Technology-assisted cognitive-behavior therapy delivered by peers versus standard cognitive behavior therapy delivered by community health workers for perinatal depression: study protocol of a cluster randomized controlled non-inferiority trial

BACKGROUND

The lack of trained mental health professionals is a key barrier to scale-up of evidence-based psychological interventions in low and middle-income countries. We have developed an app that allows a peer with no prior experience of health-care delivery to deliver the cognitive therapy-based intervention for perinatal depression, the Thinking Healthy Programme (THP). This trial aims to assess the effectiveness and cost-effectiveness of this Technology-assisted peer-delivered THP versus standard face-to-face Thinking Healthy Programme delivered by trained health workers.

METHODS

We will employ a non-inferiority stratified cluster randomized controlled trial design comparing the two formats of intervention delivery. A total of 980 women in the second or third trimester of pregnancy with a diagnosis of Major Depressive Episode, evaluated with the Structured Clinical Interview for DSM-V Disorders (SCID), will be recruited into the trial. The unit of randomization will be 70 village clusters randomly allocated in a 1:1 ratio to the intervention and control arms. The primary outcome is defined as remission from major depressive episode at 3 months postnatal measured with the SCID. Data will also be collected on symptoms of anxiety, disability, quality of life, service use and costs, and infant-related outcomes such as exclusive breastfeeding and immunization rates. Data will be collected on the primary outcome and selected secondary outcomes (depression and anxiety scores, exclusive breastfeeding) at 6 months postnatal to evaluate if the improvements are sustained in the longer-term. We are especially interested in sustained improvement (recovery) from major depressive episode.

DISCUSSION

This trial will evaluate the effectiveness and cost-effectiveness of a technology-assisted peer-delivered cognitive behavioral therapy-based intervention in rural Pakistan. If shown to be effective, the novel delivery format could play a role in reducing the treatment gap for perinatal depression and other common mental disorders in LMIC.

TRIAL REGISTRATION

The trial was registered at Clinicaltrials.gov (NCT05353491) on 29 April 2022.

Arterial Versus Venous Blood Gas Analysis Comparisons, Appropriateness, and Alternatives in Different Acid/Base Clinical Settings: A Systematic Review

Arterial blood gases (ABGs) are routinely done in critical clinical settings to ascertain acid-base status. Due to difficulties and the potential side effects following arterial blood sampling, much research has been done to find the possibility of using venous samples as an alternative. However, this comparison needs to be evaluated in various contexts. Hence, this systematic review aims to explore the differences, appropriateness, and alternatives of arterial versus venous blood gas (VBG) analysis in different acid-base states. A comprehensive literature search was conducted through electronic databases using the terms "ABG," "VBG," "Arterial Blood Gas," "Venous Blood Gas," and "Gas analysis." Studies' qualities were assessed by using Newcastle - Ottawa Quality Assessment Scale. Of 531 articles, 22 were included in the study after title, abstract, and full-text screening. Based on the Newcastle - Ottawa Quality Assessment Scale, 23% of the studies had good quality (score ≥ 7), 77% fair quality (score 2-6), and none of the studies had poor quality (score ≤ 1). Moreover, 22.5% of the included articles found a strong correlation between ABG and VBG. 73% compared arterial and VBG parameters among patients with any clinical contexts, 22.5% in respiratory diseases, and 4.5% in metabolic conditions, and their results had a significant disparity. There was a considerable discrepancy among authors about the appropriateness and utilization of VBG as an alternative to ABG. Our findings suggest that those studies did not consider physiological differences between venous and arterial blood values and obviated the significance of sampling procedures.

Transcriptional profiling of human Vδ1 T cells reveals a pathogen-driven adaptive differentiation program

γδ T cells are generally considered innate-like lymphocytes, however, an ‘‘adaptive-like’’ γδ compartment has now emerged. To understand transcriptional regulation of adaptive γδ T cell immunobiology, we combined single-cell transcriptomics, T cell receptor (TCR)-clonotype assignment, ATAC-seq, and immunophenotyping. We show that adult Vδ1⁺ T cells segregate into TCF7⁺LEF1⁺Granzyme B^neg (T_naive) or T-bet⁺Eomes⁺ BLIMP-1⁺Granzyme B⁺ (T_effector) transcriptional subtypes, with clonotypically expanded TCRs detected exclusively in T_effector cells. Transcriptional reprogramming mirrors changes within CD8⁺ αβ T cells following antigen-specific maturation and involves chromatin remodeling, enhancing cytokine production and cytotoxicity. Consistent with this, in vitro TCR engagement induces comparable BLIMP-1, Eomes, and T-bet expression in naive Vδ1⁺ and CD8⁺ T cells. Finally, both human cytomegalovirus and Plasmodium falciparum infection in vivo drive adaptive Vδ1 T cell differentiation from T_naive to T_effector transcriptional status, alongside clonotypic expansion. Contrastingly, semi-invariant Vγ9⁺Vδ2⁺ T cells exhibit a distinct ‘‘innate-effector’’ transcriptional program established by early childhood. In summary, adaptive-like γδ subsets undergo a pathogen-driven differentiation process analogous to conventional CD8⁺ T cells.

