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Schuh HB, Hooli S, Ahmed S, King C, Roy AD, Lufesi N, Islam ASMDA, Mvalo T, Chowdhury NH, Ginsburg AS, Colbourn T, Checkley W, Baqui AH, McCollum ED. Clinical hypoxemia score for outpatient child pneumonia care lacking pulse oximetry in Africa and South Asia. Front Pediatr 2023; 11:1233532. [PMID: 37859772 PMCID: PMC10582699 DOI: 10.3389/fped.2023.1233532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/07/2023] [Indexed: 10/21/2023] Open
Abstract
Background Pulse oximeters are not routinely available in outpatient clinics in low- and middle-income countries. We derived clinical scores to identify hypoxemic child pneumonia. Methods This was a retrospective pooled analysis of two outpatient datasets of 3-35 month olds with World Health Organization (WHO)-defined pneumonia in Bangladesh and Malawi. We constructed, internally validated, and compared fit & discrimination of four models predicting SpO2 < 93% and <90%: (1) Integrated Management of Childhood Illness guidelines, (2) WHO-composite guidelines, (3) Independent variable least absolute shrinkage and selection operator (LASSO); (4) Composite variable LASSO. Results 12,712 observations were included. The independent and composite LASSO models discriminated moderately (both C-statistic 0.77) between children with a SpO2 < 93% and ≥94%; model predictive capacities remained moderate after adjusting for potential overfitting (C-statistic 0.74 and 0.75). The IMCI and WHO-composite models had poorer discrimination (C-statistic 0.56 and 0.68) and identified 20.6% and 56.8% of SpO2 < 93% cases. The highest score stratum of the independent and composite LASSO models identified 46.7% and 49.0% of SpO2 < 93% cases. Both LASSO models had similar performance for a SpO2 < 90%. Conclusions In the absence of pulse oximeters, both LASSO models better identified outpatient hypoxemic pneumonia cases than the WHO guidelines. Score external validation and implementation are needed.
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Affiliation(s)
- Holly B. Schuh
- Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shubhada Hooli
- Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | | | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Tisungane Mvalo
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, UNC, Chapel Hill, NC, United States
| | | | - Amy Sarah Ginsburg
- Clinical Trial Center, University of Washington, Seattle, WA, United States
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - William Checkley
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Abdullah H. Baqui
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Eric D. McCollum
- Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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2
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Contrepois K, Chen S, Ghaemi MS, Wong RJ, Jehan F, Sazawal S, Baqui AH, Stringer JSA, Rahman A, Nisar MI, Dhingra U, Khanam R, Ilyas M, Dutta A, Mehmood U, Deb S, Hotwani A, Ali SM, Rahman S, Nizar A, Ame SM, Muhammad S, Chauhan A, Khan W, Raqib R, Das S, Ahmed S, Hasan T, Khalid J, Juma MH, Chowdhury NH, Kabir F, Aftab F, Quaiyum A, Manu A, Yoshida S, Bahl R, Pervin J, Price JT, Rahman M, Kasaro MP, Litch JA, Musonda P, Vwalika B, Shaw G, Stevenson DK, Aghaeepour N, Snyder MP. Author Correction: Prediction of gestational age using urinary metabolites in term and preterm pregnancies. Sci Rep 2022; 12:19753. [PMID: 36396676 PMCID: PMC9671899 DOI: 10.1038/s41598-022-23715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kévin Contrepois
- grid.168010.e0000000419368956Department of Genetics, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Stanford Cardiovascular Institute, Stanford University, Stanford, CA USA
| | - Songjie Chen
- grid.168010.e0000000419368956Department of Genetics, Stanford University School of Medicine, Stanford, CA USA
| | - Mohammad S. Ghaemi
- grid.168010.e0000000419368956Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA USA ,grid.24433.320000 0004 0449 7958Digital Technologies Research Centre, National Research Council Canada, Toronto, ON Canada
| | - Ronald J. Wong
- grid.168010.e0000000419368956Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Fyezah Jehan
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan ,grid.7147.50000 0001 0633 6224Biorepository and Omics Research Group, Faculty of Health Sciences, Medical College, Aga Khan University, Karachi, Pakistan
| | - Sunil Sazawal
- Center for Public Health Kinetics, New Delhi, India ,Public Health Laboratory IdC, Pemba, Zanzibar, Tanzania
| | - Abdullah H. Baqui
- grid.21107.350000 0001 2171 9311International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Jeffrey S. A. Stringer
- grid.10698.360000000122483208Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Anisur Rahman
- grid.414142.60000 0004 0600 7174Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Muhammad I. Nisar
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan ,grid.7147.50000 0001 0633 6224Biorepository and Omics Research Group, Faculty of Health Sciences, Medical College, Aga Khan University, Karachi, Pakistan
| | - Usha Dhingra
- Center for Public Health Kinetics, New Delhi, India
| | - Rasheda Khanam
- grid.21107.350000 0001 2171 9311International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Muhammad Ilyas
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arup Dutta
