Association of Individual and Combined Metabolic Risk Factors with Cancer

Introduction: The prevalence of metabolic risk factors (MRFs), individually and in the aggregate, is growing rapidly. There is limited biologic and epidemiologic evidence indicating an association between MRFs and cancer. The goal of this dissertation was to examine the association between individual and combined MRFs with subsequent risk of overall and site-specific cancers of the breast, digestive system, and lung.;Methods: A systematic review with meta-analysis on the association between metabolic syndrome (a cluster of MRFs) and breast cancer was conducted. In addition, associations between MRFs and risk of overall and site-specific cancers were assessed by multivariable Cox proportional hazards regression models. Lastly, associations between MRFs and age at cancer onset were examined by multiple linear regression analyses, using the general linear model. Data were derived from the NHANES I Epidemiologic Follow-up Study, and comprised participants ages 25 to 74 years at baseline. The primary metabolic risk factors were obesity (measured by BMI), high blood pressure, high total serum cholesterol, and diabetes. Analyses were adjusted for age, race, education, family income, physical activity, smoking status, and family history of cancer, and stratified by age and gender. All analyses incorporated the complex sample design and sample weights to produce national estimates.;Results: Results from the meta-analysis show that metabolic syndrome was modestly associated with an increased risk for breast cancer in adult women. Findings from the study on the association between individual and combined MRFs and cancer risk suggest that diabetes independently, and presence of a combination of MRFs, may serve as markers for postmenopausal breast cancer risk. The association between diabetes and a combination of three or four MRFs and earlier age at onset was observed not only for postmenopausal breast cancer, but also for overall cancer in women 50 and older, digestive cancer in women, and lung cancer in males.;Conclusion: Future research needs to examine this association between MRFs and site-specific cancers using specific, objective metabolic markers. The positive association of MRFs with postmenopausal breast cancer points toward the need to develop public health strategies to manage these risk factors.;Keywords: Metabolic syndrome, metabolic risk factors, cancer, meta-analysis, breast cancer

Interventions to Increase Completion of Hepatitis B Vaccination in People who Inject Drugs: A Systematic Review and Meta-analysis

Abstract Increases in opioid misuse and injection drug use have resulted in a rise in acute cases of hepatitis B. We conducted a systematic review and meta-analysis of randomized studies to determine the effect (pooled odds ratio) of interventions to increase hepatitis B vaccination completion in people who inject drugs (PWID). Odds ratios from the included studies were combined to create a pooled odds ratio (OR) using the Inverse Heterogeneity Model. Eleven studies met the eligibility criterion of having a randomized intervention to increase hepatitis B virus vaccination completion among PWID. The odds of vaccine completion in the intervention group were greater than in the control/comparison group (pooled OR, 2.53; 95% confidence interval [CI], 1.07–5.99). Subgroup analysis indicated that financial incentives were most effective (OR, 7.01; 95% CI, 2.88–17.06), followed by accelerated vaccine schedules (OR, 1.90; 95% CI, 1.14–3.14). Interventions using financial incentives and accelerated vaccine schedules are moderately effective at increasing hepatitis B vaccination completion in PWID

Feto-maternal haemorrhage: a review after and a case report

Feto-maternal haemorrhage is the transmission of fetal blood cells to the maternal blood stream. It is quite common in small volumes- occurring in most pregnancies. Large volumes of feto-maternal haemorrhage can have serious consequences. Some risk factors are identified, but they are not always present. Decreased perception of fetal movements is most important clinical sign, together with a pathological NST. Prompt diagnosis and immediate obstetric care is fundamental, as serious risk to the fetus might result from this condition. Author described the case report of 35 years old G3P1L1A1 with 37 weeks 5 days pregnancy, who came in outpatient department with reduced perception of fetal movements during the previous 10 hours. There was no history of abdominal trauma. Cardiotocograph showed nonreactive NST with minimal beat to beat variability for more than 40minutes. An emergency caesarean section was performed and a female limp baby delivered with heart rate <60/minutes, pale, no respiration and no reflexes. Baby resuscitated with bag and tube ventilated. APGAR score was 3/5/6 at 0, 1, and 5 minutes. Fetal haemoglobin at the first hour of life was 3.0gm/dl. Kleihauer-Betke test revealed 265.7ml of fetal erythrocytes in the maternal blood stream. Despite being rare, it is important to detect a massive feto-maternal haemorrhage. Fetal anemia could be suspected, but the diagnosis was only made after delivery. This case reveals the importance of keeping a high suspicion in obstetric practice, as feto-maternal haemorrhage is a rare but potentially catastrophic event for a fetus.