Using single-cell transcriptomics, TCR repertoire analysis, ATAC-seq, and immunophenotyping, McMurray et al. show naive Vδ1⁺ T cells can undergo transcriptional reprogramming to an effector state extremely similar to CD8 T_EMRA cells. Infections, including CMV and malaria, drive both clonotypic Vδ1⁺ T cell expansion and differentiation to this highly conserved effector program.

Simultaneous determination of nitrite and nitrate in meat and meat products using ion-exchange chromatography

Nitrite and nitrate salts are widely used as curing agents to preserve meat and meat products. Despite the benefits of using these salts in meat processing, it has some adverse health effects. The high concentration of these salts produces nitric oxide through various metabolic reactions followed by the generation of carcinogenic nitrosamines. In this study, a chromatographic method was developed for the simultaneous determination of nitrite and nitrate level in meat and meat products. Samples were collected from four different locations in Dhaka, Bangladesh and analysed by ion-exchange chromatography. Most relevant validation parameters were evaluated using the standard validation procedure. The linearity was more than 0.995 and recoveries for nitrite and nitrate were more than 96% and 97%, respectively. The Limit of detection (LOD) for nitrite and nitrate was 0.10 and 0.26 mg/L, respectively. Results showed that the highest nitrite and nitrate content was 66.04±0.55 and 55.02±1.4 mg/kg, respectively. However, nitrite and nitrate levels were lower than the prescribed value by international guidelines. Besides, temperaturebased recovery revealed that 80°C was the optimum temperature for recovering the nitrite and nitrate from meat and meat products. This developed method applying ion-exchange chromatography can monitor the content of nitrite and nitrate in meat and meat products to ensure food safety.

Explore the antiproliferative phytocompounds from ethanolic extracts of Citrus paradisi against liver cancer cell line by chemical analysis using TLC and FT-IR spectroscopy

The aim of the present study was to evaluate the in vitro antiproliferative activity of ethanolic extract of leaves and fruits Citrus paradisi plant on HepG-2 liver cell lines by MTT (3-(4, 5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-terazolium bromide) assay and to isolate and characterize the antiproliferative compounds by TLC (Thin layer chromatography) and FT-IR (Fourier transforms Infrared) spectroscopy. Qualitative phytochemical screening tests were performed to detect phytochemicals compounds from the crude extracts. Antioxidant activity of the plant extracts were characterized by using DPPH (2,2-Diphenyl-1-picrylhydrazyl) free radical scavenging method. The results showed that antioxidant activity using DPPH were found to be increased in a concentration dependent manner and decreased cell viability and cell growth inhibition in a dose dependent manner. The findings from this study indicated that fruit extract exhibited good antiproliferation and antioxidant potential. The seven functional groups of phytocompounds such as carboxylic acid, amine salt, aromatic compounds, cyclic alkene, aldehyde, fluoro compounds and alkene were detected by FT-IR which indicated that fruit extracts of Citrus paradisi possessed vast potential as a medicinal drug especially in liver cancer treatment.

Psychometric Validation of the Multidimensional Scale of Perceived Social Support During Pregnancy in Rural Pakistan

Background: The Multidimensional Scale of Perceived Social Support (MSPSS) is a short and reliable instrument that assesses perceived social support from the social network of an individual. A previous study in Pakistan among postpartum women has demonstrated a unidimensional factor structure in contrast to the original three-factor structure. The emergence of a one-factor structure for postpartum women in Pakistan may be due to traditional postpartum practices unique to the women of the subcontinent. Building upon the previous evidence, this study aims to explore the psychometric properties of MSPSS among pregnant women in their third trimester in rural Pakistan.

Methods: A cross-sectional survey was conducted from October 2014 to February 2016, in rural Pakistan. A sample of 1,154 pregnant women (aged ≥ 18 years) in their third trimester who were registered with the local Lady Health Worker Program and were living in the north of the Punjab Province was included in this study. They were assessed using Urdu translated scales of Patient Health Questionnaire, MSPSS, Maternal Social Support Index, and Perceived Stress Scale. Principal Axis Factoring was used to assess the construct validity of the MSPSS.

Results: The MSPSS scale showed an excellent internal consistency, yielding a Cronbach's α-value of 0.933. The MSPSS scale exhibited an excellent construct validity, and confirmatory factor analysis retained three factors (family, friends, and significant others) for both the depressed and non-depressed samples. Internal reliability and construct validity were also established.

Conclusion: The psychometric findings suggest that the tridimensional structure of MSPSS is a valid and reliable measure of perceived social support among the Pakistani population with and without perinatal depression. The perceived social support is an important predictor of maternal mental well-being and psychopathologies, and the MSPSS can serve as a useful tool in mental health research in Pakistan.

Generation of Stable Isopentenyl Monophosphate Aryloxy Triester Phosphoramidates as Activators of Vγ9Vδ2 T Cells

Aryloxy triester phosphoramidate prodrugs of the monophosphate derivatives of isopentenyl pyrophosphate (IPP) and dimethylallyl pyrophosphate (DMAPP) were synthesized as lipophilic derivatives that can improve cell uptake. Despite the structural similarity of IPP and DMAPP, it was noted that their phosphoramidate prodrugs exhibited distinct stability profiles in aqueous environments, which we show is due to the position of the allyl bond in the backbones of the IPP and DMAPP monophosphates. As the IPP monophosphate aryloxy triester phosphoramidates showed favorable stability, they were subsequently investigated for their ability to activate Vγ9/Vδ2 T cells and they showed promising activation of this subset of T cells. Together, these findings represent the first report of IPP and DMAPP monophosphate prodrugs and the ability of IPP aryloxy triester phosphoramidate prodrugs to activate Vγ9/Vδ2 T cells highlighting their potential as possible immunotherapeutics.

