A National Database Analysis: Does Cold Weather Affect the Surgical Intervention Rate for Developmental Dysplasia of the Hip in Children Under Five Years?

Background Cold weather in the first few months of life may increase the risk of a late diagnosis of developmental dysplasia of the hip (DDH). Early detection of DDH can often be treated non-surgically. The purpose of this study is to observe whether the rates of surgical intervention for DDH differ based on average outdoor temperatures in the winter months. Methods A retrospective observational study of DDH patients diagnosed from 2010 to 2021 was conducted using a national administrative database. Five geographic regions were defined based on the average temperatures in the coldest quarter of the year. The rates of DDH-related surgeries were compared across these temperature regions. Results A total of 55,911 patients ≤5 years old with a DDH diagnosis from 2010 to 2021 were identified in the database. When compared to the warmest region (Group 5), the coldest region (Group 1) had higher rates of open reduction (4.59% vs. 2.06%, p<0.001), adductor tenotomy (6.95% vs. 2.91%, p<0.001), femoral osteotomy (5.75% vs. 2.04%, p<0.001), pelvic osteotomy (5.27% vs. 2.04%, p<0.001), and total DDH surgeries (11.42% vs. 5.03%, p<0.001). Conclusion Children living in states with an average winter temperature of -6.17°C had an increased likelihood of requiring surgical intervention for DDH within the first five years of life.

A Retrospective Review of Seasonal Patterns of Idiopathic Facial Nerve Paralysis in a Tertiary Care Center

Background The objective of this retrospective study was to investigate the seasonal patterns of idiopathic facial nerve paralysis, specifically Bell's palsy, in Riyadh, Saudi Arabia. The study aimed to determine if there is a correlation between cold weather and the incidence of Bell's palsy, as well as to examine the relationship between age, gender, comorbidities, and the development of the disease. Methodology Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2016 and 2021. Electronic medical records of adult patients diagnosed with idiopathic facial paralysis were reviewed. Patients with facial paralysis caused by known illnesses were excluded. Demographic information, clinical characteristics, and the course of the disease were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results The study included 136 Bell's palsy patients, with a mean age of 39.9 years. Males represented 58.1% (79) of the sample, and the right side of the face was more commonly affected in 71 (52.2%) patients. The majority of patients had House-Brackmann grade III (51, 37.5%). The monthly distribution showed a higher number of Bell's palsy cases during the winter months, particularly December, October, and November, but the seasonal distribution did not yield a statistically significant difference in incidence. Conclusions While this study observed a higher incidence of Bell's palsy during the winter months, it did not establish a statistically significant correlation between cold temperatures and the onset of Bell's palsy in Riyadh, Saudi Arabia. Furthermore, the study found that Bell's palsy predominantly affects middle-aged males, and comorbidities did not appear to be significant risk factors for the development of the disease. This research lays the groundwork for future investigations into the relationship between weather and the pathogenesis of Bell's palsy in the region.

High energy level diet improves the growth performance and rumen fermentation of yaks in cold weather

To date, no research has been done on energy requirements for yaks in Tibetan cold weather. The findings of the current study provide proper energy requirements for yaks would facilitate scientific feeding of fattening yaks in cold weather. The metabolomics and 16s rRNA sequencing technologies were used to explore the underlying mechanism that affects the growth performance of yaks fed with different energy levels of diet in cold weather. Three groups of yaks (141.7 ± 3.34 kg) were fed with diets containing metabolizable energy 7.20, 7.89, and 8.58 MJ/kg DM (dry matter) and named the low-, medium-, and high-energy groups, respectively. The results showed that the average daily feed intake of the high-energy group was higher than that of the low-energy group (p  = 0.006). Plasma aspartate aminotransferase (p  = 0.004), alanine aminotransferase (p  < 0.001), and interferon-γ (p  < 0.001) in the high-energy group were lower than in the low-energy group. In contrast, superoxide dismutase (p  < 0.001), immunoglobulin G (p  < 0.001), and interleukin 2 (p  = 0.002) were higher than the low-energy group. The rumen microbial protein (p  = 0.025), total volatile fatty acids (p  = 0.029), and neutral detergent fiber digestibility (p  = 0.050) in the high-energy group were higher than in the low-energy group, whereas the acetate: propionate ratio (p  = 0.001) and ammonium nitrogen (p  = 0.001) were lower than in the low-energy group. The plasma metabolomics results displayed that yaks fed with a high-energy diet augmented the metabolism of arginine, proline, purine, taste transduction, pyrimidine, and glutathione pathways. The relative abundance of Methanobrevibacter in the high-energy group was lower (p  < 0.001), whereas the relative abundance of Methanosphaera (p  < 0.001) was higher than in the low-energy group. The results of the current study suggest that a high-energy diet in growing yaks during the cold season can improve growth performance, rumen microbial protein synthesis, antioxidants, and immunity.