Risk Factors Associated with Passenger Vehicle Fatal Rollover Crashes in West Virginia, 2001-2018

Background: Rollover crashes cause more injuries and fatalities than other types of motor vehicle crashes. West Virginia (WV) has high rates of drug overdose deaths and motor vehicle crash fatality. However, no studies have investigated risk factors associated with fatal rollover crashes in WV. Purpose: The objective of this study is to evaluate whether drug use and other risk factors are associated with fatal rollover crash fatalities in WV. Methods: This cross-sectional study utilized the Fatality Analysis Reporting System dataset from passenger vehicle crashes involving WV drivers ≥ 16 years of age with known drug test results who died within 2 hours after collision from 2001 to 2018. Risk factors associated with fatal rollover crashes were compared to non-rollover crashes using multivariable logistic regression. Results: During the study period, 880 WV drivers died in rollover crashes. Driving ≥ 60 mph [adjusted odds ratio (aOR): 4.1; 95% confidence interval (CI): 2.4-6.8], alcohol use (aOR: 1.6; 95% CI: 1.1-2.1), rural areas (aOR: 1.4; 95% CI: 1.0-1.9), and the lack of airbag deployment (aOR: 2.7; 95% CI: 2.1-3.5) were associated with fatal rollover crashes in WV. However, drug use was not associated with fatal rollover crashes in the final multivariable logistic regression model (aOR:1.13; 95% CI: 0.9-1.5). Implications: Findings of risk factors associated with rollover crash fatalities in WV can inform several public health interventions. Rapid and sensitive assessment tools and standardized toxicology testing are helpful to provide more comprehensive drug-impaired driving datasets for future analysis

A new technique to determine vertical dimension of occlusion from anthropometric measurement of interpupillary distance

Background: A number of techniques are being practiced for the evaluation of VDO, but none of them is scientifi - cally more accurate than other. Each method advocated has its own limitations. Objectives: The purpose of this study was to find correlation between vertical dimension of occlusion (VDO) and interpupillary distance (IPD). Material and Methods: A cross-sectional study was conducted on 400 dentate subjects comprising of 200 males and 200 females. Anthropometric measurement of VDO was recorded clinically using modified digital vernier caliper. Also, a standardized digital photograph of face was generated from the frontal aspect using a digital camera for the measurement of IPD in millimeters. Correlation between VDO and IPD was studied using Spearman's coefficient. For the execution of regression command and preparation of prediction equations to estimate VDO, Statistical Package for Social Sciences (SPSS) Software Version 11.5 was used. Results: VDO and IPD was more in males compared to females. VDO was significantly and positively correlated with IPD only in males whereas females showed a weak correlation. Hence, regression equation was derived only for males. VDO estimation using regression equation for IPD had a standard error of ± 3.94 in males. Conclusions: Since the variations between VDO and IPD are within the range of 2-4 mm, VDO prediction through this method is reliable and reproducible for male patients. Also, the method is simple, economic, and non invasive; hence it could be recommended for everyday practice to determine vertical dimension of occlusion in case of male patients

The Compounding Effect of Rurality on Health Disparities Among Black Patients with COVID-19