Accuracy of Community Informant Led Detection of Maternal Depression in Rural Pakistan

Maternal depression is a global mental health and a public health priority. Despite the priority its active detection is still a challenge. We tested the accuracy of an adapted version of Community Informant Detection Tool for Maternal Depression (CIDT-MD) in rural settings of Pakistan. Using a single stage design, trained community informants (lady health workers and lay peers) identified women (pregnant and/or with children) with symptoms of probable depression using CIDT-MD. This was immediately followed by diagnostic interviews of all the women using the Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID-V) for current major depressive episode by trained assessors, blinded to the outcome of CIDT-MD. Data were analyzed using Statistical Package for Social Sciences (Version 25.0, IBM Corp., Armonk, NY, USA) and FACTOR software (Version. 10.3.01, Virgili University, Tarragona, Spain). Descriptive statistics, factor analysis, validity, reliability and known group validity was conducted to evaluate the psychometric properties of the adapted CIDT-MD. In all, 425 women, with mean age of 28 years (SD = 4.7), participated. Nearly 10% were illiterate, while the rest (90%) had an education ranging from eight to 15 years of schooling. The majority (73.2%) of the participants had 1-3 children while only 17.4% had >3 children. The sensitivity and specificity of CIDT-MD in detecting depressive symptoms was 97.5% (95% CI: 94.2-99.1) and 82.4% (95% CI: 77.8-86.4) respectively. It's positive predictive value (PPV), 77.3% (95% CI: 72.9-81.2) and the negative predictive value (NPV) was 98.17% (95% CI: 95.7-99.2). While factor analysis revealed high inter-item correlation for most items (0.62-0.77) with an adequately fair Kaiser-Meyer-Olkin (KMO) sampling adequacy (0.73), significant Bartlett's test of sphericity (p < 0.001). Uni-dimensionality for the CIDT-MD based on one-dimensional congruence (0.97), explained common variance (0.85), excellent internal consistency (0.90), good criterion validity (Area Under Curve = 81%), tester-test reliability (0.87-0.89) and statistically significant known group analysis (p < 0.001). The adapted version of the Community Informant Detection Tool for Maternal Depression is a valid and a reliable tool for active case detection of maternal depression in rural settings of Pakistan.

Predictors of Prenatal Depression: A Cross-Sectional Study in Rural Pakistan

Objective: To determine the prevalence and association of prenatal depression with socioeconomic, demographic and personal factors among pregnant women living in Kallar Syedan, Rawalpindi, Pakistan. Methods: Five hundred women in the second and third trimester of pregnancy, living in Kallar Syedan, a rural area of district Rawalpindi Pakistan, were included in the study. Depression was assessed using "Patient health questionnaire" (PHQ9) in Urdu, with a cut-off score of 10. Multi-dimensional scale of perceived social support (MSPSS) was used to assess perceived social support. Life Events and Difficulties Schedule (LEDS) were used to measure stressful life events in past 1 year. Tool to assess intimate partner violence (IPV) was based on WHO Multi Country Study on "Women's Health and Domestic Violence against Women." Results: Prevalence of prenatal depression was found to be 27%. Number of pregnancies was significantly associated with prenatal depression (p < 0.01). Women living in a joint family and those who perceived themselves as moderately satisfied or not satisfied with their life in the next 4 years were found to be depressed (p < 0.01, OR 6.9, CI 1.77-26.73). Depressive symptomatology in women who experienced more than five stressful life events in last 1 year was three times higher (p < 0.001, OR 3.2, CI 1.68-5.98) than in women with 1-2 stressful events. Women who were supported by their significant others or their family members had 0.9 times (p < 0.01, OR 0.9, CI 0.85-0.96) less chance of getting depressed. Pregnant women who were psychologically abused by their partners were 1.5 times more depressed (p < 0.05 CI 1.12-2.51). Odds of having depression was also high in women who had less mean score of MSSI (p < 0.05, OR 1.1, CI 1.01-1.09). Women who had suitable accommodation had 0.5 times less chance of having depression than others (p < 0.05, OR 0.5, CI 0.27-0.92). Conclusion: Over a quarter of the women in the study population reported prenatal depression, which were predicted predominantly by psychosocial variables.

Aryloxy Diester Phosphonamidate Prodrugs of Phosphoantigens (ProPAgens) as Potent Activators of Vγ9/Vδ2 T-Cell Immune Responses

Vγ9/Vδ2 T-cells are activated by pyrophosphate-containing small molecules known as phosphoantigens (PAgs). The presence of the pyrophosphate group in these PAgs has limited their drug-like properties because of its instability and polar nature. In this work, we report a novel and short Grubbs olefin metathesis-mediated synthesis of methylene and difluoromethylene monophosphonate derivatives of the PAg (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMBP) as well as their aryloxy diester phosphonamidate prodrugs, termed ProPAgens. These prodrugs showed excellent stability in human serum (t_1/2 > 12 h) and potent activation of Vγ9/Vδ2 T-cells (EC₅₀ ranging from 5 fM to 73 nM), which translated into sub-nanomolar γδ T-cell-mediated eradication of bladder cancer cells in vitro. Additionally, a combination of in silico and in vitro enzymatic assays demonstrated the metabolism of these phosphonamidates to release the unmasked PAg monophosphonate species. Collectively, this work establishes HMBP monophosphonate ProPAgens as ideal candidates for further investigation as novel cancer immunotherapeutic agents.

Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan

BACKGROUND

Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal.

METHODS

40 village clusters in Pakistan were randomly allocated using a computerised randomisation sequence to receive a group-based, psychosocial intervention and enhanced usual care for 36 months, or enhanced usual care alone. Pregnant women (≥18 years) were screened for moderate or severe symptoms of depression (patient health questionnaire-9 [PHQ-9] score ≥10) and were recruited into the trial (570 participants), and a cohort without depression (PHQ-9 score <10) was also enrolled (584 participants). Including the non-depressed dyads enabled us to determine how much of the excess risk due to maternal depression exposure the intervention could mitigate. Research teams responsible for identifying, obtaining consent, and recruiting trial participants were blind to the allocation status throughout the duration of the study, and principal investigators, site coordinators, statisticians, and members of the trial steering committee were also blinded to the allocation status until the analysis of 6-month data for the intervention. Primary outcomes were maternal depression symptoms and remission (PHQ-9 score <10) and child socioemotional skills (strengths and difficulties questionnaire [SDQ-TD]) at 36-months postnatal. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02658994.

FINDINGS

From Oct 15, 2014 to Feb 25, 2016 46 village clusters were assessed for eligibility, of which 40 (including 1910 mothers were enrolled. After exclusions, 288 women were randomly assigned to the enhanced usual care group and 284 to the intervention group, and 1159 women were included in a group without prenatal depression. At 36-months postnatal, complete data were available from 889 mother-child dyads: 206 (72·5%) in the intervention group, 216 (75·3%) in the enhanced usual care group, and 467 (80·0%) women who did not have prenatal-depression. We did not observe significant outcome differences between the intervention group and the enhanced usual care group for the primary outcomes. The standardised mean difference of PHQ-9 total score was -0·13 (95% CI -0·33 to 0·07), relative risk of patient health questionnaire-9 remission was 1·00 (95% CI 0·88 to 1·14), and the SDQ-TD treatment estimate was -0·10 (95% CI -1·39 to 1·19).

INTERPRETATION

Reduced symptom severity and high remission rates were seen across both the intervention and enhanced usual care groups, possibly masking any effects of the intervention. A multi-year, psychosocial intervention can be task-shifted via peers but might be susceptible to reductions in fidelity and dosage over time (which were not among the outcomes of this trial). Early intervention efforts might need to rely on multiple models (eg, collaborative care), be of greater intensity, and potentially targeted at mothers who are at high risk for depression to reduce the intergenerational transmission of psychopathology from mothers to children.

FUNDING

National Institutes of Health.

AB0076 SPATIAL VARIATIONS OF BONE MICROARCHITECTURE AND MINERALIZATION IN HIP OSTEOARTHRITIS AND OSTEOPOROSIS

Background:

The pattern of changes in bone microarchitecture and mineralisation are distinctly different in osteoarthritis (OA) and osteoporosis (OP). However, the pathogenesis of OA is closely related with OP, making subchondral bone a promising target for OA treatment [1]. A detailed comparison of subchondral bone in OA and OP may help understand the relationship of the two diseases.

Objectives:

To carry out a comprehensive analysis of regional and compartmental variations in subchondral bone architecture and mineralisation in OA and OP.

Methods:

Femoral heads were collected from patients undergoing hip arthroplasty surgeries for hip OA (N=16) or osteoporotic fracture (N=7). For OP group, osteochondral plugs were collected from fixed sites: anterior, posterior and superior. For OA group, an optimised sampling procedure, based on a new macroscopic grading method and modified OARSI microscopic grading system, was used to collect plugs from regions with varying severity of cartilage degradation. Plugs were scanned by micro CT (voxel size 4.88µm). Regions of interest for cortical plate (Ct) and trabecular bone (Tb) were segmented from reconstructed images using semi-automatic approach. Densitometric (tissue and bone mineral density: TMD and BMD) and architectural parameters (cortical plate thickness (Ct.Th), trabecular bone volume fraction (BV/TV), trabecular thickness (Tb.Th), etc.) were measured using commercially available software. Unmatched inter-group regional comparisons were made between OA microscopic grades (1 to 4) and OP. Matched intra-sample regional analysis was made between ‘mild’ (Grade 1 and/or 2) and ‘severe’ (Grade 3 and/or 4) OA. TMD was also subjected to paired comparison between cortical (Ct.TMD) and trabecular (Tb.TMD) compartments. Correlations between densitometric and architectural parameters were also explored.