- Center for Public Health Kinetics, New Delhi, India
| | - Usma Mehmood
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saikat Deb
- Center for Public Health Kinetics, New Delhi, India ,Public Health Laboratory IdC, Pemba, Zanzibar, Tanzania
| | - Aneeta Hotwani
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Said M. Ali
- Public Health Laboratory IdC, Pemba, Zanzibar, Tanzania
| | - Sayedur Rahman
- Projahnmo Research Foundation, Abanti, Banani, Dhaka, Bangladesh
| | - Ambreen Nizar
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shaali M. Ame
- Public Health Laboratory IdC, Pemba, Zanzibar, Tanzania
| | - Sajid Muhammad
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Waqasuddin Khan
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan ,grid.7147.50000 0001 0633 6224Biorepository and Omics Research Group, Faculty of Health Sciences, Medical College, Aga Khan University, Karachi, Pakistan
| | - Rubhana Raqib
- International Center for Diarroheal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Sayan Das
- Center for Public Health Kinetics, New Delhi, India
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, Abanti, Banani, Dhaka, Bangladesh
| | - Tarik Hasan
- Projahnmo Research Foundation, Abanti, Banani, Dhaka, Bangladesh
| | - Javairia Khalid
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan ,grid.7147.50000 0001 0633 6224Biorepository and Omics Research Group, Faculty of Health Sciences, Medical College, Aga Khan University, Karachi, Pakistan
| | | | | | - Furqan Kabir
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fahad Aftab
- Center for Public Health Kinetics, New Delhi, India
| | - Abdul Quaiyum
- International Center for Diarroheal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Alexander Manu
- grid.3575.40000000121633745Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Sachiyo Yoshida
- grid.3575.40000000121633745Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Rajiv Bahl
- grid.3575.40000000121633745Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Jesmin Pervin
- grid.414142.60000 0004 0600 7174Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Joan T. Price
- grid.10698.360000000122483208Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Monjur Rahman
- grid.414142.60000 0004 0600 7174Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - James A. Litch
- grid.507550.20000 0004 8512 7499Global Alliance to Prevent Prematurity and Stillbirth, Seattle, USA
| | - Patrick Musonda
- grid.12984.360000 0000 8914 5257Department of Biostatistics, University of Zambia, Lusaka, Zambia
| | - Bellington Vwalika
- grid.12984.360000 0000 8914 5257Department of Obstetrics and Gynecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Gary Shaw
- grid.168010.e0000000419368956Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - David K. Stevenson
- grid.168010.e0000000419368956Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Nima Aghaeepour
- grid.168010.e0000000419368956Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Michael P. Snyder
- grid.168010.e0000000419368956Department of Genetics, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Stanford Cardiovascular Institute, Stanford University, Stanford, CA USA
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3
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Islam MA, Mohammed T, Mamoon TB, Chowdhury NH, Khan SR, Rahman ML. Hemithyroidectomy in the Treatment of Papillary Thyroid Carcinoma: A Prospective Study of 300 Patients. Mymensingh Med J 2022; 31:1013-1019. [PMID: 36189546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The correct approach to treat low-risk intra thyroidal papillary thyroid carcinoma (PTC) is still controversial. The traditional paradigm of treating all patients with thyroid cancer with total thyroidectomy, radioactive iodine and suppressive thyroid hormone therapy is no longer suitable. Many authors advocate unilateral thyroidectomy to minimize perioperative morbidity. The purpose of this study was to determine an effective treatment strategy for patients with small unilateral papillary thyroid carcinoma in a low risk group. This is a prospective study of 300 patients who were diagnosed as papillary thyroid carcinoma by preoperative FNAC or postoperative histopathology. The age of the patients' was ranged between 15 to 45 years. The criteria were: tumor ≤4cm, unilateral involvement, cytological non-aggressive subtype, absence of lymph node (LN) involvement and extra thyroidal extension (ETE) on ultrasonography (USG) and absence of clinical distant metastases. Duration of the study period was 30 years from 1989 to 2019. The study was conducted in tertiary care hospital in Bangladesh. All patients had undergone hemi thyroidectomy and followed up by a median period of 25 months (range, 6 to 166 months). Following hemithyroidectomy, among 300 patients, 267 patients (89.0%) did not show any recurrence of disease. Thirty three (33) patients (11.0%) came with locoregional recurrence of disease in clinical and USG findings without any distant metastasis. Maximum patients were between the ages 31-40 year followed by 21-30 years. Female was out number male in the ratio. Though further large scale study should require to determine the optimal treatment option for low risk PTC, but this study can lead to a result that hemi thyroidectomy is now-a-days a better surgical option for PTC even up to tumor size of ≤4cm.