Background: West Virginia had garnered national attention for its vaccination rollout against coronavirus 2019 (COVID-19). Outcomes of this mostly rural population, however, have been underreported. As the pandemic continues, identifying high risk populations remains important to further epidemiologic information and target vaccines. Purpose: The objective of this study is to examine the effects of COVID-19 and the influence of race and rurality on hospitalization and outcomes in Appalachians. Methods: In this retrospective study, data from patients who tested positive and were admitted for COVID-19 and seen within the state’s largest health system (West Virginia University Health System) between March 18 and September 16, 2020 were analyzed. Cases were stratified into rural or urban based on rural urban continuum codes (RUCCs) and by race into ‘white’, ‘black’, or ‘other’. Associations between rurality, rurality and race, and outcomes were assessed. Results: A total of 2011 adult West Virginians tested positive, of which 8.2% were hospitalized. Of the hospitalized patients, 33.5% were rural and 11.6% were black. Rural black patients were three times more likely (OR: 3.33; 95%CI:1.46-7.60) to be admitted. Rural blacks were also more likely to have a history of obstructive pulmonary disease (OR: 2.73; 1.24-6.01), hypertension (OR: 2.78; 1.38-5.57), and multiple chronic conditions (3.04; 1.48-6.22). Implications: Rural blacks were more likely to have risk factors for severe COVID-19 influencing their increased risk of hospitalization. These findings support that race as a risk factor for severe COVID-19 is compounded by rurality and identifies an important target group for vaccination

A randomized double-blind study to evaluate asurgeon-based technique to reduce post-operative pain in minimal gynecological surgery

Background: The study aims to evaluate whether instillation of levo-bupivacaine intraperitoneally decreases post-operative pain after laparoscopic gynaecological surgeries, using VAS pain Scale. Methods: Randomized placebo controlled double blinded study conducted at tertiary care hospital in New Delhi. 90 ASA I &amp; II women scheduled to undergo elective laparoscopic gynaecological surgeries. 20 ml 0.5% levo-bupivacaine diluted with 40ml normal saline (total 60ml) intraperitoneally at the end of surgery before closure of ports along with port site infiltration of levo-bupivacaine (3-5 ml) in intervention group and 60 ml normal saline intraperitoneally in control group. Results: Mean pain scores were significantly lower (p&lt;0.01) in the intervention group when compared to the control group for initial 4 hours of the study after that mean pain score was lower in intervention group than control group but it was statistically not significant. The requirement of rescue analgesia was also significantly lesser in intervention group compared to control group. Conclusions: Levo-bupivacaine is an easy, cheap and non-invasive method which provides good analgesia in the immediate postoperative period after laparoscopic gynaecological surgery, without adverse effects, especially in the early postoperative period. This improves patients experience and should be made an integral part of all minimal gynaecological endoscopic surgery

Self-medication in Primary Dysmenorrhea among Undergraduate Students in a Medical College: A Descriptive Cross-sectional Study

Introduction: Primary dysmenorrhea is painful menstruation in women with normal pelvic anatomy, usually beginning during adolescence, primarily associated with a normal ovulatory cycle. There is an increased likelihood of self-medication among medical students. The aim of this study is to find out the prevalence of self-medication in primary dysmenorrhea among undergraduate students in a medical college. Methods: A descriptive cross-sectional study was conducted in a medical college among undergraduate female students with primary dysmenorrhea from 1 February 2022 to 31 May 2022. Ethical approval was obtained from the Institutional Review Committee of the same institute (Reference number: 254/2021). Convenience sampling was done. Data were collected through a self-administered questionnaire. Point estimate and 95% Confidence Interval were calculated. Results: Among 213 students with primary dysmenorrhea, self-medication was found to be in 78 (36.62%) (30.15-43.09, 95% Confidence Interval)). Among all the self-medications used, mefenamic acid was most common, used by 45 (57.69%) students, followed by paracetamol 11 (14.10%). Conclusions: The prevalence of self-medication practice in primary dysmenorrhea among undergraduate students was lower when compared to similar studies done in similar settings