The prevalence of middle ear disease and its risk factors have been the subject of multiple studies. High prevalence of middle ear disease has been described among North American natives, especially chronic otitis media. Such studies have not been carried out in South America.To describe the prevalence of middle ear pathology and risk factors in native schoolchildren from southern Chile who belong to the Mapuche ethnic group, as well as the impact of socio-economic and demographic changes after 14 years of development.Two otologic evaluations with an interval of 14 years were performed in schoolchildren with a percentage of indigenous population above 85%. Socioeconomic and demographic data were collected from national official statistical data.p < 0.001).A total of 1067 schoolchildren were examined. Many described risk factors for ear pathology were found. An overall prevalence of 0.19% for tympanic membrane perforation, 5.6% for pars tensa retraction pockets, 1.5% for pars flaccida retraction pockets and 11.1% of otitis media with effusion was found. There were several socioeconomic improvements after 14 years. The difference between the prevalence of symptoms and the presence of otitis media with effusion was statistically significant (Despite the presence of several risk factors for middle ear disease, this study population showed a low prevalence of middle ear disease. The ethnic-racial factor seems to be a protective factor. The prevalence of middle ear pathology and its risk factors have induced multiple studies.15The prevalence of ear pathology varies according to the country and the date of the study. In Chile, in 1973, Rosenblut et al.The high prevalence of middle ear disease and especially COM in Chile has been intuitively attributed to the miscegenation with native ethnics. This statement could be supported by the theoretical common origin with North American natives as the Apaches, Inuit and Navajos in whom higher prevalence of middle ear pathology has been shown.Indigenous communities represents 4.6% of the country population, which correspond to 692,192 citizens belonging to ethnics groups  where 604,349 are Mapuches (87.3%).Alto Biobío is a Chilean commune located in the Andes (latitude 38°37′26″ South 71°57′54″ West) that borders Argentina to the east. The annual average temperature is 11.3 °C and it has a total precipitation of 2192 mm per year. It is classified as Csb according to Köppen-Geiger, a global natural climate classification that identifies each type of climate with a series of letters that indicate the behavior of the temperatures and precipitations that characterize this type of climate.In 2004, the opening of Ralco Hydroelectric power plant caused the displacement of the population.It was decided to focus our study on two specific objectives (1) describe the prevalence of middle ear disease in native Mapuche children and determine the impact of their ethnicity on it,and (2) analyze the results after 14 years of socioeconomic and environmental development.Given the poor external conditions, we expected to find a high rate of middle ear pathology in the studied population. The controlled conditions in this group allowed us to avoid the predominance of extrinsic factors. Therefore, it represents a propitious group to evaluate the influence of the ethnic-racial factor on middle ear pathology.Two assessments were carried out in native children of Alto Biobío with 14 years of interval between them. On both occasions the evaluations were conducted in 10 schools in which more than 85% of the students belong to the Mapuche ethnic group. The sample was divided into two groups. The sample population assessed on November 2nd and 3rd 1998 was assigned as Group 1 and the sample population assessed on April 12th and 13th in 2012 was assigned as Group 2. Each evaluation was performed by three otorhinolaryngologists and residents; an otologic examination was performed using a light otoscope. The findings were classified major: tympanic membrane perforation, pars tensa retraction pockets, pars flaccida retraction pockets and Otitis Media with Effusion (OME), and minor; Dimeric tympanic membrane and myringosclerosis. The patients were asked for otologic symptoms such as hearing loss, otalgia and otorrhoea during the previous month. Socioeconomic, demographic, sanitary and educational data were collected from families of the students, school references and national official statistics.According to official national data, in 1992 a total of 234,541 Mapuches resided between the Regions of Biobío and Los Lagos of Chile, where 4656 of them lived in the Alto Biobío sector. In 2013 11,486 Mapuches were registered in Alto Biobío commune.In 1998, its rural population constituted 84.4%, the percentage of indigenous ethnicity was 71% and the average schooling was 4.98 years. They had a high rate of overcrowding with an average of 4.33 people per home (43% of households inhabited five or more people). 69.9% of homes had no access to drinking water and/or had deficient sanitary facilities and 21.88% had no equipment in their houses . There was only one rural health clinic for the entire commune in 1998 and they received two visits per week by general physicians from Santa Barbara (the nearest town). A total of 70% of the healthcare in this area was provided by native alternative medicine practitioners. There was no school feeding program, and 25% of children under 6 years old were underweight. In that year, the infant mortality rate was 22.73 per 1000 newborns.26In 2012, they had a Human Development Index (HDI) of 0.637 and a Vulnerability Index (VI) of 0.674. Rural community was 80.5%, well above the regional average (16.5%). The percentage of indigenous ethnicity was 74.1% and the average level of schooling was 6.3 years. A school feeding program was already implemented in every educational establishment; 2.9% of children under 6 years were underweight. The overcrowding rate declined significantly from year to year constituting only 1.2% of households, however, 49.1% lived in poor conditions and 30.6% of the inhabitants belong to the poorest social class population (indigents). 67.7% of homes had no access to drinking water or had deficient sanitary facilities, being the commune with the lowest rate in the region.The access to medical care is one of the factors that substantially improve health. The natives relied on 8 rural health clinics and one family health center, therefore, the people who preferred native alternative medicine has decreased significantly and now the healthcare is provided mostly by physicians. In that year, infant mortality amounted to 9.4 per 1000 newbornsA total of 1067 schoolchildren (2.134 ears) were examined, 530 students on the first assessment and 537 on the second. 47.3% were male and 52.7% female, with an average age of 9.54 years . When peIn Group 1 (1.998), 530 schoolchildren were evaluated. The average age was 10 years, ranging from 3 to 17 years. 53.2% were female and 46.8% were male. 95.1% were asymptomatic and 4.9% symptomatic. The symptoms were otalgia (3.8%), followed by hearing loss (0.9%) and otorrhoea (0.19%). There was a 21.1% incidence of pathologic otoscopic findings, and 13.4% of them were major findings; tympanic membrane perforation 0.18% (1 ear), pars tensa retraction pocket 3.5% (38 ears), pars flaccida retraction pocket 0.9% (10 ears) and otitis media with effusion 8.8% (94 ears) Minor findings were observed in 7.6%: dimeric tympanic membrane 1.2% (13 ears) and myringosclerosis 6.4% (68 ears) .Figure 1In Group 2 (2012), 537 schoolchildren were evaluated. The average age was 9.08 years, ranging from 3 to 18 years. 52.1% were female and 47.9% were male. 82.7% were asymptomatic and 17.3% symptomatic. The symptoms were otalgia (11.9%), followed by hearing loss (5.2%) and otorrhoea (0.19%). There were 12.7% of pathologic otoscopic findings, and 4.9% of them were major findings: tympanic membrane perforation 0.18% (1 ear), pars tensa retraction pocket 2.02% (22 ears), pars flaccida retraction pocket 0.55% (6 ears) and otitis media with effusion 2.23% (24 ears). Minor findings were observed in 7.8%: dimeric tympanic membrane 1.3% (13 ears) and myringosclerosis 6.5% (70 ears) .p < 0.05).The distribution of patients in each group is evaluated according to their age . A homogp < 0.001). Regarding symptoms, they increased from an overall 4.9% to 17.3% due to the increase of otalgia and hearing loss (p < 0.001). Regarding otoscopic findings, OME decreased significantly, observing a decrease from 8.8% to 2.2% (p < 0.05). All other parameters measured showed no significant differences.Of all the evaluated findings, a statistically significant difference in symptoms and otoscopic findings were found  cases. Due to the different season of the evaluations between both groups (spring and autumn), it is not possible to dismiss that the statistically difference of OME rates between those groups can be secondary to this external factor, thus on this point it is not possible to state a significant impact result of the socioeconomic, housing and sanitary conditions changes after 14 years.According to indigenous genetic history of America, the indigenous population of South America could belong to Amerindians, who belong to the first people that migrated from Asia to America through Beringia.Mapuche school students from Alto Biobío have a lower prevalence of middle ear pathology than the Chilean urban continental average and North American natives. The exposure to several risk factors such as deficient environmental, socioeconomic, nutritional and sanitary conditions generates no significant impact on their low prevalence of middle ear disease. The ethnic factor seems to be an important protective factor for this population. Our findings should encourage further studies of middle ear risk factors.Ethical Approval: This article does not contain any studies with animals or clinical trials with humans.Presentation information: Results were presented at the 88th Annual Meeting 2017 of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, Congress Center der Messe Erfurt, Thüringen, Germany. May 24th–May 27th, 2017.The authors declare no conflicts of interest.