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Affiliation(s)
- M A Islam
- Professor Md Ashraful Islam, Professor and Head, Department of Otolaryngology-Head & Neck Surgery, Bangladesh Medical College, Dhaka, Bangladesh; E-mail:
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4
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Checkley W, Hossen S, McCollum ED, Pervaiz F, Miele CH, Chavez MA, Moulton LH, Simmons N, Roy AD, Chowdhury NH, Ahmed S, Begum N, Quaiyum A, Santosham M, Baqui AH. Effectiveness of the 10-valent pneumococcal conjugate vaccine on pediatric pneumonia confirmed by ultrasound: a matched case-control study. Respir Res 2022; 23:198. [PMID: 35915495 PMCID: PMC9341060 DOI: 10.1186/s12931-022-02115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Bangladesh introduced the 10-valent pneumococcal conjugate vaccine (PCV10) for children aged < 1 year in March 2015. Previous vaccine effectiveness (VE) studies for pneumonia have used invasive pneumococcal disease or chest X-rays. None have used ultrasound. We sought to determine the VE of PCV10 against sonographically-confirmed pneumonia in three subdistrict health complexes in Bangladesh. Methods We conducted a matched case–control study between July 2015 and September 2017 in three subdistricts of Sylhet, Bangladesh. Cases were vaccine-eligible children aged 3–35 months with sonographically-confirmed pneumonia, who were matched with two types of controls by age, sex, week of diagnosis, subdistrict health complex (clinic controls) or distance from subdistrict health complex (community controls) and had an illness unlikely due to Streptococcus pneumoniae (clinic controls) or were healthy (community controls). VE was measured using multivariable conditional logistic regression. Results We evaluated 8926 children (average age 13.3 months, 58% boys) with clinical pneumonia by ultrasound; 2470 had pneumonia with consolidations ≥ 1 cm; 1893 pneumonia cases were matched with 4238 clinic controls; and 1832 were matched with 3636 community controls. VE increased with the threshold used for consolidation size on ultrasound: the adjusted VE of ≥ 2 doses vs. non-recipients of PCV10 against pneumonia increased from 15.8% (95% CI 1.6–28.0%) for consolidations ≥ 1 cm to 29.6% (12.8–43.2%) for consolidations ≥ 1.5 cm using clinic controls and from 2.7% (− 14.2–17.2%) to 23.5% (4.4–38.8%) using community controls, respectively. Conclusions PCV10 was effective at reducing sonographically-confirmed pneumonia in children aged 3–35 months of age when compared to unvaccinated children. VE increased with the threshold used for consolidation size on ultrasound in clinic and community controls alike. This study provides evidence that lung ultrasound is a useful alternative to chest X-ray for case–control studies evaluating the effectiveness of vaccines against pneumonia.
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Affiliation(s)
- William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St, Room 555, Baltimore, MD, 21287, USA. .,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA. .,Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St, Room 555, Baltimore, MD, 21287, USA
| | - Eric D McCollum
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Farhan Pervaiz
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St, Room 555, Baltimore, MD, 21287, USA
| | - Catherine H Miele
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St, Room 555, Baltimore, MD, 21287, USA
| | - Miguel A Chavez
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St, Room 555, Baltimore, MD, 21287, USA
| | - Lawrence H Moulton
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.,Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Nicole Simmons
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | | | | | | | - Nazma Begum
- Johns Hopkins University -Bangladesh, Dhaka, Bangladesh
| | - Abdul Quaiyum
- Johns Hopkins University -Bangladesh, Dhaka, Bangladesh
| | - Mathuram Santosham
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Abdullah H Baqui
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
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5
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Contrepois K, Chen S, Ghaemi MS, Wong RJ, Jehan F, Sazawal S, Baqui AH, Nisar MI, Dhingra U, Khanam R, Ilyas M, Dutta A, Mehmood U, Deb S, Hotwani A, Ali SM, Rahman S, Nizar A, Ame SM, Muhammad S, Chauhan A, Khan W, Raqib R, Das S, Ahmed S, Hasan T, Khalid J, Juma MH, Chowdhury NH, Kabir F, Aftab F, Quaiyum MA, Manu A, Yoshida S, Bahl R, Rahman A, Pervin J, Price JT, Rahman M, Kasaro MP, Litch JA, Musonda P, Vwalika B, Stringer JSA, Shaw G, Stevenson DK, Aghaeepour N, Snyder MP. Prediction of gestational age using urinary metabolites in term and preterm pregnancies. Sci Rep 2022; 12:8033. [PMID: 35577875 PMCID: PMC9110694 DOI: 10.1038/s41598-022-11866-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
Assessment of gestational age (GA) is key to provide optimal care during pregnancy. However, its accurate determination remains challenging in low- and middle-income countries, where access to obstetric ultrasound is limited. Hence, there is an urgent need to develop clinical approaches that allow accurate and inexpensive estimations of GA. We investigated the ability of urinary metabolites to predict GA at time of collection in a diverse multi-site cohort of healthy and pathological pregnancies (n = 99) using a broad-spectrum liquid chromatography coupled with mass spectrometry (LC–MS) platform. Our approach detected a myriad of steroid hormones and their derivatives including estrogens, progesterones, corticosteroids, and androgens which were associated with pregnancy progression. We developed a restricted model that predicted GA with high accuracy using three metabolites (rho = 0.87, RMSE = 1.58 weeks) that was validated in an independent cohort (n = 20). The predictions were more robust in pregnancies that went to term in comparison to pregnancies that ended prematurely. Overall, we demonstrated the feasibility of implementing urine metabolomics analysis in large-scale multi-site studies and report a predictive model of GA with a potential clinical value.