Results:

Regional analysis showed that Tb.TMD in OA Grade 3 and 4 was significantly lower than in OP and Grade 1 and 2, while Tb.TMD in OP was not significantly different from OA Grade 1 and 2 (Fig 1A, F). Ct.TMD in OA Grade 4 was significantly lower than in OP, but no difference was found in other comparisons (Fig 1B, G). For BMD of trabecular bone (Tb.BMD) and architectural parameters including BV/TV and Ct.Th, values for OA Grade 3 and/or 4 were significantly higher than OP and Grade 1 and/or 2, but the difference between OP and Grade 1 and 2 was not significant (Fig 1C-E, H-J). Compartmental analysis showed that Ct.TMD was significantly lower than Tb.TMD in all groups (Table I). Tb.TMD was inversely correlated with Tb.BMD and BV/TV in both OA and OP; Ct.TMD and Tb.TMD were inversely associated with Ct.Th and Tb.Th respectively in OA (Table II).

Conclusion:

In both OA and OP, material density (TMD) of cortical plate was lower than trabecular bone. In hip OA, densitometric and architectural changes of subchondral cortical and trabecular bone were related to severity of cartilage degradation. In OA trabecular bone, the decrease in material density was compensated by increased bone volume, leading to higher apparent density (BMD); while in OP, loss of bone volume was correlated with, but not compensated by increased mineralisation, leading to lower apparent density.

References:

[1]Castaneda, S., et al. Biochem. Pharmacol., 2012

Table 1.

Compartmental comparison of TMD

OPOA Grade1234Ct.TMD1.19±0.071.18±0.091.15±0.061.16±0.061.12±0.07Tb.TMD1.34±0.06****1.37±0.10****1.33±0.07****1.22±0.06*1.19±0.09*Table 2.

Correlation analysis

OPOAPR2SlopePR2SlopeTb.TMD - BV/TV< 0.00010.69-0.01< 0.00010.84-0.01Tb.BMD - BV/TV< 0.00010.950.02< 0.00010.960.01Tb.BMD - Tb.TMD< 0.00010.60-1.25< 0.00010.81-1.37Ct.TMD - Ct.Thns0.00090.19-0.33Tb.TMD - Tb.Thns< 0.00010.55-1.97

Acknowledgments:

China Scholarship Council

Disclosure of Interests:

None declared

AB1248 MOLECULAR MARKERS OF PAIN AND OTHER SYMPTOMS IN KNEE OSTEOARTHRITIS

Background:

Osteoarthritis (OA) is one of the leading causes for disability in adults. The diagnosis of OA is generally based on patient reported pain, other symptoms and radiographic changes which occur in late stages. There have been extensive research over the last 30 years to identify and validate molecular markers for early diagnosis of OA and a large range of potential biomarkers has been identified[1, 2]. However, most of these biomarkers are markers of structural and metabolic changes, and have poor correlation with pain and stiffness in knee OA. The publicly available data from the National Institute of Health Osteoarthritis Initiative (OAI) provides an opportunity to search for clinically useful biomarkers associated with the main symptoms in OA.

Objectives:

To identify molecular biomarkers which are associated with the main symptoms of knee OA.

Methods:

600 participants from 4791 men and women aged 45 to 79 who were Kellgren & Lawrence grade 1 or more were identified with biochemical markers data, radiographic and clinical features of OA. Nineteen biochemical markers measured in serum and/or urine were analysed for their association with primary clinical features of OA: Knee injury and Osteoarthritis Outcome Score (KOOS) pain and symptoms, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness score. Patient level analysis was carried out based on the worst affected knee. The association of molecular biomarkers with KOOS and WOMAC scores were assessed using univariate and multivariate linear and logistic regression, and receiving operator characteristic curves (ROC). Area under the curve (AUC) was calculated in order to determine if a combination of the biomarkers improve the associations with the outcome variables.

Results:

Only 3 of the 19 biomarkers investigated were associated with clinical symptoms. Serum cartilage oligomeric matrix protein (COMP) and chondroitin sulphate 846 (CS846) were associated with WOMAC pain and stiffness respectively, while, urinary C-terminal crosslinked telopeptide of type II collagen (CTXII) appeared to be highly associated with WOMAC stiffness, KOOS pain and symptoms (Table 1 / 2). The AUC from the univariate model for the association of biomarkers with WOMAC pain and stiffness were 0.5 (Table 1), while the AUC for unadjusted and adjusted multivariate model for the 3 biomarkers combined were 0.56 and 0.67 respectively (Figure 1).

Table 1.

Univariate logistic regression model.

WOMAC PainWOMAC StiffnessBiomarkersOR (95%)AUC (p-value)OR (95%)AUC (p-value)sCS8461.0026 (0.9996, 1.0056)0.5200 (0.088)1.0047 (1.0013, 1.0081)0.5399 (0.007)sCOMP0.9419 (0.8912, 0.9954)0.5462 (0.034)1.0424 (0.9843, 1.1039)0.5317 (0.156)uCTXII1.0077 (0.9990, 1.0165)0.5300 (0.083)1.0099 (1.0005, 1.0194)0.5489 (0.039)

Conclusion:

Serum COMP and urinary CTXII are associated with pain in knee OA, while serum CS846 and urinary CTXII are associated with joint stiffness. The multivariate logistic regression model shows good discrimination for the association of biomarkers with clinical symptoms of OA. The data from the multivariate model suggests that a clinically useful biomarker may be created using AUC values for better specificity and sensitivity.

References:

[1]Lotz, M., et al. Annals of the Rheumatic Diseases, 2013. 72(11)

[2]Kraus, V.B., et al. Annals of the Rheumatic Diseases, 2017. 76(1)

Table 2.

