in-hospital outcomes among obese/overweight PCOS and non-PCOS patients. Further research is needed to examine health care disparities in the context of PCOS, obesity/overweight, and bariatric surgery.

BACKGROUND: Epidemiological evidence suggests that both anemia and elevated red cell distribution width (RDW) are associated with cognitive impairment. However, the interplay between these 2 predictors has been understudied. OBJECTIVES: We examined sex- and anemia-specific associations between RDW and cognitive performance among urban adults in the United States. METHODS: Data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span Study (Baltimore, MD; participants aged 30–65 y at baseline, ∼59% African-American, 45% men) were used. Participants were selected based on the completion of 11 cognitive tasks at baseline (2004–2009) and follow-up (2009–2013) visits (mean time between visits: 4.64 ± 0.93 y) and availability of exposure and covariate data, yielding a sample of between 1526 and 1646 adults out of the initial 3720 adults recruited at baseline. Multiple linear mixed-effects regression models were conducted with RDW as the main exposure of interest and anemia/sex as the key effect modifiers. RESULTS: Overall, high RDWs were linked to poorer baseline performance on the California Verbal Learning Test (CVLT) List A (per 1 unit increase in RDW %, main effect: γ(01 )= −0.369 ± 0.114; P = 0.001) and to slower rates of decline on the CVLT Delayed Free Recall (per 1 unit increase in RDW %, RDW × time: γ(11 )= +0.036 ± 0.013; P = 0.007). Among nonanemic participants, RDWs were consistently associated with poorer baseline performance on the Trailmaking Test, Part A (γ(01 )= +3.11 ± 0.89; P

Soft drink refers to sugar-sweetened beverages that contain a natural or artificial flavoring. Daily soft drinks consumption in children is an unhealthy lifestyle behavior that demands special attention to maintain their healthy lives. The present study was aimed to examine the consumption of soft drink and its influence on BMI, and academic performance among selected school children in Dhaka City of Bangladesh. This cross-sectional study was nested among 600 randomly selected young school-aged children (6-17 years, both boys and girls) from the six English Medium schools in Dhaka city of Bangladesh. Face-to-face interviews were conducted to collect the data using a semi-structured interviewer-administered questionnaire. Descriptive and bivariate analyses were done using SPSS 20.0. Results showed that about 48% of the school children consumed soft drinks regularly. Raised weight and Body Mass Index (BMI) was higher among regular soft drink consumers compared to their counterparts (p

Background: Diabetes mellitus is a major health problem in Southeast Asia and diabetic retinopathy is one of its most debilitating complications. Nevertheless, fundoscopy and systematic evaluation of non-adherence to drug therapy are not regularly done in individuals with diabetes in Bangladesh due to limited resources. Therefore, the prevalence of diabetic retinopathy and its determinants with non-adherence to drug therapy are not known. We, therefore, screened for diabetic retinopathy, non-adherence to drug therapy and other associated factors at a tertiary care hospital in Bangladesh.Methods: Between May 2017 to September 2017, we conducted a cross-sectional study of 489 systematically recruited asymptomatic, at least one-year type-2 diabetic individuals on medication and attending the outpatient department of the BIHS tertiary care centre in Dhaka, Bangladesh. We obtained a medical history, physical examination, routine laboratory tests, questionnaires, and fundus photography.Results: The prevalence of diabetic retinopathy among T2DM patients was 18.8%. Clinical factors associated with the presence of diabetic retinopathy were uncontrolled fasting blood glucose, known duration of diabetes of ≥10 years and self-reported non-adherence to drug therapy. With a known duration of diabetes of 15 years or more, the prevalence of diabetic retinopathy rose to 40%.Conclusions: Undiagnosed diabetic retinopathy is still common among patients in Bangladesh, even at tertiary care centres. It is associated with longer disease duration, poor metabolic control and self-reported non-adherence to therapy. Regular screening for diabetic retinopathy should therefore be implemented also in resource-limited settings and further efforts should be made to improve the patients’ drug adherence and metabolic control.