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6
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McCollum ED, King C, Ahmed S, Hanif AAM, Roy AD, Islam AA, Colbourn T, Schuh HB, Ginsburg AS, Hooli S, Chowdhury NH, Rizvi SJR, Begum N, Baqui AH, Checkley W. Defining hypoxaemia from pulse oximeter measurements of oxygen saturation in well children at low altitude in Bangladesh: an observational study. BMJ Open Respir Res 2021; 8:8/1/e001023. [PMID: 34728475 PMCID: PMC8565559 DOI: 10.1136/bmjresp-2021-001023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/21/2021] [Indexed: 12/16/2022] Open
Abstract
Background WHO defines hypoxaemia, a low peripheral arterial oxyhaemoglobin saturation (SpO2), as <90%. Although hypoxaemia is an important risk factor for mortality of children with respiratory infections, the optimal SpO2 threshold for defining hypoxaemia is uncertain in low-income and middle-income countries (LMICs). We derived a SpO2 threshold for hypoxaemia from well children in Bangladesh residing at low altitude. Methods We prospectively enrolled well, children aged 3–35 months participating in a pneumococcal vaccine evaluation in Sylhet district, Bangladesh between June and August 2017. Trained health workers conducting community surveillance measured the SpO2 of children using a Masimo Rad-5 pulse oximeter with a wrap sensor. We used standard summary statistics to evaluate the SpO2 distribution, including whether the distribution differed by age or sex. We considered the 2.5th, 5th and 10th percentiles of SpO2 as possible lower thresholds for hypoxaemia. Results Our primary analytical sample included 1470 children (mean age 18.6±9.5 months). Median SpO2 was 98% (IQR 96%–99%), and the 2.5th, 5th and 10th percentile SpO2 was 91%, 92% and 94%. No child had a SpO2 <90%. Children 3–11 months had a lower median SpO2 (97%) than 12–23 months (98%) and 24–35 months (98%) (p=0.039). The SpO2 distribution did not differ by sex (p=0.959). Conclusion A SpO2 threshold for hypoxaemia derived from the 2.5th, 5th or 10th percentile of well children is higher than <90%. If a higher threshold than <90% is adopted into LMIC care algorithms then decision-making using SpO2 must also consider the child’s clinical status to minimise misclassification of well children as hypoxaemic. Younger children in lower altitude LMICs may require a different threshold for hypoxaemia than older children. Evaluating the mortality risk of sick children using higher SpO2 thresholds for hypoxaemia is a key next step.
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Affiliation(s)
- Eric D McCollum
- Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA .,Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Tim Colbourn
- Global Health Institute, University College London, London, UK
| | - Holly B Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amy Sarah Ginsburg
- Clinical Trial Center, University of Washington, Seattle, Washington, USA
| | - Shubhada Hooli
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Nazma Begum
- Projahnmo Research Foundation, Sylhet, Bangladesh
| | - Abdullah H Baqui
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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7
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Baqui AH, Koffi AK, McCollum ED, Roy AD, Chowdhury NH, Rafiqullah I, Ahmed ZB, Mahmud A, Begum N, Ahmed S, Khanam R, Harrison M, Simmons N, Hossen S, Islam M, Quaiyum A, Checkley W, Santosham M, Moulton LH, Saha SK. Impact of national introduction of ten-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in Bangladesh: Case-control and time-trend studies. Vaccine 2021; 39:5794-5801. [PMID: 34465471 DOI: 10.1016/j.vaccine.2021.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bangladesh introduced the ten-valent pneumococcal conjugate vaccine (PCV10) into its national immunization program in March 2015 creating an opportunity to assess the real-world impact of PCV on invasive pneumococcal disease (IPD). METHODS Between January 2014 and June 2018, children aged 3-35 months in three rural sub-districts of Sylhet district of Bangladesh were visited every two months to collect morbidity and care-seeking data. Children attending sub-district hospitals with pneumonia, meningitis, or sepsis were assessed for IPD after obtaining informed consent. Blood and cerebrospinal fluid were collected from enrolled children to isolate pneumococcus using culture and molecular test. Children who were age-eligible to receive the PCV and had pneumococcus isolated were enrolled as cases. Four age and sex-matched clinic and community controls were selected for each case within one to two weeks of case identification. Data on immunization status and confounders were collected. PCV coverage was estimated using vaccine coverage surveys. Case-control and incidence trend analyses were conducted to assess the impact of PCV on IPD. RESULTS The community cohort yielded 217,605 child years of observations and 154,773 sick child-visits to study hospitals. Pneumococcus was isolated from 44 children who were age-eligible to receive PCV; these children were enrolled as cases. The cases were matched with 166 community- and 150 clinic-controls. The matched case-control analyses using community-controls showed 83% effectiveness (95% CI: 1.57-97.1%) and clinic controls showed 90% effectiveness (95% CI: -26.0% to 99.1%) of PCV in preventing IPD. Incidence trend analysis estimated vaccine effectiveness at 80.1% (95% CI: 38.4, 93.6). CONCLUSION PCV in this pediatric population in Bangladesh was highly effective in preventing IPD.
