Fetal and neonatal outcomes of posterior fossa anomalies: a retrospective cohort study

The primary aim of this study was to estimate the incidence of posterior fossa anomalies (PFA) and assess the associated outcomes in King Abdulaziz Medical City (KAMC), Riyadh. All fetuses diagnosed by prenatal ultrasound with PFA from 2017 to 2021 in KAMC were analyzed retrospectively. PFA included Dandy-Walker malformation (DWM), mega cisterna magna (MCM), Blake's pouch cyst (BPC), and isolated vermian hypoplasia (VH). The 65 cases of PFA were 41.5% DWM, 46.2% MCM, 10.8% VH, and 1.5% BPC. The annual incidence rates were 2.48, 2.64, 4.41, 8.75, and 1.71 per 1000 anatomy scans for 2017, 2018, 2019, 2020, and 2021, respectively. Infants with DWM appeared to have a higher proportion of associated central nervous system (CNS) abnormalities (70.4% vs. 39.5%; p-value = 0.014) and seizures than others (45% vs. 17.9%; p-value = 0.041). Ten patients with abnormal genetic testing showed a single gene mutation causing CNS abnormalities, including a pathogenic variant in MPL, C5orf42, ISPD, PDHA1, PNPLA8, JAM3, COL18A1, and a variant of uncertain significance in the PNPLA8 gene. Our result showed that the most common PFA is DWM and MCM. The autosomal recessive pathogenic mutation is the major cause of genetic disease in Saudi patients diagnosed with PFA.

Warfarin adherence and anticoagulation control in atrial fibrillation patients: a systematic review

OBJECTIVE

This paper aims to review the literature systematically on warfarin adherence in patients with atrial fibrillation and to assess the anticoagulation control focused on patient clinical outcomes. Atrial Fibrillation (AF) is a cardiac disease defined by abnormal heart rhythm, which significantly impacts a patient's health status, quality of life, and heart output, and thus a greater risk of stroke and hospitalization. Most AF patients should be managed with long-term anticoagulation, either with vitamin K antagonists such as warfarin or new oral anticoagulants (NOACs). Anticoagulants have been a core in treating AF and weighing the consequences of thrombosis with the risk of bleeding. This systematic review aimed to assess the impact of warfarin adherence on AF patients.

MATERIALS AND METHODS

A systematic search of the literature was conducted on electronic databases of PubMed/MEDLINE, EBSCO, Cochrane library, Google, and Google Scholar from January 2011 to April 2021 to determine studies that reported warfarin adherence on patients with atrial fibrillation.

RESULTS

Out of 1429 titles and abstracts were retrieved, 12 studies fulfilled and met the inclusion criteria. From the included studies, two were carried out in Brazil and one from the following nations: Libya, Jordan, Iran, KSA, Canada, Malaysia, Bahrain, UAE, Singapore, and the USA. The study designs identified were cross-section, retrospective, and prospective studies. Warfarin adherence was influenced by multiple causes, including pharmaceutical services, the number of medications, and warfarin knowledge regarding anticoagulation control. Warfarin adherence illustrates its positive association with TTR and INR as a measure of anticoagulation control.

CONCLUSIONS

While the available evidence is limited, this systematic review demonstrated a positive finding of the association between warfarin adherence and anticoagulation control in patients with AF.

The rate of secondary genomic findings in the Saudi population

Secondary findings (SF) are defined as genetic conditions discovered unintentionally during an evaluation of raw data for another disease. We aimed to identify the rate of secondary genetic findings in the Saudi population in the 59 genes of the American College of Medical Genetics and Genomics (ACMG) list. In our study, the raw data of 1254 individuals, generated from exome sequencing for clinical purposes, were studied. Variants detected in the 59 genes on the ACMG list of secondary findings were investigated. Pathogenicity classifications were assigned to those variants based on the ACMG scoring system. We identified 2409 variants in the 59 gene list, 45 variants were classified as pathogenic/likely pathogenic variants according to the ACMG classification. The LDLR gene had the greatest number of pathogenic/likely pathogenic variants 12%. Cardiovascular genetic diseases had the highest frequency of disorders detected as secondary findings. In this study, the overall rate of positive cases identified with secondary findings in the Saudi population was 8%. The different in our current study and the previous studies in Saudi Arabia can be explained by the differences between the sequencing method, the criteria used for variant classification, the availability of newer evidence at the time of the publication, and the fact that we identified Saudi novel variants never reported in other populations.

