Predicting vaccine effectiveness for mpox

The Modified Vaccinia Ankara vaccine developed by Bavarian Nordic (MVA-BN) was widely deployed to prevent mpox during the 2022 global outbreak. This vaccine was initially approved for mpox based on its reported immunogenicity (from phase I/II trials) and effectiveness in animal models, rather than evidence of clinical efficacy. However, no validated correlate of protection after vaccination has been identified. Here we performed a systematic search and meta-analysis of the available data to test whether vaccinia-binding ELISA endpoint titer is predictive of vaccine effectiveness against mpox. We observe a significant correlation between vaccine effectiveness and vaccinia-binding antibody titers, consistent with the existing assumption that antibody levels may be a correlate of protection. Combining this data with analysis of antibody kinetics after vaccination, we predict the durability of protection after vaccination and the impact of dose spacing. We find that delaying the second dose of MVA-BN vaccination will provide more durable protection and may be optimal in an outbreak with limited vaccine stock. Although further work is required to validate this correlate, this study provides a quantitative evidence-based approach for using antibody measurements to predict the effectiveness of mpox vaccination.

Viral clearance as a surrogate of clinical efficacy for COVID-19 therapies in outpatients: a systematic review and meta-analysis

BACKGROUND

Surrogates of antiviral efficacy are needed for COVID-19. We aimed to investigate the relationship between the virological effect of treatment and clinical efficacy as measured by progression to severe disease in outpatients treated for mild-to-moderate COVID-19.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Scopus, and medRxiv from database inception to Aug 16, 2023, for randomised placebo-controlled trials that tested virus-directed treatments (ie, any monoclonal antibodies, convalescent plasma, or antivirals) in non-hospitalised individuals with COVID-19. We only included studies that reported both clinical outcomes (ie, rate of disease progression to hospitalisation or death) and virological outcomes (ie, viral load within the first 7 days of treatment). We extracted summary data from eligible reports, with discrepancies resolved through discussion. We used an established meta-regression model with random effects to assess the association between clinical efficacy and virological treatment effect, and calculated I2 to quantify residual study heterogeneity.

FINDINGS

We identified 1718 unique studies, of which 22 (with a total of 16 684 participants) met the inclusion criteria, and were in primarily unvaccinated individuals. Risk of bias was assessed as low in 19 of 22 studies for clinical outcomes, whereas for virological outcomes, a high risk of bias was assessed in 11 studies, some risk in ten studies, and a low risk in one study. The unadjusted relative risk of disease progression for each extra log10 copies per mL reduction in viral load in treated compared with placebo groups was 0·12 (95% CI 0·04-0·34; p<0·0001) on day 3, 0·20 (0·08-0·50; p=0·0006) on day 5, and 0·53 (0·30-0·94; p=0·030) on day 7. The residual heterogeneity in our meta-regression was estimated as low (I2=0% [0-53] on day 3, 0% [0-71] on day 5, and 0% [0-43] on day 7).

INTERPRETATION

Despite the aggregation of studies with differing designs, and evidence of risk of bias in some virological outcomes, this review provides evidence that treatment-induced acceleration of viral clearance within the first 5 days after treatment is a potential surrogate of clinical efficacy to prevent hospitalisation with COVID-19. This work supports the use of viral clearance as an early phase clinical trial endpoint of therapeutic efficacy.

FUNDING

Australian Government Department of Health, Medical Research Future Fund, and Australian National Health and Medical Research Council.

Evaluation of Intradialytic Complications and Protein Catabolic Rate on Maintenance Hemodialysis Patients in Bangladesh

Among patients with chronic kidney disease stage-5 who are treated with dialysis, intradialytic complications commonly occur during routine hemodialysis (HD). It could be either patient related or mechanical. Protein catabolic rate during hemodialysis is a determinant of the mortality. nPCR was aimed to targets according to International guideline. This observational study was conducted in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from January 2020 to December 2020 to compare two groups of nPCR and different value of biochemical parameters. This study was involving all patients and inclusion criteria were patients who underwent routine HD for at least three months. All patients under-went conventional intermittent HD with low-flux dialyser. A total of 179 patients enrolled. Serum albumin, serum calcium, phosphate, hemoglobin and pre-dialysis urea, post dialysis urea were measured from blood sample. The nPCR was calculated by the standard international equation. nPCR value of 14.0% patients was more than 1.0 gm/kg/day and average nPCR (mean±SD) of all patients was 0.903±0.09gm/kg/day and 86.0% patients nPCR was less than 1.0 gm/kg/day. Biochemical parameters were not significantly differing between two groups. The nPCR is an indicator, can help the determination of nutritional status. This study aimed to find out the intradialytic complications, mean value of nPCR and correlation of biochemical parameters among ESRD patients on maintenance hemodialysis.

Status of Serum Magnesium, Serum Zinc and C-reactive Protein in Hospitalized Patients with Chronic Kidney Disease in Mymensingh Locality

Chronic Kidney Disease (CKD) is an important public health issue, with a leading cause of death and disability around the world. This cross-sectional study was conducted from January 2021 to December 2021 in the department of Biochemistry in Mymensingh Medical College in cooperation with the Department of Nephrology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The study was carried out to evaluate the status of serum magnesium, zinc and CRP in patients with CKD not on dialysis for monitoring the disease progression. For this purpose, 110 subjects were included, where 55 Hospitalized CKD patients were considered as Group I and 55 normal healthy individuals as Group II. Study subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. Serum magnesium and zinc were determined by colorimetric method while CRP was measured by CRP-Latex Test (Slide Agglutination Test) from each sample. SPSS windows package, version 21.0 was used to perform the statistical analysis. Statistical significance of difference between Group I and Group II were evaluated by using student's unpaired 't'-test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. Mean age of Group I was 52.65±4.93 and Group II was 51.15±6.32 years. P-value was 0.165 which is statistically insignificant. The mean ±SD of BMI was 24.46±1.84 Kg/m² for Group I and 24.50±1.05 Kg/m² for Group II. P-value was 0.886 which is statistically insignificant. Among the study groups the mean serum magnesium were 2.25±0.17 and 1.95±0.05mg/dl, zinc were 88.64±9.21 and 102.11±12.93μg/dl, CRP were 24.00±16.73 and <6.0±0.00mg/L in Group I and Group II respectively. Analysis showed that, the mean serum magnesium and CRP were significantly increased while serum zinc was significantly decreased in CKD patients in comparison to that of healthy individual. There was negative correlation between serum zinc and CRP. This study was done within the context of the facilities available to us.

Risk Factors of Patients with Postpartum Acute Kidney Injury: An Observational Study

Postpartum acute kidney injury (AKI) is a condition characterized by a sudden and rapid decline in kidney function that occurs shortly after childbirth. Several risk factors may be associated with postpartum acute kidney injury (AKI). Understanding the possible risk factors is essential for timely intervention and improved maternal healthcare. The aim of the study was to assess the risk factors of postpartum acute kidney injury patients. This prospective observational study took place at Mymensingh Medical College Hospital, from March 2020 to April 2021. It was carried out in the Departments of Nephrology and Departments of Obstetrics & Gynecology, where 153 postpartum acute kidney injury (AKI) patients were enrolled through purposive sampling. The study collected data on patient demographics, etiology and presentation. Statistical analysis was conducted using SPSS (Statistical Package for the Social Sciences) version 26.0, with a significance threshold set at p<0.05 for all tests. Among participants, puerperal sepsis (77.8%) and toxemia of pregnancy (58.8%) were prevalent risk factors. Intrauterine death was rare (1.3%). Other risk factors such as postpartum hemorrhage 22.2%, HELLP syndrome 11.1%, and antepartum hemorrhage 15.0% were found. A statistically significant difference in postpartum hemorrhage prevalence (p=0.038) was noted between hemodialysis and non-hemodialysis patients. Puerperal sepsis is the most common risk factor for postpartum acute kidney injury, closely followed by toxemia of pregnancy. Intrauterine death is rare, while postpartum hemorrhage significantly affects subjects, with variations noted between hemodialysis and non-hemodialysis patients.