BackgroundTraditional non-steroidal anti-inflammatory drugs (NSAIDs) are recognized to injure the upper gastrointestinal tract (GIT) mucosa. For example, gastric mucosal hemorrhages can be caused by a single dose of 650 mg of aspirin. Nearly 30% to 50% of NSAID users showed endoscopic lesions including subepithelial hemorrhages, erosions, and ulcerations. These lesions are often asymptomatic and are mostly found in the gastric antrum. With the chronic exposure, the mucosa adapts to the aggression of the NSAIDs, whereby these lesions slowly lessen or fade.AimThe aim of this study is to detect the association between NSAIDs and gastrointestinal complications among the general population in the Aseer region, Saudi Arabia.MethodologyA record-based retrospective study was conducted targeting people with GIT complications who were 20 years old and above. We reviewed patients' records from the GIT clinic in the Aseer region of Saudi Arabia. We reviewed specifically patients who had GIT complications like gastritis, abdominal pain, GIT bleeding, heartburn, nausea, vomiting, peptic ulcer, and diarrhea. Then we contacted those patients individually to fill out a questionnaire. Participants less than 18 years, those who refused to complete the questionnaire, or any patients with no history of GIT complications were excluded. An online questionnaire was sent to the patients with GIT complications. The questionnaire included participant's personal data, NSAID use, and associated GIT complications. The questionnaire was uploaded online using social media platforms by the researchers and their relatives and friends during the period from March 2012 to May 2022.ResultsA total of 211 participants with GIT complications completed the study questionnaire. Participant ages ranged from 20-59 years with a mean age of 31.2 ± 12.9 years old. A total of 140 (66.4%) were males and 175 (82.9%) were from urban areas. A total of 156 (73.9%) were non-smokers. A total of 103 (48.8%) participants used NSAIDs. As for complications, the most reported were peptic ulcer (37.9%), GIT bleeding (5.8%), GIT erosions (4.9%), and intestinal obstruction (3.9%) while 59.2% had no complications.ConclusionsThe current study revealed that nearly one out of every two participants in the Aseer region mainly used NSAIDs as tablets for pain. Regarding high utilization rates, less than half of them developed GIT complications, mainly peptic ulcers. Globally, non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed and used medications . NSAIDs On the other hand, upper gastrointestinal (GI) symptoms appeared among about 40% of NSAID users, with the most frequently diagnosed including gastroesophageal reflux, featured by regurgitation and/or heartburn, and dyspeptic symptoms, including belching, epigastric discomfort, bloating, early satiety, and postprandial nausea . MoreoveA record-based retrospective study was conducted targeting a population with GIT complications in the Aseer region, Saudi Arabia. We reviewed patients' records from the GIT clinic in the Aseer region, Saudi Arabia, specifically records of patients admitted with GIT complications who are 20 years of age and above. Then we contacted those patients individually to fill out a questionnaire. Participants less than 20 years old, those who refused to complete the questionnaire, and patients with no GIT complications were excluded. After obtaining ethical approval, we sent an online questionnaire to the selected population with GIT complications. Around 211 patients with GIT complications responded to the questionnaire. The questionnaire was developed by researchers after intensive literature reviews and expert consultation. The first part of the questionnaire included the participant's personal data, medical and drug history, smoking, and drug allergy. The second part covered the use of NSAIDs, frequency of use, the pattern of use, prescription, and causes of using NSAIDs. The third part covered NSAID use-associated GIT side effects and complications. The questionnaire was uploaded online using social media platforms by the researchers during the period from March 2021 to May 2022.Data analysisAfter data was extracted, it was revised, coded, and fed to statistical software IBM SPSS version 22 . All statistical analysis was done using two-tailed tests. A p-value less than 0.05 was considered statistically significant. Descriptive analysis based on frequency and percent distribution was done for all variables including participants' age, gender, residence, smoking, chronic diseases, and drug use. Also, participants' use of NSAIDs, frequency of use with associated complications, and side effects were tabulated and graphed. Cross-tabulation was used to assess factors associated with NSAID use and related complications among study participants. Relations were tested using the Pearson Chi-square test and the Exact probability test for small frequencies.A total of 211 participants completed the study questionnaire. Participant ages ranged from 20-59 years with a mean age of 31.2 ± 12.9 years old. A total of 140 (66.4%) were males and 175 (82.9%) were from urban areas. As for smoking, 156 (73.9%) were non-smokers while 48 (22.7%) were smokers. A total of 68 (32.2%) had a chronic health problem which was for more than 10 years among 44 (64.7%) and for 5-10 years among seven (10.3%). A total of 50 (23.7%) patients had a history of allergy and 57 (27%) used other drugs. by themselves. A total of 61 (59.2%) NSAID users had the drugs after meals while 26 (25.2%) had before meals. As for the frequency of taking NSAIDs/day, it was taken once daily among 46 (44.7%) and twice-daily among 34 (33%). A total of 84 (81.6%) had the drugs as tablets/capsules  participants used NSAIDs . Also, 73.5% of those with chronic health problems used NSAIDs compared to 37.1% of others without (p=.001). NSAIDs were used by 66.7% of used other drugs in comparison to 42.2% of others who did not (p=.002) (Table The most reported side effects among users were heartburn (40.8%), flatulence (34%), reflux 27.2%), nausea (22.3%), vomiting (13.6%), early satiety (7.8%), and burping (6.8%) while 28.2% had no side effects. As for complications, the most reported were peptic ulcer (37.9%), GIT bleeding (5.8%), GIT erosions (4.9%), and intestinal obstruction (3.9%) while 59.2% had no complications , by signs/symptoms with lab investigations among 37 (58.7%), while 20 (31.7%) needed endoscopy to diagnose complications. A total of 42 (40.8%) reported still using NSAIDs and 56 (91.8%) of those who stopped using NSAIDs said it was their own decision. A total of 51.9% of the current smokers experienced complications versus 75% of ex-smokers and 34.7% of non-smokers (p=.049). Also, 45.2% of users of tablets/capsules experienced GIT complications compared to 21.1% of those who took injections (p=.046)  and twice-daily among 34 (33%). A total of 84 (81.6%) had the drugs as tablets/capsules. NSAID use was significantly associated with old age and those with chronic health problems as they may experience pain and other disease-related consequences that need analgesics. Also, the older population is more diagnosed with rheumatoid disorders which include the use of NSAIDs for symptomatic treatment. The prevalence of NSAID use in patients over 65 years old is as high as 96% in the general practice setting ,16 AboutRegarding NSAID-related complications, the current study showed that less than half (41.8%) of the users experienced GIT complications. The most-reported complications were peptic ulcer (37.9%), GIT bleeding (5.8%), GIT erosions (4.9%), and intestinal obstruction (3.9%) while 59.2% had no complications. Complications were significantly higher among smokers (current and ex-smokers), and those who had NSAIDs as tablets, which is mostly due to direct contact with GIT mucosa and frequent use for a long time. These complications were the most reported in different literature studies among NSAID users -28.LimitationsThe present study has several limitations. The main limitation of this study was its retrospective nature and the lack of essential variables available in the hospital database system, such as the type of NSAID that has been used and dosing, limited information about the type of chronic illness among participants, and the small number of patients enrolled in the study, which will affect the ability to detect an association between GIT complication and NSAID use in the Aseer region.In conclusion, the current study revealed that nearly one out of two participants in the Aseer region used NSAIDs mainly for pain management. Old-aged participants with chronic health problems were the main users. Regarding high utilization rates, less than half of them developed GIT complications, mainly peptic ulcers. Concomitant smoking and NSAID use were very significant for GIT complications. These medications should be prescribed for the shortest duration possible in the lowest effective dose, and with careful surveillance to monitor GIT complications with other reported renal and cardiovascular toxicity.


General anesthesia is not without morbidity. One of the well-known life-threatening events associated with general anesthesia is difficult airway which can happen during induction of anesthesia while attempting to insert the endotracheal tube with the aid of a laryngoscope. Difficult intubation, inadequate ventilation, and esophageal intubation are the principal causes of death or brain damage related to airway manipulation.The main objective of this study was to assess the magnitude and predictors for difficult laryngoscopy and intubation among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation at Tikur Anbessa Specialized Hospital from February 1 to March 30, 2019.An institutional based cross sectional study was conducted from February 1 to March 30, 2019 on patients who underwent elective surgery under general anesthesia with endotracheal intubation. Data on socio-demographic characteristics, preanesthetic airway assessment and laryngoscopic view were collected. Data were analyzed by SPSS Version 20.0. Chi- square test, binary logistic regression and multivariate analysis were performed. Tables and texts were used to present data. A p value less than 0.05 was considered as statistically significant.The magnitude of difficult laryngoscopy, difficult intubation, and failed intubation were 12.2%, 6.1%, and 0.67%, respectively. Upper Lip Bite Test (ULBT) had a higher sensitivity (90.2%) and negative predictive value of 85.3%. Mallampati had a sensitivity of 45.8% and negative predictive value of 86% in predicting difficult laryngoscopy. Mallampati grade, thyromental distance and ratio of height to thyromental distance (HRTMD) have also showed greater sensitivity  when compared to other tests in predicting difficult intubation. Mallampati class, upper lip bite test (ULBT) and inter-incisor distance (IID) are independent predictors for difficult laryngoscopy (p < 0.05). Furthermore, Mallampati class, Thyromental distance and ratio of height to thyromental distance (HRTMD) are identified as independent predictors of difficult intubation (p < 0.001).) can predict the probability of difficult endotracheal intubation in adult patients. Whereas, Mallampati class and upper lip bite test (ULBT) predicts higher probability for difficult laryngoscopy.and recommendation: Mallampati class, Thyromental distance and Ratio of height to Thyromental distance (HRTMD •The magnitude of difficult laryngoscopy and intubation were 12.2% and 6.1%, respectively.•Mallampati class, TMD and HRTMD were predictors of difficult intubation.•Upper Lip Bite Test had a higher sensitivity to predict difficult laryngoscopy.