Genomic testing and counseling: The contribution of next-generation sequencing to epilepsy genetics

INTRODUCTION

Currently, next-generation sequencing (NGS) technology is more accessible and available to detect the genetic causation of diseases. Though NGS technology benefited some clinical phenotypes, for some clinical diagnoses such as seizures and epileptic disorders, adaptation occurred slowly. The genetic diagnosis was mainly based on epilepsy gene panels and not on whole exome and/or genome sequencing.

METHOD

We retrospectively analyzed 420 index cases, referred for NGS over a period of 18 months, to investigate the challenges in diagnosing epilepsy.

RESULT

Of the 420 cases, 65 (15%) were referred due to epilepsy with one third having a positive family history. The result of the NGS was 14 positive cases (21.5%), 16 inconclusive cases (24%), and 35 (53%) negative cases. No gene has been detected twice in the inconclusive and positive groups. Comparative genomic hybridization has been performed for all 30 NGS negative cases and four cases with pathogenic variants (deletion in 15q11.213.1, deletion of 2p16.3, deletion in Xq22.1, and deletion in 17p13.3) were identified.

CONCLUSION

These findings have implications for our understanding of the approach to genetic testing and counseling of patients affected with seizures and epilepsy disorders. The overall diagnostic yield of exome/genome sequencing in our cohort was 23%. The main characteristic is genetic heterogeneity, supporting NGS technology as a suitable testing approach for seizures and epilepsy disorders. Genetic counseling for newly identified disease-causing variants depends on the pedigree interpretation, within the context of disease penetrance and variable expressivity.

Identifying factors influencing contraceptive use in Bangladesh: evidence from BDHS 2014 data

Background

Birth control is the conscious control of the birth rate by methods which temporarily prevent conception by interfering with the normal process of ovulation, fertilization, and implantation. High contraceptive prevalence rate is always expected for controlling births for those countries that are experiencing high population growth rate. The factors that influence contraceptive prevalence are also important to know for policy implication purposes in Bangladesh. This study aims to explore the socio-economic, demographic and others key factors that influence the use of contraception in Bangladesh.

Methods

The contraception data are extracted from the 2014 Bangladesh Demographic and Health Survey (BDHS) data which were collected by using a two stage stratified random sampling technique that is a source of nested variability. The nested sources of variability must be incorporated in the model using random effects in order to model the actual parameter effects on contraceptive prevalence. A mixed effect logistic regression model has been implemented for the binary contraceptive data, where parameters are estimated through generalized estimating equation by assuming exchangeable correlation structure to explore and identify the factors that truly affect the use of contraception in Bangladesh.

Results

The prevalence of contraception use by currently married 15–49 years aged women or their husbands is 62.4%. Our study finds that administrative division, place of residence, religion, number of household members, woman’s age, occupation, body mass index, breastfeeding practice, husband’s education, wish for children, living status with wife, sexual activity in past year, women amenorrheic status, abstaining status, number of children born in last five years and total children ever died were significantly associated with contraception use in Bangladesh.

Conclusions

The odds of women experiencing the outcome of interest are not independent due to the nested structure of the data. As a result, a mixed effect model is implemented for the binary variable ‘contraceptive use’ to produce true estimates for the significant determinants of contraceptive use in Bangladesh. Knowing such true estimates is important for attaining future goals including increasing contraception use from 62 to 75% by 2020 by the Bangladesh government’s Health, Population & Nutrition Sector Development Program (HPNSDP).

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5098-1) contains supplementary material, which is available to authorized users.