Univariate and multivariate linear regression model. Confounders such as age, body mass index, gender and race were adjusted in the multivariate model.

BiomarkersKOOS PainKOOS SymptomsUnivariateMultivariateUnivariateMultivariateCoefficient (95%)p-valueCoefficient (95%)p-valueCoefficient (95%)p-valueCoefficient (95%)p-valuesMMP30.057 (-0.024, 0.138)0.1650.019 (-0.074, 0.111)0.6960.092 (0.022, 0.162)0.0100.059 (-0.021, 0.140)0.147uCTXII-0.678 (-0.124, -0.012)0.017-0.086 (-0.152, -0.021)0.010-0.730 (-0.121, -0.025)0.003-0.091 (-0.148, -0.034)0.002

Acknowledgments

Disclosure of Interests:

None declared

Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: Pooled analysis of two randomized controlled trials in India and Pakistan

BACKGROUND

The Thinking Healthy Programme (THP) is recommended to treat perinatal depression in resource-limited settings, but scale-up is hampered by a paucity of community health workers. THP was adapted for peer-delivery (THPP) and evaluated in two randomized controlled trials in India and Pakistan. Our aim was to estimate the effectiveness of THPP on maternal outcomes across these two settings, and evaluate effect-modification by country and other pre-defined covariates.

METHODS

Participants were pregnant women aged≥18 years with depression (Patient Health Questionnaire (PHQ-9) score≥10), randomized to THPP plus enhanced usual care (EUC) or EUC-only. Primary outcomes were symptom severity and remission (PHQ-9 score<5) 6 months post-childbirth. Secondary outcomes included further measures of depression, disability and social support at 3 and 6 months post-childbirth.

RESULTS

Among 850 women (280 India; 570 Pakistan), 704 (83%) attended 6-month follow-up. Participants in the intervention arm had lower symptom severity (PHQ-9 score adjusted mean difference -0.78 (95% confidence interval -1.47,-0.09)) and higher odds of remission (adjusted odds ratio 1.35 (1.02,1.78)) versus EUC-only. There was a greater intervention effect on remission among women with short chronicity of depression, and those primiparous. There were beneficial intervention effects across multiple secondary outcomes.

LIMITATIONS

The trials were not powered to assess effect-modifications. 10-20% of participants were missing outcome data.

CONCLUSIONS

This pooled analysis demonstrates the effectiveness, acceptability and feasibility of THPP, which can be scaled-up within a stepped-care approach by engaging with the existing health care systems and the communities to address the treatment gap for perinatal depression in resource-limited settings.

Delivering the Thinking Healthy Programme for perinatal depression through volunteer peers: a cluster randomised controlled trial in Pakistan

BACKGROUND

The Thinking Healthy Programme (THP), which is endorsed by WHO, is an evidence-based intervention for perinatal depression. We adapted THP for delivery by volunteer peers (laywomen from the community) to address the human resource needs in bridging the treatment gap, and we aimed to assess its effectiveness and cost-effectiveness in Rawalpindi, Pakistan.

METHODS

In this cluster randomised controlled trial, we randomly assigned 40 village clusters (1:1) to provide either THP peer-delivered (THPP) and enhanced usual care (EUC; intervention group) or EUC only (control group) to the participants within clusters. These villages were randomly selected from eligible villages by an independent researcher. The participants were pregnant women aged 18 years or older who had scored at least 10 on the Patient Health Questionnaire-9 (PHQ-9), who we recruited from households within communities in Rawalpindi, Pakistan. The research teams who were responsible for recruiting trial participants were masked to treatment allocations. Participants attended follow-up visits at 3 and 6 months after childbirth. The primary outcomes were the severity of depressive symptoms (assessed by PHQ-9 score) and the prevalence of remission (defined as a PHQ-9 score of less than 5) in participants with available data 6 months after childbirth, which was assessed by researchers who were masked to treatment allocations. We analysed outcomes by intention to treat, adjusting for covariates that were defined a priori or that showed imbalance at baseline. The trial was registered with ClinicalTrials.gov, number NCT02111915.

FINDINGS

Between April 15 and July 30, 2014, we randomly selected 40 of 46 eligible village clusters for assessment, as per sample size calculations. Between Oct 15, 2014, and Feb 25, 2016, we identified and screened 971 women from 20 village clusters that had been randomly assigned to the THPP and EUC group and 939 women from 20 village clusters that had been randomly assigned to the EUC only group. In the intervention group, 79 women were ineligible for inclusion, 11 women refused screening, 597 women screened negative on the PHQ-9, and one woman did not consent to participate. In the control group, 75 women were ineligible for inclusion, 14 women refused screening, 562 women screened negative on the PHQ-9, and one woman did not consent to participate. We enrolled 283 (29%) women in the intervention group and 287 (31%) women in the control group. At 6 months after childbirth, 227 (80%) women in the THPP and EUC group and 226 (79%) women in the EUC only group were assessed for the primary outcome. The severity of depression (assessed by PHQ-9 scores; standardised mean difference -0·13, 95% CI -0·31 to 0·06; p=0·07) and prevalence of remission (49% in the intervention group vs 45% in the control group; prevalence ratio 1·12, 95% CI 0·95 to 1·29; p=0·14) did not significantly differ between the groups 6 months after childbirth. There was no evidence of significant differences in serious adverse events between the groups.