Status of C-reactive protein, Serum Albumin and Serum Zinc in Hospital Admitted Patients with Chronic Kidney Disease

Chronic Kidney Disease (CKD) is one of the most concerned non-communicable diseases now a day. Multiple complications arise and different biochemical parameters change in this disease. This cross-sectional study was conducted from January to December, 2021 in the Department of Biochemistry, Mymensingh Medical College with the help of the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh. The motive of this study was to explore the status of C-reactive protein (CRP), serum albumin and serum zinc in patients with CKD for monitoring the disease progression. In this study, 110 subjects were included, where 55 Hospital admitted CKD patients act as Group I and 55 normal healthy individuals act as Group II. The subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. In this study, CRP levels, serum albumin and serum zinc were measured. All values were expressed as Mean±SD. All statistical analysis was done by using SPSS (statistical package for social science) windows package version 21.0. Statistical significance of difference between Group I and Group II were evaluated by using Student's unpaired 't'-test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. Mean age of Group I was 52.65±4.93 and Group II was 51.15±6.32. P value was 0.165 which is statistically insignificant. The mean±SD of BMI was 24.46±1.84 for Group I and 24.50±1.05 for Group II. P value was 0.886 which is statistically insignificant. The mean±SD values of CRP were 24.00±16.73mg/L and <6.0±0.00mg/L in Group I and Group II respectively. So, we found significant (p<0.05) increase in CRP levels. The mean±SD values of serum albumin were 3.62±0.26g/dl and 4.16±0.69g/dl in Group I and Group II respectively. We found highly significant (p<0.001) decrease in serum albumin. Among the study groups the mean serum zinc was 88.64±9.21μg/dl and 102.11±12.93μg/dl in Group I and Group II respectively. The mean serum zinc was highly significantly (<0.001) decreased. There was negative correlation between CRP and serum albumin, CRP and serum zinc. There was positive correlation between serum albumin and serum zinc. Analyzing the findings of present study, significant increase in CRP levels, significant decrease in serum albumin and serum zinc were observed in CKD patients.

Assessment of Dialysis Adequacy Using Small Solute Clearance Indices among Twice versus Thrice Weekly Maintenance Hemodialysis Patients in a Tertiary Care Hospital of Bangladesh

This observational study was carried out in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from January 2020 to December 2020. A total of 179 patients were included in this study according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients were underwent detail history taking, thorough physical examination and relevant investigations. Data collection was conducted through a structured questionnaire. Collected data were analyzed using the statistical software SPSS 23.0. Mean age ±SD of the study patients was 47.06±14.1 with a majority in age group 41-50 years. Male predominance was observed with a male: female ratio of 2.19:1 and 68.7% male patients. Level of pre-dialysis, post-dialysis urea in the study population was 123.77±26.86mg/dl, 50.27±15.70mg/dl respectively and mean ±SD of Urea Reduction Ratio (URR) in hemodialysis (target >65.0%) was 67.2±1.9. Most of the 8 hours (two times) per week hemolysis patients could not achieve the target value of dialysis adequacy parameters. On the other hand, maximum people in 12 hours (three times) per week hemodialysis group achieved the target value of dialysis adequacy parameters. It is important to calculate Kt/V or URR and individualize the dialysis doses for each patient.

Exploration of Toxic and Essential Metals in Popular Rice Grains of Bangladesh and Associated Human Health Risk Implications

In order to evaluate the benefits as well as the impacts of essential and toxic metals regarding human health, the six common rice grains (katarivhog, bashful, banglamoti, najirshail, branded miniket and loose miniket) were collected from four wholesale markets in Dhaka, the capital of Bangladesh, and were analyzed with different atomic absorption spectroscopy (AAS) techniques. The mean concentrations of the toxic metals Pb, Cd, Cr, and As had 0.299 ± 0.017, 0.157 ± 0.012, 1.33 ± 0.084, and 0.120 ± 0.006 mg/kg, respectively, while those of the essential metals Fe, Cu, Zn, Na, Ca, and Mg had 7.90 ± 0.447, 3.11 ± 0.097, 10.6 ± 0.340, 37.4 ± 0.622, 90.1 ± 7.70, and 115.8 ± 1.61 mg/kg, respectively. Among them, the mean concentrations of toxic metals (Pb, Cd, Cr, and As) exceeded the maximum allowable concentration in rice set by the Codex Alimentarius Commission (CAC). Risk assessment of the heavy metals Pb, Cd, Cr, As, Fe, Cu, and Zn showed that their estimated daily intakes were below the daily reference doses for adults. However, Cd and Cr individually were found to have the target hazard quotient value close to 1 (threshold limit), indicating that they alone are capable of potential health hazards from continuous rice consumption, while the hazard index has surpassed three units signifying greater danger associated with the current trend of consumption. A very high chance of developing cancer in the near future is predicted by incremental lifetime carcinogenic risk (ILCR) analysis for continued intake of Cr (ILCR > 1E-03), and a moderate to high risk is predicted for other carcinogenic substances (Pb, Cd, and As) (ILCR in between 1E-03 and 1E-05) with present rice consumption. The contribution of the essential metals to the RNI revealed that Cu from rice contributes more than 100% in most samples, and the overall contribution is in the following order: Cu > Zn > Fe > Mg > Ca > Na. To ensure the safety of staple foods for human health, it ought to be necessary to design a plan to measure the budget of hazardous metals from all sources with proper surveillance by relevant authorities.

Determinants of passive antibody efficacy in SARS-CoV-2 infection: a systematic review and meta-analysis

BACKGROUND

Randomised controlled trials of passive antibodies as treatment and prophylaxis for COVID-19 have reported variable efficacy. However, the determinants of efficacy have not been identified. We aimed to assess how the dose and timing of administration affect treatment outcome.

METHODS

In this systematic review and meta-analysis, we extracted data from published studies of passive antibody treatment from Jan 1, 2019, to Jan 31, 2023, that were identified by searching multiple databases, including MEDLINE, PubMed, and ClinicalTrials.gov. We included only randomised controlled trials of passive antibody administration for the prevention or treatment of COVID-19. To compare administered antibody dose between different treatments, we used data on in-vitro neutralisation titres to normalise dose by antibody potency. We used mixed-effects regression and model fitting to analyse the relationship between timing, dose and efficacy.

FINDINGS

We found 58 randomised controlled trials that investigated passive antibody therapies for the treatment or prevention of COVID-19. Earlier clinical stage at treatment initiation was highly predictive of the efficacy of both monoclonal antibodies (p<0·0001) and convalescent plasma therapy (p=0·030) in preventing progression to subsequent stages, with either prophylaxis or treatment in outpatients showing the greatest effects. For the treatment of outpatients with COVID-19, we found a significant association between the dose administered and efficacy in preventing hospitalisation (relative risk 0·77; p<0·0001). Using this relationship, we predicted that no approved monoclonal antibody was expected to provide more than 30% efficacy against some omicron (B.1.1.529) subvariants, such as BQ.1.1.

INTERPRETATION

Early administration before hospitalisation and sufficient doses of passive antibody therapy are crucial to achieving high efficacy in preventing clinical progression. The relationship between dose and efficacy provides a framework for the rational assessment of future passive antibody prophylaxis and treatment strategies for COVID-19.

FUNDING

The Australian Government Department of Health, Medical Research Future Fund, National Health and Medical Research Council, the University of New South Wales, Monash University, Haematology Society of Australia and New Zealand, Leukaemia Foundation, and the Victorian Government.