Ceftazidime/Avibactam, Polymyxin or Tigecycline as a Rescue Strategy for the Treatment of Carbapenem-Resistant Klebsiella pneumoniae in Bloodstream Infection: A Retrospective Cohort Study

Objective

To analyze the clinical characteristics, outcomes, and risk factors of patients treated with ceftazidime/avibactam, polymyxin, or tigecycline (CPT) compared with those receiving a conventional therapy (CT) (ie, imipenem, levofloxacin, or gentamicin).

Methods

A single-center retrospective cohort study included patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) treated at one Chinese tertiary hospital between March 2012 and November 2022 was performed. Clinical characteristics, outcomes, and risk factors of patients treated with CPT or CT were compared. Predictors of 30-day mortality of patients with CRKP-BSI were also analysed in our study.

Results

Among 184 recruited patients with CRKP-BSI, 39.7% (73/184) were treated with CPT, while 60.3% (111/184) were treated with CT. Compared to patients treated with CT, patients treated with CPT had worse conditions, as evidenced by a higher rate of underlying diseases and invasive procedures; however, they also had a better prognosis and lower rates of 14-day treatment failure (p = 0.024). In addition, univariate analysis and multivariate analysis showed that SOFA score [odds ratio (OR) = 1.310, 95% confidence interval (CI) 1.157-1.483; p < 0.001] and cold weather (OR = 3.658, 95% CI 1.474-9.081; p = 0.005) were independent risk factors for 30-day mortality.

Conclusion

Compared to CRKP-BSI patients treated with CT, patients treated with CPT had worse conditions but better prognoses. CRKP-BSI occurred more frequently in hot weather; however, higher 30-day mortality was associated with cold weather. A randomized trial is needed to confirm these observational results.

Effects of Housing and Management Systems on the Growth, Immunity, Antioxidation, and Related Physiological and Biochemical Indicators of Donkeys in Cold Weather

The study was designed with a 2 × 2 factorial experiment to evaluate the effects of growth performance, immune function, antioxidant status, blood biochemical indexes, and hormone levels of donkeys in different housing and management systems in cold weather. Twenty-four male donkeys with similar body weight and age were randomly allocated into four treatment groups that were as follows: a cold-water-drinking group without a windproof facility, a lukewarm-water-drinking group without windproof facilities, a cold-water-drinking group with a windproof facility, and a lukewarm-water-drinking group with a windproof facility. The experiment lasted for 42 days. The results showed that windproof facilities increased average daily gain (ADG) and decreased average daily feed intake (ADFI) and feed-to-gain ratio (F:G) at all time periods (p < 0.01) of the experiment. Windproof facilities increased the digestibility of dry matter (DM), crude fat (CF), crude protein (CP), ash, calcium (Ca), and phosphate (P) on day 21 (p < 0.01), and increased the digestibility of DM, CF, ash, and P on day 42 (p < 0.01). The respiration rate and the skin temperature of the abdomen and legs increased (p < 0.05) and rectal temperature tended to increase (p = 0.083) by adopting windproof facilities at 07:00; the windproof facilities tended to increase the skin temperature of the ears and abdomen (p = 0.081, p = 0.091) at 14:00. For the blood parameters, with windproof facilities, the concentrations of total protein (TP), blood urea nitrogen (BUN), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) increased (p < 0.05) and glucose (GLU) concentration decreased (p < 0.05) at 07:00 on day 21; the concentrations of TG and cholesterol (CHO) increased and the concentrations of TP, BUN, and GLU decreased at 07:00 on day 42 (p < 0.05). The concentrations of adrenocorticotropic hormone (ACTH), cortisol (COR), triiodothyronine (T3), and thyroxine (T4) decreased (p < 0.05) at 07:00 on day 21, and T4 concentration decreased (p < 0.05) at 07:00 on day 42. The concentrations of interleukin-4 (IL-4), immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) increased (p < 0.01) and the concentrations of interleukin-1β (IL-1β) and tumor necrosis factor-alpha (TNF-α) decreased (p < 0.01) on days 21 and 42. The activities of total superoxide dismutase (T-SOD) and glutathione peroxidase (GPx) increased (p < 0.05), and malondialdehyde (MDA) concentration decreased (p < 0.01) on day 21; the activities of T-SOD and catalase (CAT) increased (p < 0.05), and MDA concentration decreased (p < 0.01) on day 42. However, under the conditions of this experiment, water temperature did not affect the above indexes on days 21 and 42. These results indicated that adopting windproof facilities in a cold climate can mitigate the effects of atrocious weather on the production performance of donkeys.

