Gravedad de caries empleando un criterio del tamaño de la lesión y variables asociadas en una muestra de escolares mexicanos

Objective: To determine the severity of caries (lesion size) and associated variables in Mexican schoolchildren. Material and Methods: A cross-sectional study was conducted in 1373 schoolchildren 6-12 years old enrolled in public schools in Campeche, Mexico. Questionnaires were distributed to determine demographic, socioeconomic and behavioral variables. Dental examination was performed to each child to establish the size of caries lesions according “Criterion of carious lesion magnitude” index and to allocate according to the number of lesions present to one of four risk groups for developing cavities wherein the first group represents the least affected. A multivariate multinomial logistic regression model was generated. Results: Caries risk groups were distributed as follows: 598 (43.6%) were in group 1; 261 (19.0%) were assigned to group 2; 316 (23.0%) were in group 3; and 198 (14.4%) in group 4. Comparing with the least affected group by carious lesions, associated variables for severity in the multivariate model were “Risk Group 2”: age, sex and developmental enamel defects; “Risk Group 3”: dental care in the past year, mother’s attitude toward oral health and developmental enamel defects; “Risk Group 4”: age, dental care in the past year, mother’s attitude toward oral health and developmental enamel defects. Conclusions: Severity of decay is influenced by demographic, behavioral and clinical variables.Objetivo: Determinar la gravedad de caries (tamaño de la lesión) y las variables asociadas en niños escolares mexicanos. Materiales y Métodos: Se realizó un estudio transversal en 1373 escolares de 6 a 12 años de edad inscritos en escuelas públicas de Campeche, México. Se distribuyeron cuestionarios para determinar una serie de variables sociodemográficas, socioeconómicas y conductuales. Se realizó un examen bucal a cada niño para establecer el tamaño de las lesiones de caries de acuerdo al índice llamado “criterio de magnitud de la lesión cariosa” y asignarlo de acuerdo al número de lesiones presentes a uno de 4 grupos de riesgo para desarrollar caries, en donde el primer grupo representa a los menos afectados. Se generó un modelo multivariado de regresión logística multinomial. Resultados: Los grupos de riesgo a caries quedaron distribuidos de la siguiente manera: 598 (43.6%) fueron del grupo 1; 261 (19.0%) se asignaron al grupo 2; 316 (23.0%) estuvieron en el grupo 3; y 198 (14.4%) en el grupo 4. Comparando con el grupo menos afectado por lesiones cariosas, las variables asociadas en los diferentes grupos de gravedad en el modelo multivariado fueron: grupo de riesgo 2: edad, sexo y defectos de desarrollo del esmalte; grupo de riesgo 3: atención dental en el último año, actitud de la madre hacia la salud bucal y defectos de desarrollo del esmalte; grupo de riesgo 4: edad, atención dental en el último año, actitud de la madre hacia la salud bucal y defectos de desarrollo del esmalte. Conclusiones: La gravedad de caries está influenciada por variables demográficas, conductuales y clínicas

Gravedad de caries empleando un criterio del tamaño de la lesión y variables asociadas en una muestra de escolares mexicanos