Status of Serum Zinc and Albumin in Hospital Admitted Chronic Kidney Disease Patients in Mymensingh Locality

This cross-sectional study was conducted in the department of Biochemistry in Mymensingh Medical College in cooperation with Nephrology department of Mymensingh Medical College Hospital, Bangladesh from January to December, 2021. The study was carried out to evaluate the status of serum zinc and albumin in patients with CKD not on dialysis for monitoring the disease progression. For this purpose, 110 subjects were included, where 55 Hospital admitted CKD patients were considered as Group I and 55 normal healthy individuals as Group II. Serum zinc and albumin were determined by colorimetric method from each sample. Statistical analysis was performed by SPSS windows package, version 21.0. Among the study groups the mean serum zinc were 88.64±9.21μg/dl and 102.11±12.93μg/dl and serum albumin were 3.62±0.26g/dl and 4.16±0.69g/dl in Group I and Group II respectively. Analysis showed that the mean serum zinc and albumin were highly significantly (p<0.001) decreased in CKD patients in comparison to that of healthy individual. Significant positive correlation was found between serum zinc and albumin.

Different types of screen time are associated with low life satisfaction in adolescents across 37 European and North American countries

AIMS

Prolonged screen time (ST) is a potential concern for poor wellbeing. This study aimed to examine the associations of different types of ST with life satisfaction among adolescents.

METHODS

Data were from 380,446 adolescents (aged 11-15 years, 51% girls) across 37 European and North American countries who completed the 2010 and 2014 Health Behaviour in School-Aged Children surveys. Participants reported h/day during free time spent on television, electronic games, and computer/other devices. Life satisfaction was assessed using a 10-point scale (low life satisfaction ⩽5).

RESULTS

Generalized additive modelling showed non-linear associations for each ST type, with low life satisfaction increasing monotonically for >1 h/day of electronic gaming or computer/other device and >2 h/day of watching television. Multilevel multivariable modelling showed that >4 h/day of watching television was associated with 26% higher odds for boys (OR 1.26; 95% CI:1.21-1.32) and 52% higher odds for girls (1.52; 1.46-1.59) of low life satisfaction than for ⩽1 h/day of television. Electronic gaming >4 h/day was associated with low life satisfaction with odds 42% higher in boys (1.42, 1.36-1.48) and 69% higher in girls (1.69, 1.61-1.76). A similar association was found for >4 h/day of computer/other device for boys (1.43, 1.37-1.49) and girls (1.71, 1.65-1.77).

CONCLUSIONS

Low levels of ST may be beneficial; however, prolonged periods are associated with low life satisfaction among adolescents, in particular among girls. Results support ⩽2 h/day restriction of ST and highlight research is needed to understand underlying mechanisms of ST and wellbeing, which may not reflect active versus passive content.

Monoclonal antibody levels and protection from COVID-19

Multiple monoclonal antibodies have been shown to be effective for both prophylaxis and therapy for SARS-CoV-2 infection. Here we aggregate data from randomized controlled trials assessing the use of monoclonal antibodies (mAb) in preventing symptomatic SARS-CoV-2 infection. We use data on the in vivo concentration of mAb and the associated protection from COVID-19 over time to model the dose-response relationship of mAb for prophylaxis. We estimate that 50% protection from COVID-19 is achieved with a mAb concentration of 96-fold of the in vitro IC50 (95% CI: 32-285). This relationship provides a tool for predicting the prophylactic efficacy of new mAb and against SARS-CoV-2 variants. Finally, we compare the relationship between neutralization titer and protection from COVID-19 after either mAb treatment or vaccination. We find no significant difference between the 50% protective titer for mAb and vaccination, although sample sizes limited the power to detect a difference.

Status of Serum Calcium and Magnesium in Hospital Admitted Chronic Kidney Disease Patients in Mymensingh Locality of Bangladesh

The study was designed to evaluate the serum calcium and magnesium levels in hospitalized patients with Chronic Kidney Disease (CKD). This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College (MMC), Bangladesh with the help of the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from the period of January 2021 to December 2021. The subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. A total of 110 subjects were included in this study. Among them, 55 were diagnosed CKD patients denoted as Group I and 55 were normal healthy individuals denoted as Group II. The subjects were briefed and written consents were taken. Under aseptic precaution 5.0ml of venous blood was collected from median cubital vein. Analyses were carried out in the Department of Biochemistry, Mymensingh Medical College and serum calcium and magnesium levels were measured. All values were expressed as Mean±SD. All statistical analysis was done by using SPSS (statistical package for social science) windows package version 21.0. Statistical significance of difference between Group I and Group II were evaluated by using Student's unpaired 't' test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. The mean±SD values of serum calcium were 8.15±0.54mg/dl and 9.80±0.50mg/dl and serum magnesium were 2.25±0.17mg/dl and 1.95±0.50mg/dl in Group I and Group II respectively. We found mean serum calcium was highly significantly (<0.001) decreased and serum magnesium was highly significantly increased (<0.001) in CKD patients in comparison to that of healthy individual.

Serum Albumin and C-reactive protein in Hospital Admitted Patients with Chronic Kidney Disease

Adequate knowledge about the causes of chronic kidney disease and their potential prevention can improve poor clinical outcome in chronic kidney disease (CKD) patients. The study was designed to evaluate the serum albumin and C-reactive protein (CRP) levels in hospitalized patients with Chronic Kidney Disease. This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Mymensingh, Bangladesh with the collaboration of the Department of Nephrology, Mymensingh Medical College Hospital, Mymensingh, from January 2021 to December 2021. The subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. A total of 110 subjects were included in this study. Among them, 55 were diagnosed CKD patients denoted as Group I and 55 were normal healthy individuals denoted as Group II. In this study, serum albumin and CRP levels were measured. All values were expressed as Mean±SD. All statistical analysis was done by using SPSS (statistical package for social science) windows package version 21.0. Statistical significance of difference between Group I and Group II were evaluated by using student's unpaired 't'-test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. Mean age of Group I was 52.65±4.93 and Group II was 51.15±6.32 (p=0.165). The mean±SD of BMI was 24.46±1.84 for Group I and 24.50±1.05 for Group II (p=0.886). The mean±SD values of serum albumin were 3.62±0.26g/dl and 4.16±0.69g/dl in Group I and Group II respectively. We found highly significant (p<0.001) decrease in serum albumin. The mean±SD values of CRP were 24.00±16.73mg/L and <6.0±0.00mg/L in Group I and Group II respectively. So, we found significant (p<0.05) increase in CRP levels. There was negative correlation between serum albumin and CRP. Analyzing the findings of this study, significant decrease in serum albumin and significant increase in CRP levels were observed in CKD patients.

Predicting vaccine effectiveness against severe COVID-19 over time and against variants: a meta-analysis

Vaccine protection from symptomatic SARS-CoV-2 infection has been shown to be strongly correlated with neutralising antibody titres; however, this has not yet been demonstrated for severe COVID-19. To explore whether this relationship also holds for severe COVID-19, we performed a systematic search for studies reporting on protection against different SARS-CoV-2 clinical endpoints and extracted data from 15 studies. Since matched neutralising antibody titres were not available, we used the vaccine regimen, time since vaccination and variant of concern to predict corresponding neutralising antibody titres. We then compared the observed vaccine effectiveness reported in these studies to the protection predicted by a previously published model of the relationship between neutralising antibody titre and vaccine effectiveness against severe COVID-19. We find that predicted neutralising antibody titres are strongly correlated with observed vaccine effectiveness against symptomatic (Spearman [Formula: see text] = 0.95, p < 0.001) and severe (Spearman [Formula: see text] = 0.72, p < 0.001 for both) COVID-19 and that the loss of neutralising antibodies over time and to new variants are strongly predictive of observed vaccine protection against severe COVID-19.

Hemithyroidectomy in the Treatment of Papillary Thyroid Carcinoma: A Prospective Study of 300 Patients

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.