INTERPRETATION

THPP had no effect on symptom severity or remission from perinatal depression at 6 months after childbirth, but we found that it was beneficial on some other metrics of severity and disability and that it was cost-effective. THPP could be a step towards use of an unused human resource to address the treatment gap in perinatal depression.

FUNDING

National Institute of Mental Health (USA).

Models of osteoarthritis: the good, the bad and the promising

Osteoarthritis (OA) is a chronic degenerative disease of diarthrodial joints most commonly affecting people over the age of forty. The causes of OA are still unknown and there is much debate in the literature as to the exact sequence of events that trigger the onset of the heterogeneous disease we recognise as OA. There is currently no consensus model for OA that naturally reflects human disease. Existing ex-vivo models do not incorporate the important inter-tissue communication between joint components required for disease progression and differences in size, anatomy, histology and biomechanics between different animal models makes translation to the human model very difficult. This narrative review highlights the advantages and disadvantages of the current models used to study OA. It discusses the challenges of producing a more reliable OA-model and proposes a direction for the development of a consensus model that reflects the natural environment of human OA. We suggest that a human osteochondral plug-based model may overcome many of the fundamental limitations associated with animal and in-vitro models based on isolated cells. Such a model will also provide a platform for the development and testing of targeted treatment and validation of novel OA markers directly on human tissues.

Charged compact objects in f(R,T) gravity

This paper analyzes the effects of charge on the nature of relativistic compact star candidates with anisotropic distribution in the framework of [Formula: see text] gravity. For this purpose, we consider Krori–Barua solutions and obtain the values of unknown constants as well as charge using observational data of Her X-1, 4U1820-30 and SAX J 1808.4-3658 star models. For three viable [Formula: see text] models, we investigate the behavior of energy density, transverse as well as radial pressures in the interior geometry of these stars. The validity of energy conditions, effect of anisotropic factor and stability of these stellar models are also examined. We conclude that the effect of charge leads to more stable structures of relativistic compact objects.

On the stability of Einstein universe in f(R, T, Rμν Tμν) gravity

This paper investigates the existence and stability of Einstein universe in the context of f(R, T, Q) gravity, where Q = R[Formula: see text] T[Formula: see text]. Considering linear homogeneous perturbations around scale factor and energy density, we formulate static as well as perturbed field equations. We parametrize the stability regions corresponding to conserved as well as non-conserved energy–momentum tensor using linear equation of state parameter for particular models of this gravity. The graphical analysis concludes that for a suitable choice of parameters, stable regions of the Einstein universe are obtained which indicates that the big bang singularity can be avoided successfully by the emergent mechanism in non-minimal matter-curvature coupled gravity.

Effect of distillery yeast sludge on growth performance, nutrient digestibility and slaughter parameters in Japanese quails

This study was planned to evaluate the effect of distillery yeast sludge (DYS) as a protein source on growth performance, nutrient digestibility and slaughtering parameters in Japanese quail birds. For this purpose, six hundred day-old quails were randomly distributed into six dietary treatments. These dietary treatments were; G₁ (Control Group) fed a basal diet (CP 24%, ME 2900 kcal/kg) without DYS, while other dietary treatments were G₂, G₃, G₄, G₅ and G₆ fed basal diet containing DYS @ 1.5, 3.0, 4.5, 6.0 and 7.5%, respectively. It was observed that feed intake and weight gain tended to increase (P < 0.05) up to 3% DYS. Better (P < 0.05) feed conversion ratio (FCR) was observed in birds fed diet containing DYS at the level of 1.5 and 3%. Dry matter and crude protein digestibility decreased with increasing levels of DYS (P < 0.05). Cost of production per 100 g of weight gain was also less in birds fed diet containing 3% DYS. Study revealed that inclusion of distillery yeast sludge in the diet of Japanese quails up to 3% improves the growth performance and economics efficacy.

Stability Analysis of Bulk Viscous Cosmology

In this paper, we study phase space analysis of FRW universe model by taking a power-law model for bulk viscosity coefficient. An autonomous system of equations is developed by defining normalized dimensionless variables. We find corresponding critical points for di.erent values of the parameters to investigate stability of the system. It is found that the presence of power-law model of bulk viscosity appears as an e.ective ingredient to enhance the stability of the respective universe model.

MCE domain proteins: conserved inner membrane lipid-binding proteins required for outer membrane homeostasis

Bacterial proteins with MCE domains were first described as being important for Mammalian Cell Entry. More recent evidence suggests they are components of lipid ABC transporters. In Escherichia coli, the single-domain protein MlaD is known to be part of an inner membrane transporter that is important for maintenance of outer membrane lipid asymmetry. Here we describe two multi MCE domain-containing proteins in Escherichia coli, PqiB and YebT, the latter of which is an orthologue of MAM-7 that was previously reported to be an outer membrane protein. We show that all three MCE domain-containing proteins localise to the inner membrane. Bioinformatic analyses revealed that MCE domains are widely distributed across bacterial phyla but multi MCE domain-containing proteins evolved in Proteobacteria from single-domain proteins. Mutants defective in mlaD, pqiAB and yebST were shown to have distinct but partially overlapping phenotypes, but the primary functions of PqiB and YebT differ from MlaD. Complementing our previous findings that all three proteins bind phospholipids, results presented here indicate that multi-domain proteins evolved in Proteobacteria for specific functions in maintaining cell envelope homeostasis.