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Affiliation(s)
- Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Eric D McCollum
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Global Program in Respiratory Sciences, Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | | | - Iftekhar Rafiqullah
- Department of Microbiology and Immunology, University of Mississippi Medical Center (UMMC), Jackson, MS, United States
| | | | - Arif Mahmud
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Nazma Begum
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | | | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Meagan Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Nicole Simmons
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Abdul Quaiyum
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - William Checkley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
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8
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Byeon SK, Khanam R, Rahman S, Hasan T, Rizvi SJR, Madugundu AK, Ramarajan MG, Jung JH, Chowdhury NH, Ahmed S, Raqib R, Kim KP, Piazza AL, Rinaldo P, Pandey A, Baqui AH, Amanhi Bio-Banking Study Group. Maternal serum lipidomics identifies lysophosphatidic acid as a predictor of small for gestational age neonates. Mol Omics 2021; 17:956-966. [PMID: 34519752 DOI: 10.1039/d1mo00131k] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To discover lipidomic alterations during pregnancy in mothers who subsequently delivered small for gestational age (SGA) neonates and identify predictive lipid markers that can help recognize and manage these mothers, we carried out untargeted lipidomics on maternal serum samples collected between 24-28 weeks of gestation. We used a nested case-control study design and serum from mothers who delivered SGA and appropriate for gestational age babies. We applied untargeted lipidomics using mass spectrometry to characterize lipids and discover changes associated with SGA births during pregnancy. Multivariate pattern recognition software Collaborative Laboratory Integrated Reports (CLIR) was used for the post-analytical recognition of range differences in lipid ratios that could differentiate between SGA and control mothers and their integration for complete separation between the two groups. Here, we report changes in lipids from serum collected during pregnancy in mothers who delivered SGA neonates. In contrast to normal pregnancies where lysophosphatidic acid increased over the course of the pregnancy owing to increased activity of lysophospholipase D, we observed a decrease (32%; P = 0.05) of 20:4-lysophosphatidic acid in SGA mothers, which could potentially compromise fetal growth and development. Integration of lipid ratios in an interpretive tool (CLIR) could completely separate SGA mothers from controls demonstrating the power of untargeted lipidomic analyses for identifying novel predictive biomarkers. Additional studies are required for further assessment of the lipid biomarkers identified in this report.
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Affiliation(s)
- Seul Kee Byeon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA. .,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | - Tarik Hasan
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | | | - Anil K Madugundu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA. .,Institute of Bioinformatics, International Technology Park, Bangalore 560006, India.,Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.,Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Madan Gopal Ramarajan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA. .,Institute of Bioinformatics, International Technology Park, Bangalore 560006, India.,Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Jae Hun Jung
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA. .,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Chemistry, Kyung Hee University, Yongin 17104, South Korea
| | | | | | - Rubhana Raqib
- Division of Infectious Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Kwang Pyo Kim
- Department of Chemistry, Kyung Hee University, Yongin 17104, South Korea
| | - Amy L Piazza
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Piero Rinaldo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Akhilesh Pandey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA. .,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Abdullah H Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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9
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McCollum ED, Ahmed S, Roy AD, Chowdhury NH, Schuh HB, Rizvi SJR, Hanif AAM, Khan AM, Mahmud A, Pervaiz F, Harrison M, Reller ME, Simmons N, Quaiyum A, Begum N, Santosham M, Checkley W, Moulton LH, Baqui AH. Effectiveness of the 10-valent pneumococcal conjugate vaccine against radiographic pneumonia among children in rural Bangladesh: A case-control study. Vaccine 2020; 38:6508-6516. [PMID: 32873404 PMCID: PMC7520553 DOI: 10.1016/j.vaccine.2020.08.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/05/2022]
Abstract
Background Pneumococcal conjugate vaccine (PCV) effectiveness against radiographic pneumonia in South Asia is unknown. Bangladesh introduced PCV10 in 2015 using a three dose primary series (3 + 0). We sought to measure PCV10 effectiveness for two or more vaccine doses on radiographic pneumonia among vaccine-eligible children in rural Bangladesh. Methods We conducted a matched case-control study over two years from 2015 to 2017 using clinic and community controls in three subdistricts of Sylhet, Bangladesh. Cases were vaccine eligible 3–35 month olds at Upazila Health Complex outpatient clinics with World Health Organization-defined radiographic primary endpoint pneumonia (radiographic pneumonia). Clinic controls were matched to cases within a one week time window by age, sex, and clinic and had an illness unlikely to be Streptococcus pneumoniae; community controls were healthy and similarly matched within a one week time window by age and sex, and distance from the clinic. We estimated adjusted vaccine effectiveness (aVE) using conditional logistic regression. Results We matched 1262 cases with 2707 clinic and 2461 community controls. Overall, aVE using clinic controls was 21.4% (95% confidence interval, −0.2%, 38.4%) for ≥2 PCV10 doses and among 3–11 month olds was 47.3% (10.5%, 69.0%) for three doses. aVE increased with higher numbers of doses in clinic control sets (p = 0.007). In contrast, aVE using community controls was 7.6% (95% confidence interval, −22.2%, 30.0%) for ≥2 doses. We found vaccine introduction in the study area faster and less variable than expected with 75% coverage on average, which reduced power. Information bias may also have affected community controls. Conclusions Clinic control analyses show PCV10 prevented radiographic pneumonia in Bangladesh, especially among younger children receiving three doses. While both analyses were underpowered, community control enrollment – compared to clinic controls – was more difficult in a complex, pluralistic healthcare system. Future studies in comparable settings may consider alternative study designs.