•Mallampati class, Upper Lip Bite Test and IID predicts difficult laryngoscopy. Preoperative assessment of the patient's airway facilitates the anesthetists to predict the ease of visualizing the glottis and to perform intubation easily. Furthermore, Management of the difficult airway is one of the most relevant issues and core competency for practicing anesthetists . Maintai. Difficult endotracheal intubation is defined as endotracheal intubation requiring multiple attempts [The term “difficult airway” covers a spectrum ranging from problems in ventilating a patient'slung with a face mask or supraglottic airway to problems in intubating and extubating a patient's trachea. A recent guideline update defines the difficult airway as an airway for which an experienced practitioner anticipates or encounters difficulty with facemask ventilation, tracheal intubation, or supraglottic airway use or recognizes the need for an emergency surgical airway ,6. The pattempts ,14. The attempts ,10.Among the strategies proposed to decrease morbidity and mortality related to difficult tracheal intubation (DTI), the role of its predictors remains a matter of debate . Several2www.researchregistry.com with Research Registry UIN: researchregistry 6882. This work also reported in line with STROCSS 2021 criteria [The study was done after obtaining a letter for approval by institutional ethics committee of Addis Ababa University to conduct this study. An institutional based cross-sectional study was conducted at Tikur Anbessa Specialized Hospital from February 1 to March 30, 2020. All adult patients who underwent elective surgery under general anesthesia with endotracheal intubation and full-filled the inclusion criteria were included. Patients with an anticipated difficult airway, emergency and pediatric patients were excluded from the study. A pretested and structured questionnaire was prepared to collect data from the patients. Independent variables like airway parameters were collected by observing and measuring each airway assessment test, and the data for dependent variable was collected during the induction phase of anesthesia by qualified duty free anesthetist by observation. Data regarding the grade of laryngoscopy were collected from anaesthetic record sheet. Two qualified anesthetists were selected for data collection based on the capability of being free during the data collection period and experience of data collection. Half-day training was given for qualified anesthetists, who were involved in the data collection process. Furthermore, Informed consent was taken from each patient orally before data collection. This study was registered at criteria .2.1The sample size was calculated based on a previous research done in Gondar University, North Ethiopia  which sh PBM data was replaced with SVG by xgml2pxml:<glyph-data id="pc-E00C" format="PBM" resolution="300" x-size="12" y-size="9">000000000000000000000000000000000000111111111111000000000000111111111111000000000000000000000000000000000000</glyph-data><svg xmlns="http://www.w3.org/2000/svg" version="1.0" width="20.666667pt" height="16.000000pt" viewBox="0 0 20.666667 16.000000" preserveAspectRatio="xMidYMid meet"><metadata>Created by potrace 1.16, written by Peter Selinger 2001-2019</metadata><g transform="translate scale" fill="currentColor" stroke="none"><path d="M0 440 l0 -40 480 0 480 0 0 40 0 40 -480 0 -480 0 0 -40z M0 280 l0 -40 480 0 480 0 0 40 0 40 -480 0 -480 0 0 -40z"/></g></svg>N/n; 308/148 = 2.Systematic random sampling technique was employed to select study participants on daily operation schedule. From situational analysis 308 patients were operated on elective schedule for 2 month. The sampling interval; K was determined using: KTherefore, the sampling interval was two and the first study participant (random start) was selected using lottery method from the daily operation schedule list. Then, every second cases were included in the study during the study period until the required sample size is reached.2.2The data was cross-checked for completeness and consistency. Then it was entered on SPSS version 20 for analysis. Sensitivity, specificity, and positive and negative predictive value were calculated to assess the association between the outcome and exposure variables. Binary and multivariate logistic regression was used to assess the inﬂuence of each risk factors or airway parameters on the incidence of difficult laryngoscopy and difficult intubation. A P-value of less than 0.05 was considered as statistically significant.2.3Mallampati grading: Grade I: Visualization of the soft palate, fauces, uvula, anterior and the posterior pillars; Grade II: Visualization of the soft palate, fauces and uvula, Grade III: Visualization of soft palate and base of uvula; Grade IV: Only hard palate is visible, Soft palate is not visible at all.Thyromental Distance: It is defined as the distance from the mentum to the thyroid notch while the patient's neck is fully extended.2.4Grade I – Visualization of entire laryngeal aperture.Grade II – Visualization of only posterior commissure of laryngeal aperture.Grade III – Visualization of only epiglottis.Grade IV – Visualization of just the soft palate.Inter-Incisor Distance: It is the distance between the upper and lower incisors. Class 1: lower incisors can bite the upper lip above the vermilion line; Class 2: lower incisors can bite the upper lip below the vermilion line; Class 3: lower incisors cannot bite the upper lip.Sterno-mental distance: the distance from the suprasternal notch to the mentum and measured with the head fully extended on the neck with the mouth closed.Difficult laryngoscopy: Cormack and Lehane grade III (epiglottis only) or grade IV view Difficult intubation: If a trained anesthetist using direct laryngoscopy takes more than 3 attempts or more than 10 min to complete tracheal intubation.33.1One hundred forty eight (148) patients were included in the study. Majority of the participants 135 (91.2%) were within the age of 18–65 years. The body mass index data shows 121(81.8%) of the participants were above twenty five. The result also showed that out of 148 patients who underwent general anesthesia, 50(33.8%) were general surgery procedures, 18(12.2%) thoracic surgeries, 10(6.8%) orthopedic procedures, ENT 12(8.1%), 22 (14.9%) urologic and 18 (12.2%) gynecologic surgeries Table 1So3.2In this study, we found that the magnitude of difficult laryngoscopy and intubation was 18/148 (12.2%) and 9/148 (6.1%), respectively. There was one case with failed intubation (0.67%). 16(10.8%) patients had TMD <6.5 cm of whom 12 had easy and 4 had difficult intubation (p < 0.05), whereas the rest 132(89.2%) had TMD >6.5 cm and only 5 of them were difficult to intubate. 127(85.8%) and 21(14.2%) patients had SMD >12 cm and SMD <12 cm, respectively. but the 6 difficult to intubate patients were from SMD >12 cm group. Out of 130(87.7%) Mallampati class I & II patients only 3(2.3%) case of difficult intubation was observed, but out of 18(12.16%) patients who exhibited Mallampati class III&IV, difficult intubation was encountered in 5(27.8%). Furthermore, from 18 patients who developed CL laryngoscope grade III&IV (difficult laryngoscopy), 15(83.3%) had Mallampati class of III and IV (p < 0.05) .Table 2P3.33.3.1In our study we have found that upper lip bite test (ULBT) had a higher sensitivity 90.2% and negative predictive value of 85.3%. Mallampati had a sensitivity of 45.8% and negative predictive value of 86%. IID also showed higher sensitivity (93.5%) and NPV of 87.5%. Sterno-mental distance showed higher specificity (91.1%) in predicting difficult laryngoscopy . A multi3.3.2Our study found that higher accuracy to predict difficult intubation in Mallampati and HRTMD . Mallampati grade, Thyromental distance and HRTMD have also showed greater sensitivity  when compared to other tests. A higher specificity was seen in ULBT (80.2%) and SMD (79.6%). The negative predictive value of most of the pre-operative airway parameters were higher . A multi4This study found that magnitude of 12.2% and 6.1% for difficult laryngoscopy and intubation, respectively, among elective surgical patients with apparently normal airway. This result was in line with previous study from Ethiopia which showed the magnitude of difficult laryngoscopy and intubation as 13.6% and 5%, respectively. Furthermore the study revealed that 33.3% of patients with difficult laryngoscopy were found to be difficult for intubation ,17. The In our study sensitivity, specificity, PPV and NPV Mallampati classification for difficult laryngoscopy was 45.8, 65.9%, 20.4% and 86.2%, respectively. Gupta et al. showed that the sensitivity, specificity, PPV and NPV of Mallampati class as 77.3%, 98.2%, 48.7% and 99.5%, respectively in predicting difficult airway (DAW). Harjai M and his colleagues from India also reported that among the clinical predictors, the Mallampati grading had the maximum receiver operating characteristic (ROC) and area under the curve (AUC) with 86.7% sensitivity to predict difficult laryngoscopy [In accordance with our finding, a comparative study by George and Jacob in India on 141 surgical patients reported 54.5% sensitivity of Mallampati class as a predictor of difficult tracheal intubation . Gupta AULBT was found to have sensitivity of 90.2% and specificity of 16.7% to predict difficult laryngoscopy. Comparable findings were also reported by other authors ,23. ThisThere is still no single test with 100% sensitivity and specificity to predict difficult laryngoscopy and intubation. The finding of our study also revealed that Mallampati classifications had sensitivity of 69.6% and specificity 65.6% for difficult intubation, and IID with sensitivity of 34% and specificity of 50% for predicting difficult laryngoscopy. This was comparable with a prospective observational study conducted by Hailekiros AG et al. in Gondar University hospital referral hospitals, Ethiopia which revealed that the sensitivity and specificity of Mallampati was 65% and 90%, and IID 73% and 81, respectively .Available literatures did not show the predictive value of difficult laryngoscopy for difficult intubation. A good predictive test should have high sensitivity, specificity, positive and negative predictive values. Moreover, it should be simple enough to allow routine clinical use during preoperative evaluation and versatile enough so as to be applicable to different ethnic groups, gender and age. However high sensitivity is desirable as it will identify most patients in whom intubation will truly be difficult. In our study, HRTMD and Mallampati grade showed better accuracy (65.9% and 96%), respectively for difficult laryngoscopy. In addition, the accuracy of Mallampati class and HRTMD in predicting difficult intubation was 77.9% and 80.3%, respectively. According to Shiga et al. screening tests included were Mallampati classification, thyromental distance, sternomental distance, mouth opening, and Wilson risk score. Each test yielded poor to moderate sensitivity (20–62%) and moderate to fair specificity (82–97%). In contrast to the above findings, Srinivasa et al. and Savva showed greater sensitivity, specificity, and positive predictive values for most of the preoperative airway tests. This may be due to differences in patients’ physical appearance, sample size, and cutoff values for the screening tests ,19,24.In general our study found that Mallampati class, ULBT and IID as independent predictors for difficult laryngoscopy (p < 0.05), whereas Mallampati class, Thyromental distance and HRTMD as independent predictors for difficult intubation (p < 0.001). Similar finding was reported by a cross-sectional study from Gondar, Ethiopia which evaluated the magnitude and predisposing factors for difficult airway among 212 patients and showed Mallampati as a predictor of difficult airway .5Based on the result, we conclude that the magnitude of difficult intubation is not quite small that the anesthetists should expect difficult airway management in apparently normal patients.Moreover, not all preoperative screening tests reliably indicate difficult intubation when used alone. Combination of some tests may have favorable effect in predicting true difficulty. However, Mallampati class, Thyromental distance and HRTMD can predict the probability of difficult endotracheal intubation in adult patients. Whereas Mallampati class and upper lip bite test (ULBT) predicts higher probability for difficult laryngoscopy.The limitation of this study includes it is a single centre study that it is only representative for the study hospital. Nevertheless, it is most likely that studies in other hospitals would lead to similar results. Furthermore, the study was focused on apparently normal individuals that we recommended large scale multicenter studies targeting the high risk populations.Ethical approval obtained from Addis Ababa University department of anaesthesia and informed consent obtained from patients.10.13039/501100007941Addis Ababa University. The study sponsors have no role in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.This work was funded by All authors have made substantial contributions to conception, design, participated in the critical review, and editing of the manuscript drafts for scientific merit and depth.None.It has been registered with the Research Registry with unique identifying number of researchregistry 6882.All authors.The data were collected by data collectors and submitted to the authors who are willing to share the data upon request from peer researchers.Not commissioned, externally peer-reviewed.