Objective: To determine the severity of caries (lesion size) and associated variables in Mexican schoolchildren. Material and Methods: A cross-sectional study was conducted in 1373 schoolchildren 6-12 years old enrolled in public schools in Campeche, Mexico. Questionnaires were distributed to determine demographic, socioeconomic and behavioral variables. Dental examination was performed to each child to establish the size of caries lesions according “Criterion of carious lesion magnitude” index and to allocate according to the number of lesions present to one of four risk groups for developing cavities wherein the first group represents the least affected. A multivariate multinomial logistic regression model was generated. Results: Caries risk groups were distributed as follows: 598 (43.6%) were in group 1; 261 (19.0%) were assigned to group 2; 316 (23.0%) were in group 3; and 198 (14.4%) in group 4. Comparing with the least affected group by carious lesions, associated variables for severity in the multivariate model were “Risk Group 2”: age, sex and developmental enamel defects; “Risk Group 3”: dental care in the past year, mother’s attitude toward oral health and developmental enamel defects; “Risk Group 4”: age, dental care in the past year, mother’s attitude toward oral health and developmental enamel defects. Conclusions: Severity of decay is influenced by demographic, behavioral and clinical variables.Objetivo: Determinar la gravedad de caries (tamaño de la lesión) y las variables asociadas en niños escolares mexicanos. Materiales y Métodos: Se realizó un estudio transversal en 1373 escolares de 6 a 12 años de edad inscritos en escuelas públicas de Campeche, México. Se distribuyeron cuestionarios para determinar una serie de variables sociodemográficas, socioeconómicas y conductuales. Se realizó un examen bucal a cada niño para establecer el tamaño de las lesiones de caries de acuerdo al índice llamado “criterio de magnitud de la lesión cariosa” y asignarlo de acuerdo al número de lesiones presentes a uno de 4 grupos de riesgo para desarrollar caries, en donde el primer grupo representa a los menos afectados. Se generó un modelo multivariado de regresión logística multinomial. Resultados: Los grupos de riesgo a caries quedaron distribuidos de la siguiente manera: 598 (43.6%) fueron del grupo 1; 261 (19.0%) se asignaron al grupo 2; 316 (23.0%) estuvieron en el grupo 3; y 198 (14.4%) en el grupo 4. Comparando con el grupo menos afectado por lesiones cariosas, las variables asociadas en los diferentes grupos de gravedad en el modelo multivariado fueron: grupo de riesgo 2: edad, sexo y defectos de desarrollo del esmalte; grupo de riesgo 3: atención dental en el último año, actitud de la madre hacia la salud bucal y defectos de desarrollo del esmalte; grupo de riesgo 4: edad, atención dental en el último año, actitud de la madre hacia la salud bucal y defectos de desarrollo del esmalte. Conclusiones: La gravedad de caries está influenciada por variables demográficas, conductuales y clínicas

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Gravedad de caries empleando un criterio del tamaño de la lesión y variables asociadas en una muestra de escolares mexicanos

Objetivo: Determinar la gravedad de caries (tamaño de la lesión) y las variables asociadas en niños escolares mexicanos. Materiales y Métodos: Se realizó un estudio transversal en 1373 escolares de 6 a 12 años de edad inscritos en escuelas públicas de Campeche, México. Se distribuyeron cuestionarios para determinar una serie de variables sociodemográficas, socioeconómicas y conductuales. Se realizó un examen bucal a cada niño para establecer el tamaño de las lesiones de caries de acuerdo al índice llamado "criterio de magnitud de la lesión cariosa" y asignarlo de acuerdo al número de lesiones presentes a uno de 4 grupos de riesgo para desarrollar caries, en donde el primer grupo representa a los menos afectados. Se generó un modelo multivariado de regresión logística multinomial. Resultados: Los grupos de riesgo a caries quedaron distribuidos de la siguiente manera: 598 (43.6%) fueron del grupo 1; 261 (19.0%) se asignaron al grupo 2; 316 (23.0%) estuvieron en el grupo 3; y 198 (14.4%) en el grupo 4. Comparando con el grupo menos afectado por lesiones cariosas, las variables asociadas en los diferentes grupos de gravedad en el modelo multivariado fueron: grupo de riesgo 2: edad, sexo y defectos de desarrollo del esmalte; grupo de riesgo 3: atención dental en el último año, actitud de la madre hacia la salud bucal y defectos de desarrollo del esmalte; grupo de riesgo 4: edad, atención dental en el último año, actitud de la madre hacia la salud bucal y defectos de desarrollo del esmalte. Conclusión: La gravedad de caries está influenciada por variables demográficas, conductuales y clínicas

Common variants in Alzheimer’s disease and risk stratification by polygenic risk scores

Genetic discoveries of Alzheimer’s disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer’s disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer’s disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer’s disease

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2