Background and aims Dyspnea is one of the most common symptoms associated with the COVID‐19 caused by novel coronavirus SARS‐CoV‐2. This study aimed to assess the prevalence of dyspnea, observe co‐variables, and find predictors of dyspnea after 2 months of recovery from COVID‐19. Methods A total of 377 patients were included in the study based on their responses and clinical findings during initial admission to the hospital with COVID‐19. After excluding five deceased patients, a total of 327 patients were interviewed through telephone using a 12‐point dyspnea scale and using relevant questions to gauge the patient clinically. Interviews were carried out by trained physicians, and responses were recorded and stored. All analyses were carried out using the statistical programming language R. Results Of the total 327 participants in the study, 34% had stated that they were suffering from respiratory symptoms even after 2 months of COVID‐19. The study demonstrated that patient oxygen saturation level SpO2 (P = .03), D‐dimer (P = .001), serum ferritin (P = .006), and the presence and severity of dyspnea are significantly correlated. In addition to that, patient smoking history (P = .012) and comorbidities such as chronic obstructive pulmonary disease (COPD) (P = .021) were found to be statistically significant among groups. Conclusion These findings of this study can be useful for predicting and managing long‐term complications of COVID‐19.

Background The aim of this study was to evaluate the impact of the COVID-19 pandemic on trajectories in cardiometabolic health, physical activity, and functioning among U.S. older adults, overall and according to selected baseline sociodemographic characteristics. Methods We performed secondary analyses using longitudinal data on 1,372 participants from the 2006–2020 Health and Retirement Study. Pre-post COVID-19 pandemic onset was examined in relation to body mass index (BMI), number of cardiometabolic risk factors and/or chronic conditions, physical activity, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) using mixed-effects regression models and group-based trajectory models. Results The COVID-19 pandemic was associated with significantly increased BMI (β = 1.39, 95% confidence interval [CI]: 0.74, 2.03). Furthermore, the odds of having at least one cardiometabolic risk factor and/or chronic disease increased pre-post COVID-19 onset (odds ratio 1.16, 95% CI: 1.00, 1.36), whereas physical functioning worsened pre-post COVID-19 onset (ADL: β = 1.11, 95% CI: 0.94, 1.28; IADL: β = 0.59, 95% CI: 0.46, 0.73). The pre-post COVID-19 period (2018–2020) showed a stable group of trajectories, with low, medium and high levels of the selected health indicators. Health disparities according to sex, race/ethnicity, educational level, work status, and total wealth are highlighted. Conclusions The COVID-19 pandemic onset appears to worsen cardiometabolic health and physical functioning among U.S. older adults, with clusters of individuals defined by selected sociodemographic characteristics experiencing distinct trajectories pre-post COVID-19 pandemic onset.

The purpose of this longitudinal study is to construct a prediction model for Covid-19 level of concern using established Covid-19 socio-demographic, lifestyle and health risk characteristics and to examine specific contributions of obesity-related cardiometabolic health characteristics as predictors of Covid-19 level of concern among a representative sample of U.S. older adults. We performed secondary analyses of existing data on 2872 2006–2020 Health and Retirement Study participants and examined 19 characteristics in relation to the outcome of interest using logistic regression and machine learning algorithms. In mixed-effects ordinal logistic regression models, a history of diabetes, stroke as well as 1–2 cardiometabolic risk factors and/or chronic conditions were associated with greater Covid-19 level of concern, after controlling for confounders. Female sex, birth cohort, minority race, Hispanic ethnicity and total wealth as well as depressive symptoms were associated with higher level of Covid-19 concern, and education was associated with lower level of Covid-19 concern in fully adjusted mixed-effects ordinal logistic regression models. The selected socio-demographic, lifestyle and health characteristics accounted for

To identify key socio-demographic, lifestyle, and health predictors of self-reported coronavirus disease 2019 (Covid-19) history, examine cardiometabolic health characteristics as predictors of self-reported Covid-19 history and compare groups with and without a history of Covid-19 on trajectories in cardiometabolic health and blood pressure measurements over time, among United States (U.S.) older adults.Nationally representative longitudinal data on U.S. older adults from the 2006-2020 Health and Retirement Study were analyzed using logistic and mixed-effects logistic regression models.Based on logistic regression, number of household members (OR=1.26, 95% CI: 1.05, 1.52), depressive symptoms score (OR = 1.21, 95% CI: 1.04, 1.42) and number of cardiometabolic risk factors or chronic conditions ("1-2" vs "0") (OR = 0.27, 95% CI: 0.11, 0.67) were significant predictors of self-reported Covid-19 history. Based on mixed-effects logistic regression, several statistically significant predictors of Covid-19 history were identified, including female sex (OR = 3.06, 95% CI: 1.57, 5.96), other race (OR = 5.85, 95% CI: 2.37, 14.43), Hispanic ethnicity (OR = 2.66, 95% CI: 1.15, 6.17), number of household members (OR = 1.25, 95% CI: 1.10, 1.42), moderate-to-vigorous physical activity (1-4 times per month vs never) (OR = 0.38, 95% CI: 0.18, 0.78) and number of cardiometabolic risk factors or chronic conditions ("1-2" vs "0") (OR = 0.34, 95% CI: 0.19, 0.60).Number of household members, depressive symptoms and number of cardiometabolic risk factors or chronic conditions may be key predictors for self-reported Covid-19 history among U.S. older adults. In-depth analyses are needed to confirm preliminary findings.