Association of Melatonin Production with Seasonal Changes, Low Temperature, and Immuno-Responses in Hamsters

Seasonal changes impact the melatonin production and immuno-activities in vertebrates. This is believed due to the photoperiodic alterations of the different seasons which impact the functions of pineal gland. The short photoperiod promotes pineal melatonin production. As a result, during the winter, animals have significantly higher levels of melatonin than in summer. However, the seasonal changes also include temperature changes. This factor has never been systemically investigated in animals. In the current study, we observed that increased temperature had limited influence on melatonin production. In contrast, cold temperature is the major factor to induce melatonin production in hamsters. Cold temperature per se can upregulate the expressions of melatonin synthetic gene AANAT and ASMT, which are the important enzymes for melatonin biosynthesis. The elevated melatonin levels induced by the cold exposure in hamster in turn, improve the immuno-responses of the animals with increased levels of IL1, 6, and 10 as well CD3. In addition, melatonin as a potent antioxidant and thermogenic agent would improve the survival chance of animals during cold weather.

Use of primary care data to predict those most vulnerable to cold weather: a case-crossover analysis

Background

The National Institute for Health and Care Excellence (NICE) recommends that GPs use routinely available data to identify patients most at risk of death and ill health from living in cold homes.

Aim

To investigate whether sociodemographic characteristics, clinical factors, and house energy efficiency characteristics could predict cold-related mortality.

Design and setting

A case-crossover analysis was conducted on 34 777 patients aged ≥65 years from the Clinical Practice Research Datalink who died between April 2012 and March 2014. The average temperature of date of death and 3 days previously were calculated from Met Office data. The average 3-day temperature for the 28th day before/after date of death were calculated, and comparisons were made between these temperatures and those experienced around the date of death.

Method

Conditional logistic regression was applied to estimate the odds ratio (OR) of death associated with temperature and interactions between temperature and sociodemographic characteristics, clinical factors, and house energy efficiency characteristics, expressed as relative odds ratios (RORs).

Results

Lower 3-day temperature was associated with higher risk of death (OR 1.011 per 1°C fall; 95% CI = 1.007 to 1.015; P<0.001). No modifying effects were observed for sociodemographic characteristics, clinical factors, and house energy efficiency characteristics. Analysis of winter deaths for causes typically associated with excess winter mortality (N = 7710) showed some evidence of a weaker effect of lower 3-day temperature for females (ROR 0.980 per 1°C, 95% CI = 0.959 to 1.002, P = 0.082), and a stronger effect for patients living in northern England (ROR 1.040 per 1°C, 95% CI = 1.013 to 1.066, P = 0.002).

Conclusion

It is unlikely that GPs can identify older patients at highest risk of cold-related death using routinely available data, and NICE may need to refine its guidance.

The association of cold weather and all-cause and cause-specific mortality in the island of Ireland between 1984 and 2007

BACKGROUND

This study aimed to assess the relationship between cold temperature and daily mortality in the Republic of Ireland (ROI) and Northern Ireland (NI), and to explore any differences in the population responses between the two jurisdictions.

METHODS

A time-stratified case-crossover approach was used to examine this relationship in two adult national populations, between 1984 and 2007. Daily mortality risk was examined in association with exposure to daily maximum temperatures on the same day and up to 6 weeks preceding death, during the winter (December-February) and an extended cold period (October-March), using distributed lag models. Model stratification by age and gender assessed for modification of the cold weather-mortality relationship.

RESULTS

In the ROI, the impact of cold weather in winter persisted up to 35 days, with a cumulative mortality increase for all-causes of 6.4% (95% CI = 4.8%-7.9%) in relation to every 1°C drop in daily maximum temperature, similar increases for cardiovascular disease (CVD) and stroke, and twice as much for respiratory causes. In NI, these associations were less pronounced for CVD causes, and overall extended up to 28 days. Effects of cold weather on mortality increased with age in both jurisdictions, and some suggestive gender differences were observed.

CONCLUSIONS

The study findings indicated strong cold weather-mortality associations in the island of Ireland; these effects were less persistent, and for CVD mortality, smaller in NI than in the ROI. Together with suggestive differences in associations by age and gender between the two Irish jurisdictions, the findings suggest potential contribution of underlying societal differences, and require further exploration. The evidence provided here will hope to contribute to the current efforts to modify fuel policy and reduce winter mortality in Ireland.