Association between Lifestyle Behaviours and Mental Health of Adolescents: Evidence from the Canadian HBSC Surveys, 2002-2014

Physical activity (PA) and screen time (ST) are associated with mental health in adolescents, though little is known about their inter-relationships. This study examined the associations of PA and ST with psychosomatic complaints in adolescents. Data from four cycles of the Canadian Health Behaviour in School-aged Children (HBSC) surveys, collected between 2002 and 2014, were analysed. Eight psychosomatic health complaints were assessed and dichotomised as frequent (≥2 complaints/week) vs. infrequent. PA was assessed by number of days/week participants were physically active for ≥60 min. Discretionary ST was assessed by adding three screen uses: television, electronic games, and computer. Of the 37,829 adolescents (age 13.74 (SD 1.51) years; 52% girls), 25% boys and 39% girls reported frequent psychosomatic complaints. Multilevel logistic analyses showed that ST levels were positively associated while PA levels were negatively associated with reporting frequent psychosomatic complaints in a dose-dependent manner. Compared with ST ≤ 2 hrs/d, ST ≥ 4 hrs/d in girls and ST ≥ 6 hrs/d in boys showed higher odds of reporting psychosomatic complaints. Participating in PA ≥ 60 min every day compared to no PA showed lower odds of reporting psychosomatic complaints by 44% in girls and 57% in boys. Prospective research is needed to understand the causal pathway of these dose-dependent relationships.

Impact of the COVID-19 pandemic on cardiology services in the second year at a South Asian cardiac centre

Funding Acknowledgements

Type of funding sources: None.

Background

Little has been reported on the impact of the COVID-19 pandemic and the new delta variant, on cardiology services and catheterization volumes in South Asia, during the second year of the pandemic.

Purpose

We aimed to assess this impact during the second year of the pandemic on cardiology services, procedures and catheterization volumes at a tertiary cardiac centre in Bangladesh.

Methods

Data on patient visits (outpatient and emergency), admissions, procedures and catheterization volumes were collected for January to June 2020 and 2021 via hospital electronic records. Comparisons for each corresponding month were made between 2021 and 2020. The differences were expressed as a percentage (%Δ).

Results

Trends showed that admissions in cardiology and cardiac surgery units, outpatient visits, procedures and cardiac catheterization volumes had reached almost pre-pandemic levels in the first quarter of 2021, as compared to 2020. However, ER visits showed >50% reductions in February (Δ-58.7%) and March (Δ -51.9%) 2021, compared to 2020. Admissions and procedures showed a steep decline from March to April 2021, coinciding with the COVID19 surge owing to the Delta variant. A gradual increase in numbers of admissions, patient visits, and procedures were seen in May and June 2021, as compared with corresponding months in 2020. In terms of catheterization volumes, a sharp decline was seen in angiographies and percutaneous coronary intervention (PCI) from March to April 2021, similar to 2020. Cath lab procedures showed an increasing trend in May-June 2021, and were greater in numbers, compared to corresponding volumes in 2020 [May: Δ+36.9%; June: Δ+33.2% in 2021]. A greater increase was seen for PCI (May Δ+ 46.8%; June Δ+367%) than angiographies (May Δ+32.5%; June Δ+32.5%).

Conclusion

Cardiology services and cath lab volumes had reached almost pre-pandemic levels in January and February 2021. The surge caused by the delta variant resulted in reduced admissions, outpatient and cath lab volumes beginning from April 2021, however numbers remained greater in 2021 than corresponding months in March-June 2020, possibly indicating an adaptation of the healthcare system to the prevailing pandemic.

Pattern of Glomerular Disease in a Tertiary Care Hospital of Bangladesh

Glomerular disease is one of the most important causes of chronic kidney disease in developing countries like Bangladesh as well as the whole world. The pattern of glomerular disease varies in different countries and can have different clinical presentations. The aim of the study was to analyze the clinical profile and to determine the histological pattern of glomerular diseases in a large tertiary care hospital in Bangladesh. All kidney biopsies performed in Mymensingh Medical College Hospital, Bangladesh from October 2018 to March 2020 were prospectively analyzed in the study. A total of 101 patients with kidney biopsy were examined by clinical and laboratory findings and by light and immuno-fluorescence microscopy. The mean age was 30.0±14.6 years and 50(49.5%) were male and 51(50.5%) were female with a male to female ratio of 1:1. The clinical syndromes namely nephrotic syndrome, nephritic syndrome, nephrito-nephrotic presentation, RPGN like presentation, macroscopic haematuria and asymptomatic urine abnormality were present in 31.7%, 34.5%, 22.8%, 11.9%, 19.8% and 10.9% patients respectively. The most common histological varieties found in the study were mesangial proliferative glomerulonephritis (MesPGN) (18.8%) and focal segmental glomerulosclerosis (FSGS) (18.8%). Other histopathological pattern among the studied subjects revealed minimal change disease (MCD) in 5.9%, membranous nephropathy (MN) in 7.9%, membranoproliferative glomerulonephritis (MPGN) in 16.8%, IgA nephropathy in 5%, IgM nephropathy in 2%, IgG nephropathy in 2%, diffuse proliferative glomerulonephritis (DPGN) in 1%, focal proliferative glomerulo-nephritis (FPGN) in 3%, crescentic GN in 3%, lupus nephritis (LN) in 13.9%, amyloidosis in 1% and fibrillary glomerulopathy in 1% patient. The pattern of glomerular disease found in this study was similar to other studies performed in Bangladesh with a little variation. It may guide the future researchers to establish a national kidney biopsy registry in Bangladesh.

Impact of the COVID-19 pandemic on cardiology services at a tertiary cardiac centre in a low- and middle-income country in Asia

Background

The COVID-19 pandemic resulted in reduced numbers of patients presenting with and undergoing procedures for cardiac conditions worldwide. This impact, specifically looking at the changes in patient visits, admissions and procedure volumes, has not been recorded thus far, in terms of a South Asian LMIC setting.

Purpose

We aimed to assess the impact of the pandemic on emergency room (ER) visits, cardiology admissions, out-patient and in-patient procedures at a LMIC tertiary cardiac centre.

Methods

Data on ER visits, specific in-patient and out-patient procedures (echocardiography, exercise stress tests, electrocardiography [ECG]) were collected via hospital electronic records from January to December 2020, and compared with corresponding data for the same months in 2019. The difference or deficits were expressed as a percentage (%Δ). Data for each quarter were compared using paired t-test. A p value &lt;0.05 was considered significant.

Results

There were significantly reduced numbers of out-patient visits (Δ −31.2%; p=0.007), ER visits (%Δ −59.5%; p=0.0), in-patient admissions (Δ −33.1%; p=0.005), total out-patient procedures (%Δ −31.9%; p=0.008) and catheterization volumes (%Δ-29.7%; p=0.001) in 2020, as compared with 2019 (Table 1 & Figure 1). Among out-patient procedures, adult trans-thoracic echo, ECG and stress tests showed greatest deficits in April 2020. No trans-oesophageal echocardiograms were performed in April to July 2020. The greatest deficits were observed in April 2020, as compared with 2019 (out-patient visits: Δ-92.7%; out-patient procedures: %Δ-94.5%; in-patient admissions: %Δ-85.9%; catheterization procedures: %Δ-85.2%), except for ER visits, where the greatest deficit was seen in June 2020: %Δ-90.7%). Numbers continued to remain extremely low in May 2020, coinciding with the nation-wide lockdown measures. Out-patient visits, procedures and in-patient admissions have gradually increased since July 2020. However, the greatest impact seems to have been on ER visits, continued to remain low, with significantly reduced volumes in both 2nd and 3rd quarters of 2020. The lowest deficits in outpatient visits (Δ-4.9%), ER visits (Δ-31.9%) and out-patient procedures (Δ-0.9%) were seen in December 2020, while for in-patient admissions (Δ-7.9%) and catheterization procedures (Δ-6.5%) this was in October 2020.

Conclusion

There was a significant reduction of out-patient and in-patient cardiology services volumes in 2020, with the greatest reduction in April and May, coinciding with a general “lockdown”. ER visits were the most greatly affected. Trends show a steady increase in out-patient and catheterization procedures, beginning from July, but have not yet reached pre-COVID volumes, even by the end of 2020. These findings indicate that, the pandemic has resulted in significantly fewer ER visits; however, patients still present as outpatients, both for procedures and catheterization.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1

Impact of the COVID-19 pandemic on catheterization laboratory procedural volumes at a tertiary cardiac centre in a low- & middle-income country in South Asia

Background

Globally, reports have suggested that cardiac catheterization procedures, particularly elective coronary procedures declined as a result of the COVID-19 pandemic. However, there is scarce data on this aspect, in terms of a South Asian low- & middle-income country (LMIC) setting.