Sero-prevalence and epidemiology of peste des petits ruminants in Libya

We conducted a cross-sectional study during 2013 to quantify the serological prevalence of peste des petits ruminants (PPR) infection and to investigate host factors associated with PPR infection in small ruminants in Libya. A two-stage sampling design was carried out. A total number of 148 flocks owning at least 100 heads each were randomly selected. Sixteen to forty-eight samples were collected from each selected flock. A total number of 3,508 serum samples from unvaccinated animals were collected and analysed at IZSLER Brescia, Italy, by using competitive ELISA, IDvet innovative diagnostics (IDvet 310, France). The overall serological prevalence among SR was 33% (95% CI: 31.4-34.5). Significant differences between the prevalence in the geographical branches were observed. The lowest prevalence level was observed in Zawiyah branch (16.1%), whereas the highest value was obtained for the Sabha branch (56.8%). Considering the age, a serological prevalence of 24.7%, 31.5% and 42.1% was observed in SR <1 year, between 1 and 2 years and more than 2 years, respectively. Statistically significant differences (p < .001) in the sero-prevalence levels were also observed between the age groups. Our findings suggest that the southern part of Libya could be more exposed to the infections coming from the neighbouring countries and this should be better investigated to correctly identify wherever specific entry points can be considered at higher risk than others. The results also confirmed the endemic status of PPR in Libya, with a constant exposure to the infection of the animals during their life. In the framework of the global strategy for control and eradication of PPR, our results, even if obtained by a preliminary study, can contribute to the assessment of the epidemiological situation of PPR in Libya as required by the Stage 1 of the plan.

Effect of graded levels of dietary corn steep liquor on growth performance, nutrient digestibility, haematology and histopathology of broilers

This experiment was conducted to assess nutritional potential of corn steep liquor (CSL) as an alternative protein source in broiler's diet. A total of 280-day-old unsexed broiler chicks were randomly distributed into four experimental groups in a simple randomised experimental design (each group had seven replicates; 10 birds per each). Four iso-nitrogenous and iso-caloric broiler starter and finisher diets (C, LCSL, MCSL and HCSL) were formulated containing 0%, 5%, 10% and 15% CSL respectively. Results revealed that chicks fed MCSL diet had significantly (p ≤ .05) the heaviest Body weight, highest Body weight gain and the lowest feed conversion ratio followed by those fed HCSL diet. In the starter period, LCSL and MCSL diets resulted in better (p ≤ .05) dry matter (DM) (89.57%) and crude protein (67.67%) digestibilities respectively. In the finisher period, DM, crude fibre and fat digestibilities were not affected by CSL inclusion levels; while crude protein digestibility was significantly (p ≤ .05) high in the groups fed LCSL and HCSL diets. The CSL inclusion had no effect on blood haematology except serum uric acid, which tended to increase with increasing CSL levels. No microscopic changes were exhibited on liver, heart, kidneys and intestine of birds across all dietary treatments. However, crops in birds fed HCSL diet showed moderate to severe hypertrophy and hyperplasia of the mucosal lining. The study showed that CSL could be added up to 15% in broiler's diet without any adverse effect on bird's performance.

Physical behavior of anisotropic compact stars in f(R, T, RμνTμν) gravity

This paper investigates the behavior of anisotropic compact stars in the background of R + αRμνTμν gravity model. For this purpose, we use Krori–Barua metric solutions where constants are calculated using masses and radii of compact stars like Her X-1, SAX J 1808.4–3658, and 4U1820–30. We analyze regular behavior of effective energy density, and radial and transverse pressures in the interior of compact stars. We also discuss energy conditions, effect of anisotropic factor, and stability criteria of these stars. It is concluded that the considered compact star models satisfy all the energy conditions and remain stable against the anisotropic effect in this gravity.

Application of multiplex PCR for the simultaneous detection of Taenia spp. from domestic dogs in the north of Iran

The family Taeniidae is of great importance in the medical and veterinary fields, particularly in the tropics and subtropics. Identification of eggs of different Taenia spp. in the final host by morphological examination is difficult owing to their similarity. Therefore, a multiplex polymerase chain reaction (PCR) targeting a mitochondrial gene was applied to identify morphologically indistinguishable eggs. Fecal samples from 100 domestic dogs, from the Mazandaran province in Iran, were examined using the flotation/sieving method followed by multiplex PCR. Taeniid eggs were observed in 24 % samples, of which 12 %, 10 %, and 2 % were infected with Echinococcus granulosus, Taenia spp., and both E. granulosus and Taenia spp., respectively. E. multilocularis was absent in these samples. The prevalence of E. granulosus in the examined domestic dogs as definitive hosts in north of Iran was high (14 %). Therefore, people living in this region of Iran are in danger of acquiring hydatid cyst, which is a serious public health problem.

HIV diagnosis in a patient presenting with vasculitis

A patient with digital ischaemia and gangrene was treated with iloprost and antiplatelets for two weeks. His vasculitic screen was negative except for a positive HIV test. His vasculitis improved three weeks after treatment with antiretroviral medications. Though vasculitis is well known to be associated with HIV infection, very few cases of HIV present as vasculitis.