Background Associations of Apolipoprotein (APOE) ε2 or ε4 (APOE2 or APOE4) dosages with cognitive change may differ across racial groups. Methods Longitudinal data on 1770 middle-aged White and African American adults was compiled from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS 2004-2013) study. APOE2 and APOE4 dosages were the two main exposures, while v1 and annual rate of change in cognitive performance (between v1 and v2) on 11 test scores were the main outcomes of interest (v1: 2004–2009 and v2: 2009–2013). Mixed-effects linear regression models were conducted adjusting for socio-demographic, lifestyle, and health-related potential confounders. Race (African American vs. White) and sex within racial groups were main effect modifiers. Results Upon adjustment for multiple testing and potential confounders, APOE4 allelic dosage was associated with faster decline on a test of verbal memory among Whites only (CVLT-List A: γ12 = − 0.363 ± 0.137, p = 0.008), but not among African Americans. In contrast, among African American women, APOE4 dosage was linked to slower decline on a test of attention (BTA: γ12 = + 0.106 ± 0.035, p = 0.002), while no association was detected among African American men. APOE2 and APOE4 dosages showed inconsistent results in other domains of cognition overall and across racial groups that did not survive correction for multiple testing. Conclusions In conclusion, APOE4 dosage was associated with faster decline on a test of verbal memory among Whites only, while exhibiting a potential protective effect among African American women in the domain of attention. Further longitudinal studies are needed to replicate our race and sex-specific findings.

Although 50% of U.S. medical students are women, this percentage fails to translate to cardiology. Gender disparities are striking in interventional cardiology (IC) and electrophysiology (EP) and in leadership. Left atrial appendage closure with the WATCHMAN device, as a novel procedure, is a lens into inequities.The purpose of this study was to identify the characteristics and prevalence of women (1) as early WATCHMAN implanters and (2) in related leadership.Data were collected on WATCHMAN implanters and hospitals from January 2017 to December 2018. The gender of physicians in leadership positions was identified via survey as Director of IC, Director of EP, and Chief of Cardiology. The Firth logistic model controlling for covariates modeled the rare event of a woman implanter.Data were obtained for 100% of the cohort. Men comprised 97% of implanters (860/886). No differences in subspecialty or implants by gender were observed. There were 414 hospitals performing WATCHMAN: 24% academic, 97% urban, and most medium/large size (94%). EP made up 61% of implanters. Only 4.8% of hospitals had women in selected leadership roles. Women represented1% of Directors of IC and only 2.6% of both Directors of EP and Chiefs of Cardiology. Hospitals with a woman in leadership had a 4 times greater odds of a woman implanter (odds ratio 4.24; 95% confidence interval 1.16-15.41; P = .028).Women are underrepresented in cardiology procedural subspecialties in the use of novel technology and in key leadership roles. There was a greater odds of women early implanters of WATCHMAN if a woman led locally. Increasing women in leadership may improve gender diversity through visibility of role models.

BACKGROUND: Elevated levels of inflammatory biomarkers are consistently associated with chronic conditions, for which periodontitis and sleep are established risk factors. We examined the relationships between periodontitis, hours of sleep and white blood cell (WBC) markers among a nationally representative sample of US adults. METHODS: Cross-sectional study using existing demographic, examination, laboratory and questionnaire data on 11,813 participants (5,814 men and 5,999 women, mean age ± SE; range: 52.74 ± 0.24; 30 to 80 years) from the 2009 to 2014 National Health and Nutrition Examination Surveys. Unadjusted, sex- and age-adjusted, as well as fully adjusted linear and logistic regression models were conducted in addition to generalized structural equations models, while considering sampling design complexity. β, odds ratios with their 95% confidence intervals, indirect effects and mediation proportions were estimated. RESULTS: The weighted mean WBC count was 7,130 cells/μL, with the WBC 5-part differential estimated in terms of percentages of lymphocytes (29.50%), monocytes (7.99%), neutrophils (59.03%), eosinophils (2.84%), and basophils (71.88%). Furthermore, 36.2% of participants reported