Purpose

We aimed to evaluate temporal trends and impact of the pandemic on elective and emergency cardiac catheterization procedural volumes at a high-volume tertiary cardiac centre in a LMIC.

Methods

Data on both emergency and elective catheterization procedures, including coronary angiography, percutaneous coronary intervention (PCI), peripheral angiography, pacing & electrophysiology (EP) were collected from January to December 2020, and compared with corresponding data for the same months in 2019. Data were obtained from hospital's catheterization laboratory database. The difference was expressed as a percentage (%Δ). Data for each quarter were compared using paired t-test. A p value <0.05 was considered significant.

Results

Overall, a significant (32.4%) reduction of cath lab procedures was seen in 2020, as compared with 2019 (p=0.006). There were significantly reduced numbers of coronary angiographies (%Δ −31.4%; p=0.009), PCI (%Δ −32.2%; p=0.008), peripheral procedures (%Δ −69.9%; p=0.001) and pacing & EP procedures (Δ−-48.7%; p=0.001) in 2020, as compared with 2019 (Table 1 & Figure 1). For coronary procedures this was most marked in 2nd and 3rd quarters of 2020 (p<0.05). The greatest deficits for coronary angiographies were observed in April 2020, compared to 2019 (Δ −85.1%); the greatest reductions in PCI (Δ-87.7%) and pacing & EP (Δ −94.7%) were seen in May 2020, coinciding with the nation-wide lockdown measures. Coronary procedures showed a gradually increasing trend since July 2020. Given their elective nature, no peripheral procedures were performed from April to July 2020. In terms of PCI, there was a significant reduction in elective procedures in the 2nd quarter of 2020 (p=0.001), with a steep “catch-up” incline in September (Δ +2.9%) and October 2020 (Δ −8.3%), coinciding with availability of in-hospital COVID19 screening tests (Table 1). Among ad hoc PCI for acute coronary syndrome (ACS), although a 32.3% reduction was seen overall (p=0.108), a significant decrease was only observed in the 2nd quarter. Ad hoc PCI for non-ACS was significantly reduced throughout 2nd to 4th quarters of 2020. In line with national guidelines preferring fibrinolysis as first-line for STEMI, as well as absence of negative pressure ventilation cath labs and unavailability of rapid-screening COVID test kits, no primary PCI procedures were performed since May 2020.

Conclusion

The impact of COVID-19 resulted in a significant reduction in all cardiac catheterization procedures in 2020, as compared with 2019. This reduction was most marked for coronary procedures in the 2nd and 3rd quarters of 2020, with a significant reduction in elective procedures.

Funding Acknowledgement

Type of funding sources: None.

Dose-dependent and joint associations between screen time, physical activity, and mental wellbeing in adolescents: an international observational study

BACKGROUND

Mental wellbeing in adolescents has declined considerably during past decades, making the identification of modifiable risk factors important. Prolonged screen time and insufficient physical activity appear to operate independently and synergistically to increase the risk of poor mental wellbeing in school-aged children. We aimed to examine the gender-stratified dose-dependent and joint associations of screen time and physical activity with mental wellbeing in adolescents.

METHODS

We used data from three rounds of Health Behaviour in School-aged Children cross-sectional surveys (2006, 2010, and 2014) from 42 European and North American countries. Survey participants, aged 11 years, 13 years, and 15 years, provided self-reported information by completing an anonymous questionnaire that included items on health indicators and related behaviours. We used the self-reported variables of life satisfaction and psychosomatic complaints as indicators of adolescents' mental wellbeing, combining these with the self-reported discretionary use of screens and engagement in physical activity. We used generalised additive models and multilevel regression modelling to examine the gender-stratified relationships between mental wellbeing and screen time and physical activity.

FINDINGS

Our sample included 577 475 adolescents (mean age 13·60 years, SD 1·64), with 296 542 (51·35%) girls and 280 933 (48·64%) boys. The mean reported life satisfaction score (on a scale of 0-10) was 7·70 (95% CI 7·69-7·71) in boys and 7·48 (7·46-7·50) in girls. Psychosomatic complaints were more common among girls (mean 9·26, 95% CI 9·23-9·28) than boys (6·89, 6·87-6·91). Generalised additive model analyses showed slightly non-linear associations of screen time and physical activity with life satisfaction and psychosomatic complaints for girls and boys. Detrimental associations between screen time and mental wellbeing started when screen time exceeded 1 h per day, whereas increases in physical activity levels were beneficially and monotonically associated with wellbeing. Multilevel modelling showed that screen time levels were negatively associated with life satisfaction and positively associated with psychosomatic complaints in a dose-dependent manner. Physical activity levels were positively associated with life satisfaction and negatively associated with psychosomatic complaints in a dose-dependent manner. Joint associations of screen time-physical activity with mental wellbeing showed that, compared with the least active participants with more than 8 h per day of screen time and no physical activity, most of the other screen time-physical activity groups had considerably higher life satisfaction and lower psychosomatic complaints.

INTERPRETATION

Higher levels of screen time and lower levels of physical activity were associated with lower life satisfaction and higher psychosomatic complaints among adolescents from high-income countries. Public health strategies to promote adolescents' mental wellbeing should aim to decrease screen time and increase physical activity simultaneously.

FUNDING

None.

Association of carbonated soft drink and fast food intake with stress-related sleep disturbance among adolescents: A global perspective from 64 countries

BACKGROUND

Poor quality sleep adversely impacts on adolescent wellbeing. More multinational research is needed to understand modifiable risk factors, such as dietary behaviours. This study aimed to examine the association of carbonated soft drink and fast food intake with stress-related sleep disturbance among adolescents across 64 countries.

METHODS

We analysed the Global School-based Student Health Survey data from 175,261 adolescents (mean age 13.8 [0.98]; 48.5% females). Adolescents reported frequency of stress-related sleep disturbance and consumption of carbonated soft drinks and fast foods. Country-level estimates were obtained by using multivariable logistic regression and meta-analysis to obtain pooled estimates.

FINDINGS

Overall, 7.5% of adolescents reported sleep disturbance during the past 12 months (males: 6.6%; females: 8.4%). Meta-analysis showed that adolescents having carbonated soft drinks ≥3 times/day had over 50% higher odds of reporting sleep disturbance than <once/day (OR=1.55, 95% CI 1.42-1.70 for males; 1.51, 1.37-1.68 for females). Adolescent males who had fast foods ≥4 days/week had 55% higher odds of reporting sleep disturbance than ≤1 day/week (1.55, 1.39-1.73), while the odds was 50% higher in females (1.50, 1.32-1.70). Carbonated soft drinks ≥3 times/day and fast foods ≥ 4 days/week were significantly associated with sleep disturbance in all but low-income countries for both genders; while the associations were significant in males and mixed in females across WHO regions.

INTERPRETATION

Our findings suggest strong positive associations between carbonated soft drink and fast food intake with stress-related sleep disturbance. Prospective studies are needed to understand the directionality of the relationship.

Parental and Peer Support are Associated with Physical Activity in Adolescents: Evidence from 74 Countries

Although parental and peer support can influence adolescents’ physical activity (PA), these associations have not been fully examined through a global assessment. This study examined the associations of parental and peer support with PA among adolescents from 74 countries. The Global School-based Student Health Survey data from 250,317 adolescents aged 11–17 years (48.8% girls), collected between 2007 and 2016, were analysed. Adolescents were asked how many days/week they were physically active and about their parental and peer support. Meta-analysis showed that adolescents who had high parental or peer support had higher odds of attaining sufficient PA (odds ratio (OR): 1.40, 95% confidence interval (CI): 1.34–1.46; OR: 1.57, 95% CI: 1.49–1.65, respectively). Pooled estimates of association were significant across all World Health Organization (WHO) regions and country-income categories with the highest estimate from the low-income countries. The Western Pacific region showed the highest association between parental support and adolescents’ PA (OR: 1.49, 95% CI: 1.41–1.59), while South-East Asia exhibited the highest association between peer support and adolescents’ PA (OR: 1.80, 95% CI: 1.59–2.04). Country-level estimates of associations are presented. Future studies should use robust assessment of PA and PA-specific parental and peer support with emphasis on qualitative investigation to understand the complexity of the relationships.