Dementia’s prevalence increases due to population aging, it has become a major public health concern.To estimate the incidence of dementia and to describe the socio-demographic and clinical profile of patients attended in the psychiatry department of Gabes (Southern of Tunisia).It was a retrospective descriptive study including all the patients who attended for the first time in the psychiatry department of Gabes, from the 1st January, 2010 to December 31, 2018, and who were diagnosed with dementia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Socio-demographic and clinical data were assessed. The Mini Mental State Examination (MMSE) was used as a neuropsychological examination.We included 98 patients. The mean annual hospital incidence of dementia was 2.38%. The mean age was 76.5 ± 9.8 years. Patients were married (68%), illiterate (68%) and jobless (42.9%). A family history of dementia was noted in 39.8% of patients. The common cardiovascular comorbidity was high blood pressure (41.8%). Among our patients, 30 (30.6%) were smokers. The mean age of onset of dementia was 73 ± 11 years. The mean duration of untreated dementia was 3 years [3 months to 11 years]. First symptoms were mainly memory disorders (57.3 %) and behavioral disorders (17.3%) The mean MMSE score was 14 ± 4.8. Alzheimer’s disease was the most frequent etiology of dementia .Our study shows a high incidence of dementia and made it possible to draw up a socio-demographic and clinical profile of dementia patients.No significant relationships.


Cardiovascular Health in India – a Report Card from Three Urban and Rural Surveys of 22,144 Adults. Global Heart. 2022; 17(1): 52. DOI:  After the publication of ‘Cardiovascular Health in India – a Report Card from Three Urban and Rural Surveys of 22,144 Adults’ [They had inadvertently repeated the percentage of poor cardiac health in low, middle and high wealth index groups of smaller cities in the rural area. The correct percentage of poor cardiac health in low, middle, and high wealth index groups of rural areas are 24.0%, 28.8%, and 35.5% respectively Ref: .In the original, incorrect figure, these percentages were listed as 36.9%, 47.0%, and 49.2%.


In this publication, we report preliminary toxicity results of a prospective phase II trial where the first 20 patients with in lung presence of pleural mesothelioma were treated with accelerated hypofractionated radiotherapy. No G3-G4 acute and late toxicity was found, while the most common acute toxicity was pneumonitis with 65.0% G1 and 10% G2. The median OS was 33.1 months (95% CI:14.4–not estimable) and the median Time To Progression was 18.2 months (95% CI:11.3–not estimable). The trial is ongoing, but these results can be considered encouraging.Malignant Pleural Mesothelioma (MPM) is a rare malignancy with an overall poor prognosis. The standard therapeutic strategy in early-stage disease is trimodality therapy. In this publication, we report the preliminary toxicity results of the first 20 patients treated with accelerated hypofractionated radiotherapy. Between July 2017 to June 2019, 20 MPM patients were enrolled and treated with accelerated hypofractionated radiotherapy using helical tomotherapy and intensity-modulated arc therapy. The prescription dose was 30 Gy in five daily fractions, while an inhomogeneous dose escalation to 40 Gy was prescribed based solely upon the presence of gross residual tumor. Only one case of G3 toxicity was reported, which was a bilateral pneumonitis that occurred two years after treatment probably due to superinfection. Median Time to Progression reached 18.2 months while one- and three-year Overall Survival rates were 85% (95% CI:60.4–94.9) and 49.5% (95% CI:26.5–68.9), respectively. Treatment of the intact lung with pleural intensity-modulated arc irradiation is a novel treatment strategy that appears to be safe, feasible, and without a high grade of lung toxicity. Survival rates and Time to Progression are encouraging. Malignant pleural mesothelioma (MPM) is a relatively rare aggressive malignancy  of the pBased on an innovative adjuvant radiotherapy scheme for MPM patients, we retrospectively reported our experiences using accelerated hypofractionated intensity-modulated arc therapy in tomotherapy. The aim of the treatment was palliation, and the prescription dose was 25 Gy in five fractions over five consecutive days. In considering the feasibility of an acceptable lung toxicity profile and encouraging survival rates in this retrospective analysis, a prospective monocentric pilot trial was initiated (MESO-RT). The trial’s aim was to evaluate local control and the potential for dose escalation of 30 Gy in five fractions. In the present paper, we report preliminary toxicity data as an interim analysis result of the active MESORT protocol .Patient enrollment started in 2017 with the aim of enrolling 30 patients. To date, we have enrolled 29 patients of which 20 were assessed in this paper. We conducted a prospective mono-institutional clinical trial enrolling cyto-histological proven, MPM patients. The protocol inclusion criteria were defined as life expectancy greater than six months, normal organ and marrow function, and FEV1 ≥ 50. Patients after biopsy must have measurable disease defined as at least one lesion that can be accurately measured according to modified RECIST criteria; for resected patients no more than three months are allowed for RT start. Female participants of childbearing potential and male participants whose partner is of childbearing potential must be willing to ensure that they or their partner use effective contraception during the study and for four months thereafter. Ability to understand and the willingness to sign a written informed consent document is required. Exclusion criteria were: previous thorax radiotherapy, chemotherapy allowed but completed three weeks before RT starting, participation in another clinical trial with any investigational agents within 30 days before study screening, contralateral mediastinum involvement (N3) and/or M1, respiratory needing oxygen therapy, interstitial pneumopathy, active pneumonitis, fissural disease; uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure. All cases were priorly discussed in a multidisciplinary lung meeting.To perform radiotherapy, patients were immobilized in the supine position with their arms overhead using a Posirest-2 (CIVCO) before the CT simulation scan. It was acquired through a 3 mm thickness slice, at times 0, 30, 60, and 150 s with free breathing. The Pinnacle treatment planning system (version 9.3) was used to contour CT simulation images. Contouring and planning procedures were reported in the previous paper . All treth month onwards. Currently, the protocol is ongoing.Clinical evaluations were scheduled two, four and six months after the end of radiotherapy to record acute toxicity and then every six months thereafter for late toxicity with a time frame up until 36 months. Each follow-up visit included a patient interview, clinical examination, recent imaging, pulmonary function, and laboratory tests. In case of evidence for locoregional recurrence or distant spread, additional tests, or imaging studies, such as 18FDG PET/CT, were performed to confirm or exclude disease progression. Early chest CT scans without contrast were performed after two months, while the subsequent total-body CT scans with contrast were performed at six months and then every six months thereafter. Response and progression were evaluated using the Modified RECIST criteria for assessment of response in malignant pleural mesothelioma . PulmonaThe primary endpoint of this study is to evaluate acute and late pulmonary toxicity. No formal sample size calculation was done, but based on the previous study , it was In this paper, we report the results of an interim analysis of the primary objectives of the study: acute and late toxicity. All patient characteristics are shown in All patients completed the radiotherapy schedule without interruptions. The treatment duration was five consecutive days as scheduled. The dose prescription was 30 Gy for all patients, while the inhomogeneous dose escalation to 40 Gy was prescribed to 10 patients who had the residual gross disease, which was all the six patients who had undergone a biopsy-only procedure and four patients who had undergone partial P/D. Dose distribution and dose-volume histograms (DVH) are reported in No G3-G4 acute toxicity was found, while the most common acute toxicity was pneumonitis with 65.0% G1 and 10% G2. The vast majority of the G1 patients had only mild symptoms and pneumonitis was described only for radiologic features with no need for medical therapy. Four months after the end of radiotherapy, one patient developed a radiologically documented contralateral G2 pneumonia with fever, cough, and dyspnea treated with antibiotics and steroids for about three months. This manifestation was attributed to bacterial superinfection. Other respiratory toxicities were G1–G2 cough in 50% of the patients; G1 dyspnea occurred in 65% of the patients with three patients with G2 (15%). Other relevant toxicities were G1–G2 fatigue in 40%, G1 chest pain in 27%, and dysphagia in 5%. Completed toxicities are reported in No G3/G4 pneumonitis were reported. Only two (10%) cases of G1 pneumonitis were reported. Regarding cough, three patients (15%) reported G1 and two (10%) G2; G1 dyspnea occurred in 2 (10%) patients. Furthermore, we recorded G1 pericardial effusion in 10%. We observed differences in toxicity between patients who underwent radiotherapy after P/D and those treated after pleural biopsy only in terms of pneumonitis G1, cough G1, dyspnea G1 and pain G1 which were higher in the first group. One case of pericarditis was reported two years after the treatment, it was diagnosed as possible viral infection, though, we decided to consider it as late toxicity since RT was delivered to the left hemithorax. Moreover, in two female patients treated for left MPM, G1 and G2 breast disorders have been reported .p-value 0.061)  recorded was 75.5% (range: 46–137%) before the treatment was initiated, indicating a restrictive ventilatory defect. Seventeen patients were evaluable for pulmonary function test before treatment and after three months. Baseline median value for this group was 74% (range 56–137%) underlining a worsening of a restrictive ventilatory defect even if not statistically significant (e 0.061) . The mede 0.061) —Raw datap-value 0.086) (p = 0.015) , though, 1-year OS was 85% (95% CI:60.4–94.9) and 3-years was 49.5% (95% CI:26.5–68.9) where the better outcome was for the patients who underwent P/D compared to patients with biopsy only; 12-months OS 92.9% (95% CI:59–98.9) and 66.7% (95% CI:19.5–90.4), respectively. More apparent distinction appears in the 36-months OS with 63.5% (95% CI:33.1–82.9) in the P/D arm with respect to 16.7% (95% CI:0.8–51.7) for the non-surgery arm (e 0.086) A,B. The = 0.015) —Raw datap = 0.015). Overall Survival showed encouraging results as well, median OS was 33.1 months (95% CI:14.4–not estimable), though, 1-year OS was 85 (95% CI:60.4–94.9) and 3-years was 49.5 (95% CI:26.5–68.9). Patients who underwent P/D also had a favorable median OS 45.7% (95% CI:14.4–not estimable) compared to those who weren’t amenable to surgery 15.7% (95% CI:4.1–not estimable), with 1-year and 3-years OS 92.9% (95% CI:59.1–98.9) vs. 66.7% (95% CI:19.5–90.4), 63.5% (95% CI:33.1–82.9) vs. 16.7% (95% CI:0.8–51.7), respectively, reinforcing the importance of adequate surgery for MPM patients in specialized Institute. Apart from our study, only two other prospective studies are reported, by Minatel et al. and Rimner et al. [Malignant pleural mesothelioma is a rare disease with a poor prognosis for which the role of radiotherapy (RT) is still lacking high-level evidence to guide the most effective use. In the past, the role of radiotherapy in the treatment of pleural mesothelioma was in the field of palliation to control pain or in the field of prophylaxis to prevent cutaneous metastasis in the site of previous pleural interventions. In the last years, with the advent of trimodality treatment, it has turned out that radiotherapy could have a role also in the curative setting, which can be performed in neoadjuvant but most commonly, in the adjuvant setting. The only relevant neoadjuvant study was the SMART trial (Surgery for Mesothelioma after Radiation Therapy) published by De Perrot et al. . In thisr et al. ,29, bothr et al. .Our results indicate that accelerated hypofractionated radiotherapy could play an important therapeutic role after pleurectomy/decortication or after biopsy in non-operable patients. The dose prescription, 30 Gy in five daily fractions, is a novel treatment strategy in this setting; moreover, this new fractionation appears to be safe without a high grade of lung toxicity and, as far we know, our paper is the first to report an experience of accelerated hypofractionated radiotherapy in the intact lung in malignant pleural mesothelioma with curative intent. Overall Survival and Time to Progression appear to be comparable to the conventional adjuvant scheme, though, we will have to attend the completion of the trial to calculate the definitive rates. Further analysis, ideally multicentric randomized trials with a greater number of patients, is necessary to consolidate this treatment strategy as an option for managing patients with locally advanced MPM.