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Affiliation(s)
- Eric D McCollum
- Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, USA; Health Systems Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Arun D Roy
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | | | - Holly B Schuh
- Health Systems Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Syed J R Rizvi
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | - Abu A M Hanif
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | - Ahad M Khan
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | - Arif Mahmud
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | - Farhan Pervaiz
- Global Disease Epidemiology and Control Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Meagan Harrison
- Health Systems Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Megan E Reller
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Hubert-Yeargan Center for Global Health, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA
| | - Nicole Simmons
- Global Disease Epidemiology and Control Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Abdul Quaiyum
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nazma Begum
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | - Mathuram Santosham
- Health Systems Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Global Disease Epidemiology and Control Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence H Moulton
- Global Disease Epidemiology and Control Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Abdullah H Baqui
- Health Systems Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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10
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Pervaiz F, Hossen S, Chavez MA, Miele CH, Moulton LH, McCollum ED, Roy AD, Chowdhury NH, Ahmed S, Begum N, Quaiyum A, Santosham M, Baqui AH, Checkley W. Training and standardization of general practitioners in the use of lung ultrasound for the diagnosis of pediatric pneumonia. Pediatr Pulmonol 2019; 54:1753-1759. [PMID: 31432618 PMCID: PMC6899663 DOI: 10.1002/ppul.24477] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/20/2019] [Accepted: 07/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pneumonia is a leading cause of death in children of low-resource settings. Barriers to care include an early and accurate diagnosis. Lung ultrasound is a novel tool for the identification of pediatric pneumonia; however, there is currently no standardized approach to train in image acquisition and interpretation of findings in epidemiological studies. We developed a training program for physicians with limited ultrasound experience on how to use ultrasound for the diagnosis of pediatric pneumonia and how to standardize image interpretation using a panel of readers. METHODS Twenty-five physicians participating in the training program conducted lung ultrasounds in all children with suspected pneumonia, aged 3 to 35 months, presenting to three subdistrict hospitals in Sylhet, Bangladesh, between June 2015 and September 2017. RESULTS A total of 9051 pediatric lung ultrasound assessments were conducted through 27 months of data collection. Study physicians underwent training and all were successfully standardized, achieving 91% agreement and maintained a sensitivity and specificity of 88% and 92%, respectively, when their diagnosis was compared with experts. Overall kappa between two readers was high (0.86, 95% confidence interval [CI], 0.84-0.87), and remained high when a third expert reader was included (0.80, 95% CI, 0.79-0.81). Agreement and kappa statistics were similarly high when stratified by age, sex, presence of danger signs, or hypoxemia. CONCLUSIONS Lung ultrasound is a novel tool for the diagnosis of pediatric pneumonia with evidence supporting its validity and feasibility of implementation. Here we introduced a training program that resulted in a high level of inter-sonographer agreement.
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Affiliation(s)
- Farhan Pervaiz
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Miguel A. Chavez
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Catherine H. Miele
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence H. Moulton
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Eric D. McCollum
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Eudowood Division of Pediatric Respiratory Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Arun D. Roy
- Johns Hopkins University‐Bangladesh, Dhaka, Bangladesh
| | | | | | - Nazma Begum
- Johns Hopkins University‐Bangladesh, Dhaka, Bangladesh
| | - Abdul Quaiyum
- Reproductive Health Unit, icddr,b, Dhaka, Bangladesh
| | - Mathuram Santosham
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Abdullah H. Baqui
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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11
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McCollum ED, Ahmed S, Chowdhury NH, Rizvi SJR, Khan AM, Roy AD, Hanif AA, Pervaiz F, Ahmed ANU, Farrukee EH, Monowara M, Hossain MM, Doza F, Tanim B, Alam F, Simmons N, Reller ME, Harrison M, Schuh HB, Quaiyum A, Saha SK, Begum N, Santosham M, Moulton LH, Checkley W, Baqui AH. Chest radiograph reading panel performance in a Bangladesh pneumococcal vaccine effectiveness study. BMJ Open Respir Res 2019; 6:e000393. [PMID: 31179000 PMCID: PMC6530497 DOI: 10.1136/bmjresp-2018-000393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/13/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction To evaluate WHO chest radiograph interpretation processes during a pneumococcal vaccine effectiveness study of children aged 3–35 months with suspected pneumonia in Sylhet, Bangladesh. Methods Eight physicians masked to all data were standardised to WHO methodology and interpreted chest radiographs between 2015 and 2017. Each radiograph was randomly assigned to two primary readers. If the primary readers were discordant for image interpretability or the presence or absence of primary endpoint pneumonia (PEP), then another randomly selected, masked reader adjudicated the image (arbitrator). If the arbitrator disagreed with both primary readers, or concluded no PEP, then a masked expert reader finalised the interpretation. The expert reader also conducted blinded quality control (QC) for 20% of randomly selected images. We evaluated agreement between primary readers and between the expert QC reading and the final panel interpretation using per cent agreement, unadjusted Cohen’s kappa, and a prevalence and bias-adjusted kappa. Results Among 9723 images, the panel classified 21.3% as PEP, 77.6% no PEP and 1.1% uninterpretable. Two primary readers agreed on interpretability for 98% of images (kappa, 0.25; prevalence and bias-adjusted kappa, 0.97). Among interpretable radiographs, primary readers agreed on the presence or absence of PEP in 79% of images (kappa, 0.35; adjusted kappa, 0.57). Expert QC readings agreed with final panel conclusions on the presence or absence of PEP for 92.9% of 1652 interpretable images (kappa, 0.75; adjusted kappa, 0.85). Conclusion Primary reader performance and QC results suggest the panel effectively applied the WHO chest radiograph criteria for pneumonia.