Internet Use, eHealth Literacy, and Dietary Supplement Use Among Young Adults in Pakistan: Cross-Sectional Study

Background

Increased access to the internet has facilitated widespread availability of health information. Thus, electronic health (eHealth) literacy—the ability to seek, find, understand, and appraise health information from electronic resources and apply that knowledge in making a health-related decision—is a crucial skill. Despite the increasing use of the internet as a source of health information in developing countries, only a few studies have examined the eHealth literacy of young adults, who frequently use the internet to access health information in these developing countries.

Objective

The aim of this study was to assess the patterns of internet use and eHealth literacy levels among university students pursuing a non–health-related degree in Pakistan. We also examined the association of the eHealth literacy levels of these young adults with their physical activity levels and dietary supplement intake.

Methods

Students from 2 leading engineering universities in Pakistan were invited to participate in a cross-sectional anonymous web-based survey in order to collect data on their internet use, eHealth literacy, and dietary supplement intake. Of the 900 eligible university students who were invited to participate, 505 (56.1%) students who completed the questionnaire were included in the analysis. The findings were converted to median values and frequency analyses were performed. The associations between the variables were determined using the chi-square test; P≤.05 was considered significant.

Results

In this study, the median eHealth literacy scale (eHEALS) score was 29, which did not vary across gender. The most common type of health-related information that was searched by the participants was that related to maintaining a healthy lifestyle (305/505, 60.4%). Participants with high eHEALS scores were those who used the internet frequently for finding people with similar health issues (P<.001). The use of specific social media platforms was not associated with the perceived eHealth literacy levels. Neither the frequency of physical activity nor the dietary supplement use was associated with the eHealth literacy of the participants.

Conclusions

University students in non–health-related disciplines in Pakistan expressed high confidence in their skills to find health-related information on the internet, as indicated by the aggregate eHEALS scores. However, the findings of our study show that the perceived eHealth literacy was not associated with health behaviors such as physical activity and dietary supplement intake. Further research is necessary to investigate the extent to which eHealth literacy can be considered as a panacea for solving public health challenges in developing countries.

Low physical activity and high sedentary behaviour are associated with adolescents' suicidal vulnerability: Evidence from 52 low- and middle-income countries

AIM

To examine the relationships of physical activity (PA) and sedentary behaviour (SB) with suicidal thoughts and behaviour among adolescents in low- and middle-income countries (LMICs).

METHODS

Global School-based Student Health Survey data from 206 357 students (14.6 ± 1.18 years; 51% female) in 52 LMICs were used. Students reported on suicidal ideation, suicide planning, suicide attempts, PA, leisure-time SB and socio-demographic characteristics. Multilevel mixed-effects generalised linear modelling was used to examine the associations.

RESULTS

High leisure-time SB (≥3 hours/day) was independently associated with higher odds of suicidal ideation, suicide planning and suicide attempts for both male and female adolescents. Insufficient PA (<60 mins/day) was not associated with higher odds of ideation for either sex; however, it was associated with planning and attempts for male adolescents. The combination of insufficient PA and high SB, compared with sufficient PA and low SB, was associated with higher odds of suicidal ideation and suicide planning for both male and female adolescents, and suicide attempts for male adolescents.

CONCLUSION

High SB may be an indicator of suicidal vulnerability among adolescents in LMICs. Low PA may be a more important risk for suicidal thoughts and behaviours among male, than female, adolescents. Promoting active lifestyle should be integrated into suicide prevention programmes in resource-poor settings.

National Clinical Guidance for the Management of Cardiovascular Intervention in the COVID-19 Pandemic: From Bangladesh Society of Cardiovascular Interventions (BSCI)

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

Assessment of knowledge, attitudes and practice towards Vitamin D among university students in Pakistan

Background

Pakistan has one of the highest reported incidence of vitamin D deficiency in studies conducted worldwide. However, there has been very limited exploration of vitamin D related knowledge, attitudes and practices among healthy youth in Pakistan.

Methods

A cross-sectional survey was conducted among youth (aged > 16 years) from two engineering universities in Pakistan. Participants were asked questions on their concern about vitamin D levels, testing, and supplementation practices. Knowledge was examined using questions about food sources, health benefits and factors affecting vitamin D production within the human body. Of the 900 eligible students invited to participate, 505 (56%) completed the questionnaire and were included in the analysis.

Results

Only 9% participants were able to identify the correct food sources of vitamin D, 33% were aware of the bone health benefits (bone health and calcium absorption) of vitamin D and 36% identified sunlight exposure as a factor influencing vitamin D production. Knowledge about food sources and health benefits of vitamin D was not associated with gender and individuals concern about their levels. Those tested and taking supplements were more likely to identify bone related health benefits and factors affecting vitamin D production. Forty percent male and 52% female students expressed concern that their vitamin D levels were too low. However, 72% participants reported that they had never been tested for vitamin D levels. Use of supplements was significantly higher among female students (F = 52% vs M = 37%; P = 0.003). Those who had been tested for vitamin D deficiency were more likely to take supplements.

Conclusion

Despite being identified as a high-risk population, knowledge about vitamin D was limited among university students. Interventions are needed to increase awareness about the importance of vitamin D for health, including the need for exposure to sunlight and adequate dietary intake of vitamin D. Our study provides much needed baseline evidence for making health-policy recommendations for this vulnerable population group.

Clustering of lifestyle risk factors for non-communicable diseases in 304,779 adolescents from 89 countries: A global perspective

The precursors of non-communicable diseases (NCDs) are often manifested during childhood and adolescence with little knowledge about co-occurrence of their related lifestyle risk factors. To address this deficit, we estimated the prevalence and clustering of six major NCD-risk factors in adolescents around the world. Data from the Global School-based Student Health Survey, collected between 2007 and 2016, were analysed in 304,779 adolescents aged 11-17 years (52.2% females) from 89 countries. We compared the observed (O) to expected (E) prevalence ratios of 64 possible combinations of six risk factors to determine their clustering patterns. Overall, 82.4% (95% CI 82.1-82.7) of adolescents had ≥2 risk factors, while 34.9% (34.6-35.3) had ≥3. Adolescents aged 16-17 years, compared to those aged 11-13 years, had higher odds (OR 1.33; 95% CI 1.31-1.36) of reporting ≥3 risk factors. Risk factors clustered in multiple combinations and differed by sex. The clustering of physical inactivity and low fruit and vegetable intake was evident in both males (O/E 1.10; 95% CI 1.07-1.12) and females (1.08; 1.06-1.10). The co-occurrence of cigarette smoking, alcohol drinking, physical inactivity, and low fruit and vegetable intake was 165% greater in females (2.65; 2.28-3.07) and 110% greater in males (2.10; 1.90-2.32) than expected. Globally, adolescents exhibit multiple modifiable risk factors for future development of NCDs. Early gender-specific prevention strategies targeting clusters of lifestyle risk factors should be prioritised to help mitigate future burden of NCDs globally. Periodical collection of behavioural risk factor data should be encouraged to facilitate a sustainable global surveillance.