This study comparatively analyzed the hemodynamic changes resulting from various simulated stent-assisted embolization treatments to explore an optimal treatment strategy for intracranial vertebral artery fusiform aneurysms. An actual vertebral fusiform aneurysm case treated by large coil post-stenting (PLCS) was used as a control.A single case of an intracranial vertebral artery fusiform aneurysm underwent a preoperative and eight postoperative finite element treatment simulations: PLCS [single and dual Low-profile Visualized Intraluminal Support (LVIS)], Jailing technique  with or without large coils (LCs). Qualitative and quantitative assessments were performed to analyze the most common hemodynamic risk factors for recurrence.Jailing technique and PED-only had a high residual flow volume (RFV) and wall shear stress (WSS) on the large curvature of the blood flow impingement region. Quantitative analysis determined that PLSC and PED had a lower RFV compared to preoperative than did the jailing technique [PED+LC 2.46% < PLCS 1.2  4.75% < PLCS 1.1 (single LVIS) 6.34% < PED 6.58% < Jailing 2.2 12.45% < Jailing 1.2 12.71% < Jailing 1.1 14.28% < Jailing 2.1 16.44%]. The sac-averaged flow velocity treated by PLCS, PED and PED+LC compared to preoperatively was significantly lower than the jailing technique [PED+LC = PLCS 1.2  17.5% < PLCS 1.1 (single LVIS) = PED 27.5% < Jailing 1.2 = Jailing 2.2 32.5% < Jailing 1.1 37.5% < Jailing 2.1 40%]. The sac-averaged WSS for the PLCS 1.2  model was lower than the PED+LC, while the high WSS area of the Jailing 1 model was larger than for Jailing 2 [PLCS 1.2 38.94%  < PED+LC 41% < PLCS 1.1 43.36% (single LVIS) < PED 45.23% < Jailing 2.1 47.49% < Jailing 2.2 47.79% < Jailing 1.1 48.97% < Jailing 1.2 49.85%].For fusiform aneurysms, post large coil stenting can provide a uniform coil configuration potentially reducing the hemodynamic risk factors of recurrence. Flow diverters also may reduce the recurrence risk, with long-term follow-up required, especially to monitor branch blood flow to prevent postoperative ischemia. Fusiform aneurysms are more prone to occur in the posterior circulation . IntracrHemodynamically, wall shear stress (WSS) is an important risk factor for aneurysm rupture. Low WSS induces destructive remodeling caused by inflammatory cells, resulting in aneurysm instability. Higher than normal WSS also can result in the enlargement and rupture of aneurysms based on other mechanisms . This stHowever, no CFD mechanism-related studies exist on the potential recurrence risk among different reconstruction techniques for intracranial vertebral artery fusiform aneurysms. This present study modeled an actual case of vertebral artery fusiform aneurysm treated with PLCS without considering thrombosis, simulating and comparing the preoperative hemodynamic effects and eight post-operative finite element treatment simulations– PLCS x 2 ), Jailing technique x 4 (single and double LVIS both simulated twice with different coil configurations), and 2x Pipeline Embolization Device (PED) with or without large coils (LCs) – to analyze the most common hemodynamic risk factors for recurrence.A man in his 40 s with an intracranial fusiform aneurysm in the dominant vertebral artery experienced a sudden headache once 2 months ago. The left vertebral artery fusiform aneurysm diagnosed on MRI in a local hospital was treated with PLCS techniques  using Siemens equipment Axiom Artis Zeego, Siemens Medical Solutions, Erlangen, Germany). The acquired raw data were reconstructed in Mimics 17 software  to generate STL files subsequently imported into Geomagic 12 software for model repair, trimming, and smoothing .A two-step finite element simulation of stent deployment was devised . Firstly−8kg/m3, Young's modulus of 10,000 Pa, and Poisson's ratio of 0.39 (The simulation of the coil insertion process was carried out in ABAQUS . The pro of 0.39 . The thr*20 mm) was determined by two neuro-interventionists with over 10-year experience.The simulated hemodynamics of the preoperative untreated model was adopted as baseline parameters. The jailing technique with coiling was conducted twice, to simulate both separated and connected coils. A total of eight postoperative treatment options were simulated : 1. PED 3 and a viscosity of.0035 kg/m·s . A grid independence test was performed to determine the appropriate grid size for the stability of the calculation outcomes and the efficiency calculation. Due to the different geometric dimensions of vessels, stents, and coils, the mesh sizes of different object surfaces are determined to various values. The grid size for the stent wire surface was finally set to 1/6 of the circumference of the wire. The artery and coil surface were 0.16 mm along with the 0.03 mm LVIS surface and the 0.015 mm PED surface grid. A three-layer boundary mesh was added to improve the accuracy of the simulation results in the near-surface region of the model. Final mesh calculations were generated as follows: 3 million for the preoperative model; 96 million for PED and PED with large coil; 45 million for Jailing1.1, 1.2, and PLCS1.1; 65 million for Jailing 2.1, 2.2, and PLCS1.2. The hemodynamic simulations were fitted with the Navier-Stokes equations for steady-state simulations using ANSYS CFX version 2019 . The blood was designed as an incompressible, laminar flow, Newtonian fluid with a density of 1,056 kg/m5 kg/m·s . The ves5 kg/m·s . Outlet 5 kg/m·s . A steadQualitative and quantitative methods were used to analyze and compare the flow velocity, WSS, and RFV (v >0.03 m/s)  in the aRFV was discerned in the sac after PED implantation alone. According to the simulated projection and down-the-barrel view, the Jailing technique had a higher RFV on the large curved side due to the non-uniformity of the coil embolization, more similar to PED-only implantation than the RFV values of the PED+LC and PLCS techniques , 5.Both PLCS and PED with or without large-coils had lower residual percentages of RFV than the Jailing technique compared with pre-operation. The residual percentage of RFV of for dual stents in PLCS and Jailing are smaller than for the single stent [PED + LC 2.46% < PLCS 1.2  4.75% < PLCS 1.1 (single LVIS) 6.34% < PED 6.58% < Jailing 2.2 12.45% < Jailing 1.2 12.71% < Jailing 1.1 14.28 % < Jailing 2.1 16.44%; The streamline diagram and quantitative analysis showed that the averaged flow velocity in the aneurysm sac after PLCS for PED with and without large-coils decreased significantly more than for the Jailing technique. The sac-averaged flow velocity for dual stents in PLCS and Jailing technique are smaller than single stent [PED+LC = PLCS1.2 (double LVIS) 17.5% < PLCS1.1 (single LVIS) = PED 27.5% < Jailing1.2 = Jailing2.2 32.5% < Jailing1.1 37.5% < Jailing2.1 40%; WSS values of all postoperative models decreased significantly compared with pre-operation. Jailing 1 experienced a larger high WSS region than Jailing 2 .WSS from the PLCS 1.2 (double LVIS) had the largest decline [PLCS1.2  38.94% < PED+LC 41% < PLCS1.1 (Single LVIS) 43.36% < PED 45.23% < Jailing2.1 47.49% < Jailing 2.2 47.79% < Jailing 1.1 48.97% < Jailing1.2 49.85 %; The main conclusion of this study is that PLCS and PED with or without large-coils can significantly decrease the hemodynamic risk factors of recurrence in the treatment of fusiform vertebral aneurysm compared with the jailing technique. Hemodynamic studies have shown that high WSS, large RFV, and high-velocity areas after interventional treatment are risk factors for aneurysmal recurrence , 19, 30.Quantitative analysis showed hemodynamic risk factors for recurrence after jailing was also confirmed higher than PLCS and PED techniques due to incomplete embolization from the micro-catheter fixed by the stent . Hong etProcedure critical points of the PLCS technique on coil, stent, and embolizing microcatheter selection should be emphasized for fusiform aneurysms. Coil packing has some inherent randomness in clinical practice. Coil configuration for PLCS should achieve a more even distribution than the jailing technique. The framing coils (diameter ≥ aneurysm width) often require repeated adjustment contributing to uniform coil distribution. While protecting the patency of the involved branches, semi-deployment of the stent can assist in framing the large coils. Soft coils with a smaller primary helix diameter were preferred to result in stent well-apposition. The proper amount of large-coils –4 is norThis study has the following limitations. This proof-of-concept study was a single case. However, it effectively demonstrates hemodynamic effects after treatment for different stent-assisted techniques. Comprehensive intracranial stents such as Solitaire and Neuroform were not tested. In addition, not all treatment strategy combinations were simulated such as Jailing + Pipeline. Since a Murray flow outlet was employed in this study, the flow rate change of the PICA branch was inapplicable. The pressure outlet should be a feasible way to evaluate the influence on the flow rate of PICA. Flow change may be affected by thrombus and stent endothelialization. This study did not address the degree of vascular curvature which can affect the different stent-assisted strategies. The coil distribution from the PLCS technique is somewhat random and the simulation cannot be completely consistent with actual placement. This CFD study used common assumptions such as rigid walls and a lack of specific inflow and outflow tract flow conditions.For fusiform aneurysms of the intracranial vertebral artery, the PLCS technique can more uniformly pack aneurysm sacs and may reduce the hemodynamic risk factors of recurrence similar to flow diverters, though long-term follow-up is still required. Attention should be paid to the impact on any perforators or branches to lessen the ischemic risk.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Institution Review Board of Huashan Hospital affiliated to Fudan University approved this retrospective study and waived the requirement for informed consent. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.XZ and JX conceived and designed the research and handled the funding and supervision. YJ acquired the data and drafted the manuscript. YJ, GLu, LG, GLi, and RZ analyzed and interpreted the data. YJ, XL, and HW performed the statistical analysis. All authors made critical revisions to the manuscript for important intellectual content and reviewed the final version of the manuscript.This work was partially supported by the National Natural Science Foundation of China (No. 81771242).GLi, RZ, XL, and JX were employed by the company ArteryFlow Technology Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Specifically Targets the ABL Myristoyl Pocket (STAMP), is approved worldwide for the treatment of adults with Philadelphia chromosome–positive chronic myeloid leukemia in chronic phase (CML-CP) treated with ≥2 prior tyrosine kinase inhibitors (TKIs). In ASCEMBL, patients with CML-CP treated with ≥2 prior TKIs were randomized (stratified by baseline major cytogenetic response [MCyR]) 2:1 to asciminib 40 mg twice daily or bosutinib 500 mg once daily. Consistent with previously published primary analysis results, after a median follow-up of 2.3 years, asciminib continued to demonstrate superior efficacy and better safety and tolerability than bosutinib. The major molecular response (MMR) rate at week 96 (key secondary endpoint) was 37.6% with asciminib vs 15.8% with bosutinib; the MMR rate difference between the arms, after adjusting for baseline MCyR, was 21.7% . Fewer grade ≥3 adverse events (AEs) (56.4% vs 68.4%) and AEs leading to treatment discontinuation (7.7% vs 26.3%) occurred with asciminib than with bosutinib. A higher proportion of patients on asciminib than bosutinib remained on treatment and continued to derive benefit over time, supporting asciminib as a standard of care for patients with CML-CP previously treated with ≥2 TKIs.Asciminib, the first BCR::ABL1 inhibitor that  The treatment of patients with chronic myeloid leukemia in chronic phase (CML-CP) after ≥2 prior ATP-competitive tyrosine kinase inhibitors (TKIs) is poorly established owing to a lack of prospective studies in this setting –4. For pSpecifically Target the ABL Myristoyl Pocket (STAMP) [–BCR::ABL1 T315I mutation [Asciminib is the first BCR::ABL1 inhibitor to  (STAMP) . Based o (STAMP)  and the  (STAMP) –16, ascimutation , followeBCR::ABL1IS ≤ 0.1%) rate at week 24 nearly doubled with asciminib compared with bosutinib (25.5% vs 13.2%); the MMR rate difference between arms, adjusted for baseline major cytogenetic response (MCyR), was 12.2% —meeting the primary objective [Primary (week 24) efficacy and safety results from ASCEMBL in patients with CML-CP after ≥2 prior TKIs were reported previously . Briefly25.5% vs .2%; the 25.5% vs .2%; the After 1 year (48 weeks) of follow-up, asciminib continued to show increasing efficacy benefit vs bosutinib, with no new or worsening safety findings as compared with the primary analysis , 18. To BCR::ABL1 mutations prior to study entry were ineligible.Study design and patient eligibility for ASCEMBL (NCT03106779) were described previously . BrieflyPatients meeting lack of efficacy criteria were to permanently discontinue study treatment. A protocol amendment on December 14, 2018, allowed patients for whom bosutinib treatment failed due to lack of efficacy (based on objective laboratory criteria) the possibility to switch to asciminib. Data collected for patients receiving asciminib after switching from bosutinib are not part of this manuscript.BCR::ABL1IS ≤ 0.1% at week 96 and must not have met any criteria for treatment failure (defined as lack of efficacy per 2013 European LeukemiaNet recommendations or treatment discontinuation for any reason) before this time point. Additional details on secondary and exploratory endpoints and analyses are in the Supplemental Appendix. Analysis sets are in described in Supplementary Table Full details of the primary efficacy and safety assessments were described previously . The keyMMR rate at week 96 was calculated based on the intent-to-treat population . The Cochran-Mantel-Haenszel chi-square test, stratified by MCyR status at baseline, was used to compare MMR rates between the treatment groups. Hypothesis testing for the primary and key secondary endpoints followed a hierarchical testing approach to preserve an overall alpha level of 5%. Because the test of the primary endpoint was significant, the key secondary endpoint was tested at the 5% level of significance (two-sided test). The Mantel-Haenszel estimates of the common risk difference and the corresponding 95% CIs and the MMR rates and 95% CIs based on the Pearson-Clopper method for each treatment arm are presented.The study was designed collaboratively by the sponsor and lead study investigators. The protocol was approved by the sites’ institutional review boards and conducted in accordance with the Declaration of Helsinki. All patients provided written informed consent. An independent Data Monitoring Committee reviewed safety data approximately every 6 months. All authors had access to the results and analyzed them in collaboration with the sponsor.n = 157) or bosutinib (n = 76). Baseline characteristics were reported previously  and 15 (19.7%) patients randomized to asciminib and bosutinib, respectively, with 72 (45.9%) and 61 (80.3%) patients having discontinued treatment. One patient assigned to asciminib developed cytopenia after randomization and was not treated per investigator’s decision. As in the primary analysis , lack ofThe median duration of exposure by the data cutoff was 23.7  months for asciminib and 7.0 (0.2–43.3) months for bosutinib. The median dose intensity (range) was 79.7 (33–80) mg/day for asciminib and 463.8 (181–566) mg/day for bosutinib.p = 0.001), meeting the key secondary objective of the study. The MMR rate at week 96 showed a consistent trend in favor of asciminib over bosutinib across all analyzed subgroups for demographic and prognostic factors of response, including baseline MCyR status, reason for discontinuation of the last prior TKI, number of prior lines of TKI therapy, and BCR::ABL1 mutation status at baseline  than with bosutinib (33.7%), and differences were evident by week 8. The rate of BCR::ABL1IS ≤ 1% for patients receiving asciminib continued to increase after 48 weeks of treatment  or BCR::ABL1IS ≤ 1%  maintained these levels of response by the time of their last molecular assessment. The probability (95% CI) of maintaining MMR and BCR::ABL1IS ≤ 1% for ≥72 weeks was 96.7% (87.4–99.2) and 94.6% (86.2–97.9), respectively, with asciminib and 92.9% (59.1–99.0) and 95.0% (69.5–99.3), respectively, with bosutinib.MMR and 4, BCR::ABL1IS ≤ 0.01%; and MR4.5, BCR::ABL1IS ≤ 0.0032%) were consistently higher with asciminib  than with bosutinib   than bosutinib (82.9%) experienced treatment failure  was 94.4% (88.6–97.3) with asciminib and 91.1% (79.5–96.3) with bosutinib; the 2-year estimated overall survival rate (95% CI) was 97.3% (92.9–99.0) with asciminib and 98.6% (90.2–99.8) with bosutinib.BCR::ABL1 mutations detected by Sanger sequencing at baseline, 15 had ATP-binding site mutations, one had a mutation in the myristoyl pocket region  with asciminib and 66.7% (20/30) with bosutinib  and grade ≥3 AEs (56.4% vs 68.4%). The most common grade ≥3 AEs (≥10%) with asciminib were thrombocytopenia 22.4%) and neutropenia (18.6%) and with bosutinib were neutropenia (14.5%), diarrhea (10.5%), and increased alanine aminotransferase (ALT) (14.5%) (Table 2.4% and Fewer patients receiving asciminib (7.7%) than bosutinib (26.3%) experienced AEs leading to treatment discontinuation. The most common grade ≥3 AEs leading to treatment discontinuation with asciminib included thrombocytopenia (3.2%) and neutropenia (2.6%) and with bosutinib included increased ALT (3.9%), neutropenia (3.9%), and pleural effusion (2.6%)  were managed first by dose interruption and upon resolution, by dose reduction. A lower proportion of patients receiving asciminib than bosutinib had dose modifications of study drug: 66 (42.3%) and 47 (61.8%) patients, respectively, had at least one dose interruption due to AEs; 37 (23.7%) and 34 (44.7%) patients, respectively, had at least one dose reduction due to AEs  for non-hematologic AEs were lower with asciminib than with bosutinib (Supplementary Table n = 8) with asciminib and 1.3% (n = 1) with bosutinib. For asciminib, the EAIR decreased since the primary analysis from 3.3 to 3.0 per 100 patient-years [The frequency of arterial-occlusive events (AOEs) was 5.1%  patients receiving asciminib and two (2.6%) receiving bosutinib died during the study. Deaths occurring by the primary analysis cutoff were previously described . Since tThe completion rate for MD Anderson Symptom Inventory–chronic myeloid leukemia (MDASI-CML) was 96% with asciminib and 92% with bosutinib at baseline and 79.5% and 72.2%, respectively, at week 96. The mean total symptom score at baseline across both treatment arms was 2.0 , with fatigue being the most severe (4.0). Most symptoms either remained stable or decreased in severity from baseline with asciminib (for ≤96 weeks), particularly fatigue, upset feeling, and mood  over time [After an additional 16.4 months of follow-up since the ASCEMBL primary analysis, asciminib showed increasingly superior efficacy compared with bosutinib in patients with CML-CP treated with ≥2 prior TKIs—more patients on asciminib achieved clinically relevant and highly durable responses (ver time .p = 0.029) at week 24 [p = 0.001) at week 96. As in the primary analysis [BCR::ABL1 mutations detected at baseline.The MMR rate at week 96 for asciminib was more than double that for bosutinib, meeting the key secondary objective. The statistically significant difference (95% CI) in MMR rates between the two arms increased from 12.2% , suggesting alternative mechanisms of resistance may be involved. Newly emerging mutations detected at the end of treatment among patients who discontinued due to lack of efficacy or disease progression were more common with asciminib than with bosutinib (25.6% vs 6.7%). This observation may be an artifact, attributable to the longer duration of treatment with asciminib and higher fraction of bosutinib-treated patients discontinuing treatment early; 25 of the 61 patients who discontinued bosutinib did so before week 24. As noted previously, the frequency of mutations detected at baseline and end of treatment among patients discontinuing due to lack of efficacy or disease progression was similar with asciminib (15.4%) and bosutinib (16.7%); however, the median time to treatment failure was 2 years and 6 months, respectively.Conclusions on the impact of analysis . Drug-retogether , 24. In Interpretation of the safety results also