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Affiliation(s)
- Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Global Program in Respiratory Sciences, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA.,Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | | | | | - Syed J R Rizvi
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | - Ahad M Khan
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | - Arun D Roy
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | - Abu Am Hanif
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | - Farhan Pervaiz
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Asm Nawshad U Ahmed
- Department of Pediatrics, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Child Health Research Foundation, Dhaka, Bangladesh
| | | | - Mahmuda Monowara
- Department of Radiology and Imaging, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Mohammad M Hossain
- Department of Radiology and Imaging, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Fatema Doza
- Department of Radiology and Imaging, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - Bidoura Tanim
- Department of Radiology and Imaging, National Institute of Ophthalmology, Dhaka, Bangladesh
| | - Farzana Alam
- Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Nicole Simmons
- Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Megan E Reller
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Hubert-Yeargan Center for Global Health, Durham, North Carolina, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Meagan Harrison
- Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Holly B Schuh
- Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Abdul Quaiyum
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Nazma Begum
- Johns Hopkins University - Bangladesh, Dhaka, Bangladesh
| | - Mathuram Santosham
- Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Lawrence H Moulton
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - William Checkley
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abdullah H Baqui
- Health Systems, Department of International Health, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
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12
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Das S, Khan RK, Alam SM, Chowdhury NH, Das P. Study on Electrophysiological Findings of Guillain Barre Syndrome Patients Attending the Department of Neurology in BSMMU. Mymensingh Med J 2018; 27:631-640. [PMID: 30141456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Incidence and predominant subtype of Guillain Barre Syndrome (GBS) differ geographically. Electrophysiology has an important role in the early diagnosis and prediction of the prognosis. This study conducted to determine the predominant subtype of Guillain Barre Syndrome in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh and to compare the nerve conduction study finding between the axonal and demyelinating form of GBS. To analyze the nerve conduction study findings of Guillain Barre Syndrome patients attending the department of Neurology in BSMMU. This observational, descriptive and cross sectional study was carried out in the department of Neurology, BSMMU, Dhaka from July 2014 to June 2016. Considering the inclusion and exclusion criteria, 50 patients recruited as the study population. Then after performing the nerve conduction study, patients classified into three groups: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor and sensory axonal neuropathy (AMSAN). Among the 50 patients that are finally included in the study; about 50%, 42%, 8% had the AIDP, AMAN and AMSAN variety of GBS respectively. Out of all patients, 64% were male and 34% were female. GBS was seen in a wide range of age (18-75 years). In AIDP, maximum clustering of the cases was seen in the elderly population and in the AMAN it was seen in the younger age group. Cerebrospinal fluid (CSF) analysis did not show any significant difference between the AIDP and AMAN variant of GBS. Distal latency prolonged in at least one nerve in all patients with AIDP. In axonal form of GBS (AMAN and AMSAN), the compound muscle action potential (CMAP) amplitude was 80% of the lower limit of the normal in at least two motor nerves. Prolonged F wave latency by >80% of the upper limit of the normal was seen in 40% of the AIDP patients. According to the nerve conduction study, finding- acute inflammatory demyelinating polyneuropathy (AIDP) is the predominant subtype. Although the electrophysiology and the CSF analysis are the important tools for the diagnosis of GBS, classification should not be making based on a distinct finding alone. If all the NCS parameters in multiple nerves tested after one week and within four weeks of onset of symptoms, definite diagnosis is possible in almost all the patients of Guillain Barre Syndrome.