Morning (First) Urine Copper Concentration: a New Approach for the Diagnosis of Wilson's Disease

Twenty-four-hour (h) urinary copper content is considered as the most suitable tool for the diagnosis of Wilson's disease (WD); however, it is less accurate, time-consuming, and non-economical. Consequently, in the present study, an alternative method through measuring the morning (first) urine copper (Cu) concentration is proposed for the diagnosis of WD, which is more accurate, precise, faster, and cheaper. For this purpose, a sensitive, accurate, and precise analytical method was developed and validated in regard to Commission Decision 657/2002/EC, Council Directive 333/2007/EC, ISO/IEC 17025:2005, and EURACHEM 1998 for the determination of Cu in urine using flame atomic absorption spectrometry (FAAS). The methods LoD and LoQ for urine Cu were estimated as 6.68 μg/L and 16.7 μg/L respectively. The accuracy of the method was found to be 93.70-101.88% calculated from the spike recovery experiment. The RSDs for the repeatability and reproducibility precision were measured as 0.67-3.16 and 0.26-1.95 respectively. The method validation performance criteria indicated that the method was suitable for the determination of Cu in urine. The validated method was then applied for the determination of Cu in both 24 h and first urine. From the analysis, it was found that the amount of Cu per liter in the first urine was almost equivalent to the amount of Cu per 24 h indicating that instead of considering the 24-h urine, morning (first) urine investigation might be an alternative approach for the diagnosis of WD.

The effect of sunscreen on vitamin D: a review

BACKGROUND

Sunscreen use can prevent skin cancer, but there are concerns that it may increase the risk of vitamin D deficiency.

OBJECTIVES

We aimed to review the literature to investigate associations between sunscreen use and vitamin D₃ or 25 hydroxyvitamin D [25(OH)D] concentration.

METHODS

We systematically reviewed the literature following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. We identified manuscripts published in English between 1970 and 21 November 2017. Eligible studies were experimental [using an artificial ultraviolet radiation (UVR) source], field trials or observational studies. The results of each of the experimental studies and field trials are described in detail. Two authors extracted information from observational studies, and applied quality scoring criteria that were developed specifically for this question. These have been synthesized qualitatively.

RESULTS

We included four experimental studies, three field trials (two were randomized controlled trials) and 69 observational studies. In the experimental studies sunscreen use considerably abrogated the vitamin D₃ or 25(OH)D production induced by exposure to artificially generated UVR. The randomized controlled field trials found no effect of daily sunscreen application, but the sunscreens used had moderate protection [sun protection factor SPF) ~16]. The observational studies mostly found no association or that self-reported sunscreen use was associated with higher 25(OH)D concentration.

CONCLUSIONS

There is little evidence that sunscreen decreases 25(OH)D concentration when used in real-life settings, suggesting that concerns about vitamin D should not negate skin cancer prevention advice. However, there have been no trials of the high-SPF sunscreens that are now widely recommended. What's already known about this topic? Previous experimental studies suggest that sunscreen can block vitamin D production in the skin but use artificially generated ultraviolet radiation with a spectral output unlike that seen in terrestrial sunlight. Nonsystematic reviews of observational studies suggest that use in real life does not cause vitamin D deficiency. What does this study add? This study systematically reviewed all experimental studies, field trials and observational studies for the first time. While the experimental studies support the theoretical risk that sunscreen use may affect vitamin D, the weight of evidence from field trials and observational studies suggests that the risk is low. We highlight the lack of adequate evidence regarding use of the very high sun protection factor sunscreens that are now recommended and widely used.

Effect of solar ultraviolet radiation exposure on serum 25(OH)D concentration: a pilot randomised controlled trial

Sunlight generates vitamin D, but there are scant human data from randomised trials on which to base health policy advice about how much sun exposure is necessary to change 25(OH)D concentrations. The purpose of the study was to evaluate the feasibility of using solar ultraviolet (UV) radiation exposure to generate a change in 25(OH)D concentration in a randomised controlled trial (RCT). The intervention tested in this RCT was supervised exposure to one standard erythemal dose (SED; 100 J m-2) of solar UV radiation three days per week for three weeks with approximately 35% of the body surface area not covered by clothing. Thirty-six fair-skinned (skin type II and III) indoor workers from Brisbane, Australia were randomised into either the intervention group (n = 16) or the control group (n = 20); the latter did not receive any supervised sun exposure. We asked both groups to use sunscreen and to minimise time outdoors during the study period. We collected blood samples at baseline, once per week during the three week intervention period, and four weeks after the intervention finished. The cumulative UV radiation exposure over the intervention period measured using polysulphone badges was higher in the intervention group than in the control group (median 8 vs. 4 SEDs, p = 0.14). After three weeks, the mean serum 25(OH)D concentration increased from 60 to 65 nmol l-1 in the intervention group and from 55 to 57 nmol l-1 in the control group. After adjustment for baseline 25(OH)D, the mean change per week during the intervention phase was non-significantly higher in the intervention than in the control group (0.7 vs. 0.3; p = 0.35). This difference was not sustained during the follow-up period. Large field trials are needed to inform policy about how much natural sun exposure is required to raise 25(OH)D concentrations. This pilot identified key issues that need to be considered in the design of such a trial.

Extraction of maxillary teeth by dental students without palatal infiltration of local anaesthesia: a randomised controlled trial

OBJECTIVE

Palatal infiltration of local anaesthesia (LA) for maxillary tooth extractions is painful. One of the techniques for reducing the discomfort of this injection is to avoid it altogether. Given enough time, LA administered only as buccal infiltration diffuses to reach and anaesthetise the palatal tissues. The aim of this double-blind randomised controlled trial was to test the hypothesis that buccal infiltration alone of LA by dental students should be adequate for maxillary tooth extractions.

PATIENTS AND METHODS

Fifty adult patients presenting for single-tooth maxillary extractions were randomly allocated between two groups. The control group received palatal injections of 0.1 ml 2% lidocaine with 1:100,000 adrenaline, whilst the experimental group received a similar amount of saline (placebo). Extractions performed without further administration of LA were categorised as successful.

RESULTS

Palatal infiltration of lidocaine with adrenaline was significantly more effective than saline (P = 0.002). Overall buccal infiltration alone was successful in 28% patients, with a 40% success rate in the posterior maxilla.

CONCLUSION

Results suggest that dental students should, as a matter of routine, extract maxillary teeth with both buccal and palatal infiltration of LA, whilst buccal infiltration alone may be considered in the posterior maxilla.

Bupropion Hydrochloride

Bupropion hydrochloride is a norepinephrine-dopamine disinhibitor (NDDI) approved for the treatment of depression and smoking cessation. Bupropion is a trimethylated monocyclic phenylaminoketone second-generation antidepressant, which differs structurally from most antidepressants, and resides in a novel mechanistic class that has no direct action on the serotonin system. Comprehensive chemical, physical, and spectroscopic profiles are presented. This analytical profile provides an extensive spectroscopic investigation utilizing mass spectrometry, one- and two-dimensional NMR, solid-state NMR, IR, NIR, Raman, UV, and X-ray diffraction. The profile also includes significant wet chemistry studies for pH, solubility, solution, and plasma stability. Both HPLC and UPLC methodology are presented for bupropion and its related impurities or major metabolites. The profile concludes with an overview of biological properties that includes toxicity, drug metabolism, and pharmacokinetics.

Relative suitability of DMSO and NaHCO3 for reversal of RISUG® induced long-term contraception

Among the vas-based methods on trial, reversible inhibition of sperm under guidance (RISUG(®) ), a co-polymer of styrene and maleic anhydride is being projected as an effective alternative to No Scalpel Vasectomy. RISUG offers long-term contraception with safety, efficacy in human trials and can be delivered by no-scalpel injection. Currently, the procedure is under phase-III clinical trial. However, reversal of this vas-based drug-induced contraception needs to be established in animal models prior to clinical trials to ensure its claim as an effective alternative for vasectomy. In the present investigation, the relative suitability of dimethyl sulphoxide (DMSO) and NaHCO3 for RISUG induced long-term vas occlusion reversal was carried out in albino rats. Animals were allocated into four groups (n = 10), viz., sham-operated control (group-I), vas occlusion with RISUG for 360 days (group-II), vas occlusion with RISUG for 360 days and reversal with DMSO (group-III) and vas occlusion with RISUG for 360 days and reversal with NaHCO3 (group-IV). A variable response in fertility was observed in different groups. Absolute sterility in group III at all mating intervals, while, zero percent fertility in groups II and IV following 90 days of occlusion was observed. Following reversal restoration of fertility with DMSO at 45 days, whereas, reversal by NaHCO3 at 30 days was noticed. Ejaculated spermatozoa of RISUG injected and initial intervals of reversed animals exhibited various degrees of abnormalities. The testes exhibited focal degeneration in vas occluded animals. The occluded lumen of the vas deferens contained an eosinated polymer with exfoliated epithelium. Following vas occlusion reversal, a complete regeneration in the vas epithelium was seen. All other parameters remained unaltered. The reversal with NaHCO3 resulted into an early resumption of fertility when compared with DMSO and the procedure found to be successful, feasible and safe up to F1 generation. Thus, RISUG provides a hope for reversible male contraceptives.