warrants consideration that the duration of exposure was much longer for asciminib (approximately three times longer) than for bosutinib by the data cutoff, leading to a longer time for AE reporting. The median duration of exposure for asciminib increased since the primary analysis from 10.0 months to 23.7 months . DespiteThe burden of AEs with asciminib  decreased over time in patients who continued treatment beyond 6 months. Consistent with reports on other TKIs , 25, 26,The decreased burden of AEs over time was consistent with the lower EAIR of AEs with asciminib than with bosutinib. Regardless of the longer duration of exposure for asciminib vs bosutinib, the risk of AEs did not increase, allowing more than half of the patients receiving asciminib (53.5%) to remain on therapy with the continued benefit of deepening responses, which was especially relevant in these hard-to-treat patients who were previously treated with ≥2 TKIs. Fewer patients remained on bosutinib therapy (19.7%), similar to that at the primary cutoff, when 61.8% vs 28.9% of patients were still receiving treatment with asciminib vs bosutinib, respectively .The safety and tolerability of bosutinib in ASCEMBL is comparable to that of bosutinib in the BYOND study . As in AOverall, the risk of AOEs with asciminib did not increase with longer-term follow-up. The EAIR of AOEs with asciminib decreased from 3.3 per 100-patient years in the primary analysis to 3.0 in the current analysis. The EAIR of AOEs with bosutinib also decreased from 2.0 to 1.4; however, most patients receiving bosutinib discontinued early, thus preventing a meaningful comparison between the two arms. Patients were not stratified by cardiovascular disorders and prior TKI exposure at baseline, hence baseline risk for AOEs was not equivalent between treatment arms. The risk of developing AOEs is seen with most ATP-competitive TKIs, is heightened in patients who have other risk factors for these events, and increases with an increase in comorbidities . In ASCEOverall, after >2 years of follow-up in ASCEMBL, asciminib remained consistently superior to bosutinib with clinically relevant and durable efficacy. Treatment was ongoing in >50% of patients receiving asciminib, allowing for greater potential benefit from long-term asciminib therapy and opportunity to achieve deeper levels of response. These high response rates to a specific inhibitor emphasize that BCR::ABL1 remains the driving force in most patients with CML-CP, even in later lines of therapy, and highlight the need for highly potent, well-tolerated, and targeted TKIs.Collectively, these updated results from ASCEMBL are a confirmation of the enduring clinical benefit of asciminib after longer exposure and continue to illustrate that asciminib has transformed CML treatment as a new standard of care for patients with CML-CP treated with ≥2 prior TKIs and support its ongoing development in earlier lines of therapy.Supplemental AppendixFigure S1Figure S2Figure S3Figure S4Table S1Table S2Table S3Table S4Table S5Table S6Table S7Table S8Table S9Table S10Table S11Table S12CONSORT Checklist


Human papillomavirus is a primary cause of cervical cancer and genital warts. HPV vaccine can prevent high-grade cervical lesions as well as cervical cancer. The aim of this study was to analyze the prevalence and genotype distribution of human papillomavirus among women in Guangxi before and after the HPV vaccine was approved for use in China.From January 2016 to May 2021, 41,140 women were tested for HPV infection. HPV genotyping included 15 high-risk HPV (HR-HPV) and 6 low-risk HPV (LR-HPV) genotypes. Total prevalence, annual trend, and specific age group prevalence and genotype distribution were analyzed.The overall HPV infection rate was 18.10% among Guangxi women self-referred to clinic for gynecologic problems in southern China. During 2016–2018, the prevalence of HPV infection showed an upward trend, from 18.21% in 2016 to 21.99% in 2018, and later it showed a downward trend, from 18.35% in 2019 to 12.26% in May 2021. Pure HR-HPV genotypes (14.36%) were found in more infections than pure LR-HPV genotypes (2.77%) and mixed genotypes (0.97%). Two peaks of HPV infection were found in the ≤ 25 years (22.94%) and 56–65 years (21.25%) groups. The six most prevalent HR-HPV genotypes were HPV 52 (4.06%), 16 (2.70%), 58 (2.24%), 51 (1.87%), 39 (1.52%), and 53 (1.52%). The three most prevalent LR-HPV genotypes were HPV 6 (1.31%), CP8304 (1.01%), and 11 (0.82%). Infection with a single HR-HPV genotype was the most common type of infection, with an overall infection rate of 12.30%. Infection with two HPV genotypes was the most common multiple HR-HPV infection type, with an infection rate of 2.35%.The cervical HPV infection rate of women in Guangxi is very high, and there is significant age specificity. There is a need to increase HPV vaccination of young people and the screening of middle-aged and elderly people. Human papillomavirus (HPV) infection is the main causative factor of cervical cancer; specifically, persistent infection with high-risk HPV (HR-HPV) genotypes. Studies have confirmed that more than 80% of women have had at least one HPV infection  and thatAmerican Society of Colposcopy and Cervical Pathology (ASCCP)  issued aThe bivalent HPV vaccine (which protects against HPV 16/18) was approved in China in July 2016, and the quadrivalent vaccine (HPV 6/11/16/18) and nine‑valent vaccine (HPV 6/11/16/18/31/33/45/52/58) were introduced in May 2017 and April 2018, respectively. This study analyzed the status of HPV infection in Guangxi over the past 6 years and examined the trend of HPV infection and genotype distribution. The purpose of this work was to generate information that would allow improvements in the performance of the corresponding healthcare work.The study population consisted of women who attended the gynecological clinic of Minzu Hospital in the Guangxi Zhuang Autonomous Region from January 2016 to May 2021. Reasons for their HPV testing include gynecological exams, urethritis, vaginitis, irregular vaginal bleeding, cervicitis, and condyloma acuminatum undiagnosed abdominal pain. The age of the patients ranged from 14 to 87 years old. Information about their HPV test results was collected retrospectively.A speculum was used to expose the cervix, and a dry cotton swab was used to remove cervical secretions. A cervical brush was placed in the cervical canal and unidirectionally rotated four to five times to ensure that sufficient epithelial cells were obtained. The cervical brush was then placed into a sample preservation tube with preservation solution and the cap tightened. The sample tubes were compatible with the HPV genotyping test kit of Chaozhou Hybribio Biochemical Co., Ltd. (China). In accordance with the manufacturer’s instructions, all samples were sent to the laboratory within 24 h and stored at 4 °C, and HPV testing was performed within one week.All collected samples were genotyped for HPV using the HPV Genotyping Test Kit (polymerase chain reaction (PCR) + flow-through hybridization; Chaozhou Hybribio Biochemical Co., Ltd., Guangdong, China). The test has been approved by the State Food and Drug Administration (Permit Number: 0041040) and can detect 21 HPV genotypes: 6, 11, 16, 18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56, 58, 59, 66, 68, and CP8304.DNA extraction, amplification, and hybridization and interpretation of the results were carried out in accordance with the instructions of the kit. DNA was extracted using an automated nucleic acid extraction apparatus . An ABI 9700 PCR instrument was used to perform gene amplification. An automatic nucleic acid molecule rapid hybridization instrument (HBHM-3000S) was used for reverse dot hybridization. Negative and positive controls were established throughout the experiment. At the same time, internal quality control and external quality evaluation were carried out, and the results were in line with the requirements of the laboratory.P < 0.05 was considered statistically significant. GraphPad Prism 5.0 software was used for drawing.The data were added to an Excel spreadsheet, filtered, and stratified by age . Analyses were conducted with SPSS version 20.0. HPV infection rate differences across years and age groups were calculated using the chi-square test. 2 = 238.352, df = 5, P < 0.001). The highest overall HPV infection rate was found to be in 2018 (21.99%), while the lowest HPV infection rate was found to be in 2021 (12.26%). During 2016–2018, the prevalence of HPV infection showed an upward tendency, and it showed a downward tendency from 2019 to May 2021.This study included 41,140 women who attended Minzu Hospital in the Guangxi Zhuang Autonomous Region. The overall HPV infection rate was 18.10%  during the study period of January 2016 to May 2021 . Two peaks of HPV infection were found in the ≤ 25 years (22.94%) and 56–65 years (21.25%) groups . The HPV infection rates were significantly different among the age groups . The rate then generally declined from 18.35% in 2019 to 12.26% in 2021. Luo et al.  showed t9%. The rParticipants were placed into six groups according to their age . Two peaks of HPV infection were detected in the ≤ 25 years 22.94%) and 56–65 years (21.25%) groups  was higher than that with pure LR-HPV 2.77%) and mixed HPV . The related studies can provide data references for vaccine development. HPV 6 and 11 infections were mainly concentrated in the ≤ 25 years group, and infection with these genotypes was found to be low in the other age groups.In summary, the HPV infection rate in Guangxi is high (18.10%), it had an upward trend from 2016 to 2018, a downward trend after 2018, and was dominated by single high-risk genotypes. The highest rates of HPV infection were in women ≤ 25 years and 56–65 years. The main genotypes were HPV 52, 16, 58, 51, 39, and 53. The 46–55 years group had the highest HPV 16 infection rate, and the highest HPV 18 infection rate was found in the 36–45 years group.Given that China is a developing country with a population of 1.4 billion, that the most prevalent HR-HPV genotypes vary across regions, and that there is significant age specificity, understanding HPV genotype distribution is essential for better planning of cervical cancer screening and HPV vaccine development. It is necessary to increase HPV vaccination of young people and the screening of middle-aged and elderly people.