CONTEXT: Breast cancer (BC) is the most common malignancy among women in the US. Vitamin D status and intakes are thought to be inversely associated with BC occurrence. OBJECTIVES: In our systematic review and meta-analysis, we evaluated evidence linking serum 25(OH)D (both in serum and diet) with breast cancer (BC) occurrence. DATA SOURCES AND EXTRACTION: Only observational studies from databases such as PubMed and Cochrane (January 1st 2000 through March 15th, 2018) were included using PRISMA guidelines. Publication bias and consistency upon replication were assessed, while harmonizing risk ratios (RR, 95% CI) of BC, per fixed increment of 5 exposures [10 ng/mL of 25(OH)D; 100 IU/d for total/dietary vitamin D intakes; vitamin D deficiency; supplement use). RRs were pooled using random effect models. DATA ANALYSIS: Pooled findings from 22 studies suggested a net direct association between 25(OH)D deficiency and BC, with RR(pooled) = 1.91, 95% CI: 1.51–2.41, P < 0.001). Total vitamin D intake (RR(pooled) = 0.99, 95% CI: 0.97–1.00, P = 0.022, per 100 IU/d) and supplemental vitamin D (RR(pooled) = 0.97, 95% CI:0.95–1.00, P = 0.026) were inversely associated with BC. No evidence of publication bias was found; all 5 exposures of interest were consistent upon replication. CONCLUSIONS: 25(OH)D deficiency was directly related to BC while total vitamin D and supplemental vitamin D intakes had an inverse relationship with this outcome. Randomized clinical trials are warranted pending further evidence from primary meta-analyses of observational studies.

Context Serum anti-Müllerian hormone level (AMH) and body mass index may be jointly associated with cardiometabolic risk. Objectives Examine the contribution of AMH to cardiometabolic disturbances by weight status among US adult men. Design Cross-sectional analysis using data from the 1999 to 2004 waves of the National Health and Nutrition Examination Survey. Setting Multistage probability sampling of the noninstitutionalized US population. Participants US men aged ≥18 years. Final analytic sample sizes ranged from 517 to 1063 participants. Main Outcome and Exposure Measures Cardiometabolic disturbances (metabolic syndrome and its components, insulin resistance, diabetes, and chronic inflammation) and AMH were obtained from trained staff and nurses in a mobile examination center or during in-home visits. Results AMH was directly associated with insulin resistance among obese men [OR 1.08 (95% CI 1.00, 1.15); P = 0.046; N = 146], whereas AMH was inversely associated with waist circumference (WC) among obese men [OR 0.95 (95% CI 0.91, 0.99); P = 0.049; N = 146]. An inverse relationship was also observed between categorical AMH and diabetes status [medium vs low AMH; OR 0.19 (95% CI 0.043, 0.84); P = 0.030; N = 145] among obese men, with a strong inverse relationship also detected among overweight men [high vs low AMH; OR 0.011 (95% CI 0.0004, 0.27); P = 0.007; N = 193]. An inverse relationship between continuous AMH and diabetes [OR 0.75 (95% CI: 0.59, 0.93); P = 0.011; N = 193] was also detected among overweight men. Conclusions AMH was associated with specific cardiometabolic risk factors, including WC, diabetes status, and insulin resistance, in overweight and obese US men.