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Affiliation(s)
- S Das
- Dr Saumitra Das, Biochemist, Department of Biochemistry, Comilla Medical College, Comilla, Bangladesh; E-mail:
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13
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Baqui AH, McCollum ED, Saha SK, Roy AK, Chowdhury NH, Harrison M, Hanif AAM, Simmons N, Mahmud A, Begum N, Ahmed S, Khan AM, Ahmed ZB, Islam M, Mitra D, Quaiyum A, Chavez MA, Pervaiz F, Miele CH, Schuh HB, Khanam R, Checkley W, Moulton LH, Santosham M. Pneumococcal Conjugate Vaccine impact assessment in Bangladesh. Gates Open Res 2018; 2:21. [PMID: 29984359 PMCID: PMC6030398 DOI: 10.12688/gatesopenres.12805.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 12/28/2022] Open
Abstract
The study examines the impact of the introduction of 10-valent Pneumococcal Conjugate Vaccine (PCV10) into Bangladesh’s national vaccine program. PCV10 is administered to children under 1 year-old; the scheduled ages of administration are at 6, 10, and 18 weeks. The study is conducted in ~770,000 population containing ~90,000 <5 children in Sylhet, Bangladesh and has five objectives: 1) To collect data on community-based pre-PCV incidence rates of invasive pneumococcal diseases (IPD) in 0-59 month-old children in Sylhet, Bangladesh; 2) To evaluate the effectiveness of PCV10 introduction on Vaccine Type (VT) IPD in 3-59 month-old children using an incident case-control study design. Secondary aims include measuring the effects of PCV10 introduction on all IPD in 3-59 month-old children using case-control study design, and quantifying the emergence of Non Vaccine Type IPD; 3) To evaluate the effectiveness of PCV10 introduction on chest radiograph-confirmed pneumonia in children 3-35 months old using incident case-control study design. We will estimate the incidence trend of clinical and radiologically-confirmed pneumonia in 3-35 month-old children in the study area before and after introduction of PCV10; 4) To determine the feasibility and utility of lung ultrasound for the diagnosis of pediatric pneumonia in a large sample of children in a resource-limited setting. We will also evaluate the effectiveness of PCV10 introduction on ultrasound-confirmed pneumonia in 3-35 month-old children using an incident case-control design and to examine the incidence trend of ultrasound-confirmed pneumonia in 3-35 month-old children in the study area before and after PCV10 introduction; and 5) To determine the direct and indirect effects of vaccination status on nasopharyngeal colonization on VT pneumococci among children with pneumonia
. This paper presents the methodology. The study will allow us to conduct a comprehensive and robust assessment of the impact of national introduction of PCV10 on pneumococcal disease in Bangladesh.
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Affiliation(s)
- Abdullah H Baqui
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Eric D McCollum
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.,Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Arun K Roy
- Johns Hopkins University, Bangladesh, Dhaka, Bangladesh
| | | | - Meagan Harrison
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | | | - Nicole Simmons
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Arif Mahmud
- Johns Hopkins University, Bangladesh, Dhaka, Bangladesh
| | - Nazma Begum
- Johns Hopkins University, Bangladesh, Dhaka, Bangladesh
| | | | - Ahad M Khan
- Johns Hopkins University, Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Abdul Quaiyum
- International Centre For Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Miguel A Chavez
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Farhan Pervaiz
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Catherine H Miele
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Holly B Schuh
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Rasheda Khanam
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - William Checkley
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Lawrence H Moulton
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Mathuram Santosham
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
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14
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Amin MR, Mamun SMH, Chowdhury NH, Rahman M, Ghose A, Al Hasan A, Faiz MA. Consecutive bites on two persons by the same cobra: a case report. J Venom Anim Toxins Incl Trop Dis 2008. [DOI: 10.1590/s1678-91992008000400014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Abstract
Over a period of 28 months, 45 episodes of septic shock from 83 episodes of bacteraemia were studied prospectively to evaluate their clinical profile, management and outcome. Thirty-six patients were studied, the overall incidence of septic shock being 54.2%. Gram-negative organisms accounted for 23 (51.1%) of such episodes, Gram-positive 17 (37.8%), and three episodes were polymicrobial (6.7%). The organisms isolated most frequently were Staphylococcus epidermidis (17.8%), Pseudomonas aeruginosa (13.3%), Escherichia coli and Klebsiella sp. (each 11.1%). Coagulation abnormalities were detected in 32 episodes (78%) and disseminated intravascular coagulation (DIC) occurred in 11 of these with high mortality. The most common underlying conditions were respiratory, hepatic and renal failures. The majority of these patients received crystalloids, colloids, vasopressor drugs and blood. Swan-Ganz catheters (SGC) were inserted on eight occasions, the majority of times indicating a hyperdynamic circulatory response. The overall mortality was 40%, despite aggressive management and intensive care. The most important factor in reducing mortality is early detection of bacteraemia and prompt management of these patients.
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Affiliation(s)
- N S Dahmash
- Department of Pulmonary Critical Care Medicine, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
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16
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Chowdhury NH. Cytohormonal and cytochemical studies in obstetrics. J Indian Med Assoc 1976; 67:186-7. [PMID: 1022818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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