Hepatitis B is a severe, widespread infectious disease of the liver that affects millions of people around the world. It is one of the life-threatening liver infections caused by the hepatitis B virus (HBV). HBV is the cause of up to 80% of cases of primary liver cancer. Due to the potential risk associated with HBV infection, it is important to study the factors which are associated with the seropositive volunteers.  The purpose of this study was to identify factors associated with seropositivity for the hepatitis B virus among volunteers who donated blood at the Jimma Blood Bank in southern Ethiopia.  Cross-sectional research was conducted on blood donors who came to the Jimma Blood Bank to donate their blood. Three hundred and fifty-nine volunteer blood donors who arrived at the Jimma Blood Bank were investigated face-to-face in order to collect sociodemographic characteristics and risk factors for HBV infection. The data were analyzed using statistical software SPSS version 20.0. The association between the risk factor for HBV infection and HBV infection was determined using chi-square tests. p=0.042).  In total, there were 359 participants; their mean age was 22.5, among which 161 (44.8%) were males. Out of 359 volunteers, 13 (3.6%) were seropositive for HBsAg. The test positivity rate among males was 7/198 (3.54%), while the rate among females was 6/161 (3.7%). More than 3/4 of those who tested positive were under the age of 40. Chi-square analysis showed that volunteers whose income was between 12 and 26.84 USD were less likely to have the infectious disease than those whose income was less than 11.84 USD per month ( The prevalence of HBV was found to be 3.6% among selected volunteers. It was found that, out of 20 volunteers, 13 had infection. Chi-square analysis showed that HBV infection was associated with low monthly income and the use of unsafe therapeutic injections. HBV is a well-known hepadnavirus with a double-stranded circular DNA genome . A totalAccording to the estimation of the World Health Organization (WHO), unsafe blood transfusions due to infection with the hepatitis B virus were 8–16 million . Around The study was conducted in the Jimma Blood Bank, Jimma town, located 350 km away from the country's capital city. The Jimma Blood Bank was established in 1979 in Ethiopia under the Ethiopia Red Cross Association and transferred to the Oromia Regional Health Bureau in 2004 in Ethiopia. Currently, the Jimma Blood Bank serves a population of more than 5 million and has eight catchment hospitals. Six hospitals in Oromia Jimma zone and two hospitals in Southern Nations, Nationalities, and Peoples' Region were selected for the study. The town is located at 1763 m above sea level, and its climate condition is Woyenadega, with an annual rainfall range from 1138 to 1690 mm. The Jimma town has a total population of 120,960 (CSA 2021) and has a temperature range of 11.5–27°C. The study period was conducted from Feb 1 to 30, 2021, at the Jimma Blood Bank.Jimma Blood Bank conducted a cross-sectional study of volunteer blood donors to determine their preferences. Most volunteer blood donors who met donor selection criteria at the Jimma Blood Bank were included during the study period.It was estimated that the seropositivity of important blood-borne infection between many blood donors at Bahir Dar Felege Hiwot Tertiary Hospital in Ethiopia of hepatitis B was (4.5%) with a precession of 2.25%, so the sample size was calculated using this estimate .A brief explanation of the study objectives was given to the participants. Participants were asked to give their informed consent before any information was collected about them. Structured questionnaires adopted from the related literature were used to address the associated behavioural variables and the sociodemographic character.From each participant, 5 ml of blood was collected using sterile capped tubes, centrifuged, the plasma was separated, and stored at 2–8°C until testing. Each plasma sample was tested for HBsAg using ELISA kits. A Human HBsAg 3rd Generation ELISA kit was used to analyze the sample.In this study, three hundred and fifty-nine (359 (100%)) volunteer blood donors were investigated. Among these, 198 (55.2%) and 161 (44.8%) were men and women, respectively. The mean age was 22.5 years, 87.2% of them were unmarried, 89.4% lived in urban areas, and 89% had a degree and above in terms of their educational level. Almost all 98.3% of the study subjects had no history of transfusion problems, as shown in p ≤ 0.042). Among the study subjects who had been exposed to potentially hazardous therapeutic drug injection (10 (2.8%)), 3 (30%) of them were positive for hepatitis B virus infection; therefore, compared to individuals who did not receive an injection of unsafe therapeutic medication, those who received an injection of hazardous therapeutic medication were more prone to contract an infection p < 0.001 (p < 0.001). Test positivity was high in females (3.7%), and it was higher when compared with males (3.54%), but it has no statistical significance p ≤ 0.923 (p ≤ 0.923). More than 3/4th (10 (76.9%)) of the participants who tested positive were lower than 40 in terms of their age. The rate of test positivity was slightly greater among those who were not married. The rate of test positivity was slightly greater among those who were not married (2.8%) when compared to married study participants (0.8%), but there are no statistical significances p ≤ 0.503 (p ≤ 0.503).When analyzed with a chi-square test, two variables were identified as statistically significant; the first one is monthly income; those earnings of 581–1,300 ETB per month were less infected with hepatitis B virus than those earning less than 580 per month ETB (p ≤ 0.225). In spite of the fact that test positivity was comparable amongst rural and urban dwellers, 84.6% of those who screened positive were from urban regions. The positivity of the test among rural dwellers was 2 (0.6%) and 11 (11%) for those who tested positive in urban areas (3.1%) (p ≤ 0.636). Educated (p < 0.644), employed (p < 0.486), knew about transmission (p < 0.195), history of transfusion (p < 0.085), shared sharp materials (p < 0.981), exposure to surgical operations (p ≤ 0.247), had unprotected sex (p < 0.178), tattoo and ear piercing (p < 0.068), and tooth extraction (p < 0.411) were also not statistically significant, and this could be due to the homogeneity of the study sample, which consisted primarily of students who were about to graduate from the university.In a similar vein, when taking into account the marital status of attendees who examined positive for HBV, trial positivity was marginally greater between unmarried attendees than between married participants (2.8% versus 0.8%), but this difference was not statistically meaningful (p < 0.047). According to the results of the multidimensional evaluation, individuals being paid between 581 and 26.55 USD each month were 32.2% less likely to be sick than those making less than 11.84 USD for every month. When positive, it was compared amongst other survey respondents who were classified according to average annual income (p < 0.042). The number of contributors who were subjected to hazardous therapeutic drug injection was 10 (2.8%), and of those, 3 (30%) tested positive for hepatitis B virus. Whether compared to volunteers who had not been exposed to the 10 (2.8%), exposed donors had a higher chance of contracting HBV than those who were not (p ≤ 0.001). The prevalence of HBV (13 (3.6%)) was positive for HBV.When comparing the frequency of blood donation first, fewer donors test positive for HBV infection than multiple donors (2.8% vs. 0.8%) and  among many volunteer blood donors was 2.3% . While especially in comparison with the above study, the total incidence of HBV among many volunteer contributors at the Jimma Blood Bank was 3.6%; however, when compared to this study, the prevalence of HBV was more likely to be higher in the latter. The higher HBV reported in a previous study in Bahir Dar was 4.11% , the higLower finding was also reported from Kathmandu in Nepal (0.47%) , Babylonp=0.042). This could imply that, as people's socioeconomic status improves, they are more likely to take precautions against HBV-related factors. This was similar to but higher by percentage, than the findings in Jimma, Southwest Ethiopia, where the seroprevalence of HBsAg, as well as its risk factors among many pregnant women with incomes less than 10.21 USD/month, was 88.9% (p0.05), but lower by percentage than the findings in Jimma despite the fact that the rapid chromatographic immunoassay test was used in those studies [p=0.000) was found to be associated with a higher risk of miscarriage. This finding was consistent with a study conducted among many pregnant women in the city of Bahir Dar, in North West Ethiopia, which reported an important association with unsafe therapeutic injection in 15.9% of cases  [In this study, a statistically significant relationship was discovered between the income status and HBV. If the study participants were divided into groups based on their average monthly income, those earnings of 12–26.55 USD were 32.2% less likely to be infected than those earning less than 11.84 USD per month (4–22.19) . An addip=0.042). Volunteer donors were revealed to dangerous therapeutic drug injection in 10 cases (2.8%), and of those, 3 (30%) tested positive for hepatitis B virus (HBV). Donors who had been exposed had a higher risk of contracting HBV specially than those volunteer donors who had not been exposed (p=0.000)According to the findings of this study, the prevalence of HBV among voluntary blood donors at the Jimma Blood Bank was 3.6%. HBV was detected in 13 of the 20 participants. Males constituted 3.5% of the total detection. The test positivity rate among males was 7/198 (3.54%), while the rate among females was 6/161 (3.7%). More than 3/4 of those who tested positive were under the age of 40. When the results of the chi-square analysis were tried to compare among many study participants who were divided into groups based on their average household salary, participants' earnings 12–26.84 USD were less likely to have the infectious disease as compared to those earning less than 11.84 USD per month (Improved community awareness, infection control, and posttreatment counselling will all be implemented to keep infections under control.