Objective This study aimed to examine patterns of sleep disorders among hospitalized adults 65 years and older as related to Parkinson's disease (PD) status and to evaluate sex differences in the associations between PD with sleep disorders. Methods A cross-sectional study was conducted using 19,075,169 hospital discharge records (8,169,503 men and 10,905,666 women) from the 2004-2014 Nationwide Inpatient Sample databases. PD and sleep disorder diagnoses were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification coding. Logistic regression models were constructed for each sleep disorder as a correlate of PD status; adjusted odds ratios (aOR) with their 95% confidence intervals (CIs) were calculated taking into account patient and hospital characteristics. Results Period prevalences of PD and sleep disorder were estimated to be 2.1% and 8.1%, respectively. Most sleep disorder types, with the exception of sleep-related breathing disorders, were positively associated with PD diagnosis. Statistically significant interactions by sex were noted for associations of insomnia (men: aOR = 1.29, 95% CI = 1.24-1.36; women: aOR = 1.17, 95% CI = 1.12-1.22), parasomnia (men: aOR = 3.74, 95% CI = 3.44-4.07; women: aOR = 2.69, 95% CI = 2.44-2.96), sleep-related movement disorder (men: aOR = 1.09, 95% CI = 1.07-1.11; women: aOR = 1.22, 95% CI = 1.20-1.25), and any sleep disorder (men: aOR = 1.06, 95% CI = 1.05-1.08; women: aOR = 1.15, 95% CI = 1.13-1.17) with PD status. Conclusions Overall, hospitalized men are more likely to experience PD with insomnia or parasomnia, whereas hospitalized women are more likely to experience PD with sleep-related movement disorder or any sleep disorder. Prospective cohort studies are needed to replicate these cross-sectional findings.

Background and objectives: Lower vitamin status has been linked to cognitive deficits, pending mechanistic elucidation. Serum 25-hydroxyvitamin D [25(OH)D], folate and cobalamin were explored against brain volumes and white matter integrity (WMI). Methods: Three prospective waves from Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study were used [Baltimore, City, MD, 2004-2015, N = 183-240 urban adults (Agev1: 30-64 years)]. Serum vitamin 25-hydroxyvitamin D [25(OH)D], folate and cobalamin concentrations were measured at visits 1 (v1: 2004-2009) and 2 (v2: 2009-2013), while structural and diffusion Magnetic Resonance Imaging (sMRI/dMRI) outcomes were measured at vscan: 2011-2015. Top 10 ranked adjusted associations were corrected for multiple testing using familywise Bonferroni (FWER 50 years: +205 ± 54]; parietal WM; [overall: +251 ± 77, males: +486 ± 129 and Agev1 > 50 years: +393 ± 108] and left occipital pole volume [overall: +15.70 ± 3.83 and above poverty: 19.0 ± 4.3], findings replicated for 25(OH)D (v2-v1) annualized exposure, which was also linked with greater WMI (fractional anisotropy, FA) in the anterior limb of the internal capsule (ALIC); FWER < 0.05 [Overall: +0.0020 ± 0.0004; Whites: +0.0024 ± 0.0004] and in the cingulum (hippocampus) [Overall: +0.0016 ± 0.0004]. Only trends were detected for cobalamin exposures (q < 0.10), while serum folate (v1) was associated with lower mean diffusivity (MD) in ALIC, reflecting greater WMI, overall. Conclusions: Among urban adults, serum 25(OH)D status and increase were consistently linked to larger occipital and parietal WM volumes and greater region-specific WMI. Pending longitudinal replication of our findings, randomized controlled trials of vitamin D supplementation should be conducted against brain marker outcomes.

Study Objective To examine associations of personality dimensions and facets with insomnia symptoms in a community sample of older adults. Methods We studied 1049 participants aged 60–97 years in the Baltimore Longitudinal Study of Aging. Personality was assessed by the Revised NEO Personality Inventory (NEO-PI-R), and insomnia symptom severity was measured by the Women’s Health Initiative Insomnia Rating Scale (WHIIRS). Results Adjusting for demographic characteristics, higher neuroticism, lower conscientiousness, and lower extraversion were associated with greater insomnia symptom severity. These associations remained significant for neuroticism and conscientiousness when further adjusting for depressive symptoms and comorbidities. Higher scores on neuroticism facets Anxiety, Angry Hostility, and Depression, and lower scores on conscientiousness facets Competence, Order, and Achievement Striving and on agreeableness facet Altruism were associated with greater insomnia symptom severity in fully adjusted models. Results were similar among cognitively normal older adults (N = 966), except higher scores on extraversion facets Warmth and Assertiveness associated with lower insomnia symptom severity, and agreeableness facet Altruism was unassociated. Conclusion Among older adults, insomnia symptoms appear partially related to personality, with persons higher in neuroticism experiencing greater insomnia symptom severity, and those higher in conscientiousness experiencing lower insomnia symptom severity. Exploring facets of the Big-Five dimensions may provide additional insight regarding the etiology and resolution of sleep disturbance, and some of these associations may differ based on cognitive status. Future studies should investigate the hypothesis that sleep impairment mediates part of the association between specific personality traits and health-related outcomes.