Recovery experience and burnout in cancer workers in Queensland

PURPOSE

Two key recovery experiences mediating the relationship between work demands and well-being are psychological detachment and relaxation over leisure time. The process of recovery from work-related stress plays an important role in maintaining well-being, but is poorly understood in cancer workers. The aim of this exploratory study was to examine the relationships of burnout, psychological well-being and work engagement with the recovery experiences of psychological detachment and relaxation in oncology staff.

METHODS

A cross sectional survey of 573 cancer workers in Queensland was conducted (response rate 56%). Oncology nurses (n = 211) represented the largest professional group. Staff completed surveys containing demographics and psychosocial questionnaires measuring burnout, psychological distress, work engagement and recovery experience. Multiple regression analyses were performed to identify explanatory variables which were independently associated with Recovery Experience Score (RES).

RESULTS

There was a negative association between the RES and burnout (p = 0.002) as well as psychological distress (p < 0.0001), but not work engagement. Age >25 years was negatively correlated with RES as was having a post graduate qualification, being married or divorced, having carer commitments. Participating in strenuous exercise was associated with high recovery (p = 0.015).

CONCLUSIONS

The two recovery experiences of psychological detachment and relaxation had a strong negative association to burnout and psychological well-being, but not work engagement. Further research needs to be undertaken to better understand if improving recovery experience reduces burnout and improves the well-being of cancer workers.

Burnout and Work Engagement in Occupational Therapists

Introduction:

Work engagement, characterized by vigour, dedication, and absorption, is often perceived as the opposite of burnout. Occupational therapists with burnout feel exhausted and disengaged from their work. This study aims to investigate demographic and work-related psychosocial factors associated with burnout and work engagement.

Method:

A cross-sectional postal survey of 951 occupational therapists was conducted.

Findings:

Two models representing factors associated with burnout (F(15,871) = 28.01, p < .001) and work engagement (F(10,852) = 16.15, p < .001) accounted for 32.54% and 15.93% of the variance respectively. Burnout and work engagement were inversely associated (χ2(n = 941) = 55.16, p < .001).

Conclusion:

Factors associated with burnout and work engagement were identified. The variables associated with burnout included: low psychological detachment from work during out-of-work hours, low income satisfaction, perceived work overload, difficulty saying ‘no’, < 10 years' experience, low frequency of having a ‘belly laugh’, and not having children. High levels of work engagement were reported by therapists with the following: low psychological detachment from work, high income satisfaction, postgraduate qualifications, > 40 hours work/week, high frequency of having a ‘belly laugh’, and having children. Understanding the factors associated with burnout and work engagement provides prerequisite information to inform strategies aimed at building healthy workforces.

Comparison of P2Y12 receptor inhibition by clopidogrel and prasugrel in patients undergoing percutaneous coronary intervention

Dual antiplatelet treatment (DAPT) with aspirin and clopidogrel is vital after percutaneous coronary intervention (PCI). Clopidogrel and prasugrel act on P2Y12 platelet surface receptors. Both these P2Y12 inhibitors are pro-drugs and depend on cytochrome system of the liver for their conversion to active metabolite. There is growing concern regarding suboptimal response in platelet inhibition by clopidogrel. Verify Now system got approval by Federal Drug Administration, USA, for assessing platelet function as its result is almost comparable to gold standard Light Transmission Aggregometry (LTA). There are no data on the prevalence of clopidogrel resistance in Bangladeshi population. Prasugrel, as an antiplatelet drug, is a newer introduction in this country. This study will show light on the efficacy of these drugs on our population especially in patients who undergo PCI where DAPT is mandatory. A total 120 (60 diabetics) patients with Acute Coronary Syndrome (ACS), were alternatively given 600 mg clopidogrel loading dose (LD) followed by 75 mg maintenance dose (MD) daily or 60 mg LD of prasugrel followed by 10 mg MD daily. Five samples of blood were taken at different time intervals over a period of 2 weeks. Measurement of percent inhibition of P2Y12 was done by VerifyNow. Patients who showed less than 20% inhibition (clopidogrel resistant) at any stage were switched to prasugrel. The outcomes of clopidogrel, prasugrel and clopidogrel switched to prasugrel groups were then compared. Nearly half (46.7%) of the patients in the clopidogrel group was found resistant to the drug as opposed to none in the prasugrel group. No difference was found between diabetic and non-diabetic subjects with respect to drug resistance. Intracoronary blood samples showed high degree of platelet inhibition with prasugrel. There was a gradual decline of platelet inhibition over two weeks with prasugrel. Almost fifty percent of the population is clopidogrel resistant in our study. Prasugrel is a much more potent antiplatelet drug and should be preferred in patients undergoing PCI. Prasugrel may also show resistance over time.

Stress oxidative: nephrolithiasis and chronic kidney diseases

The association between nephrolithiasis and many chronic kidney diseases suggests a common causative link. There are indications that stone formation can lead to hypertension, diabetes, chronic disease and myocardial infarct. The reverse also appears to be true in that diabetes and hypertension can lead to stone formation. The production of reactive oxygen species (ROS) and the development of oxidative stress (OS) are common features of many renal and cardiovascular diseases including, hypertension, diabetes, metabolic syndrome and nephrolithiasis. It is my hypothesis that oxidative stress produced by one disease may lead to another under suitable conditions. For example mild hypercalciuria, hyperoxaluria, hypocitraturia which under normal conditions may just be a curiosity or nuisance can promote crystallization when cells are injured by ROS produced by the co-morbid condition. On the other hand OS produced during or as a result of nephrolithiasis may promote hypertension or diabetic nephropathy.

Morphometry of the intercommissural distances and other structures of the aortic valve of bovine heart

The morphometry of the intercommissural distances and their relation with other structures of the aortic valve of bovine heart was carried out. A total of 32 apparently healthy bovine hearts of indigenous cattle of both sexes (50% male and 50% female), 2-4 years of age, weighing 500 to 800 gms were used in this study. The external intercommissural distances were higher in all cusps of the valve compared to the internal intercommissural distances. The internal intercommissural distance was larger in the RC sinus in case of male animals followed by that of the LC and NC sinus. The mean external intercommissural distances were 34.67+/-3.40, 34.40+/-3.64 and 34.97+/-4.37 mm and the internal intercommissural distances were 21.60+/-4.21, 21.20+/-4.70 and 20.67+/-4.06 mm for LC, RC and NC respectively. Analyzing the internal intercommissural distance, value in the LC sinus was higher followed by the RC and the NC but this variation was non-significant. In regard to the position of the coronary ostia, there were two coronary ostia, the right coronary ostium present in the RC sinus and the left coronary ostium in the LC sinus respectively and the right coronary ostium was supracommissural in position in bovine heart. Data about the morphometrical analysis of intercommissural distances and the position of the coronary ostia of the aortic valve facilitate the knowledge of manufacturing bovine tissue valve as well as those might be involved in valve replacement in human.

Modeling of hyperoxaluric calcium oxalate nephrolithiasis: experimental induction of hyperoxaluria by hydroxy-L-proline

A number of animal models have been developed to investigate calcium oxalate (CaOx) nephrolithiasis. Ethylene glycol (EG)-induced hyperoxaluria in rats is most common, but is criticized because EG and some of its metabolites are nephrotoxic and EG causes metabolic acidosis. Both oxalate (Ox) and CaOx crystals are also injurious to renal epithelial cells. Thus, it is difficult to distinguish the effects of EG and its metabolites from those induced by Ox and CaOx crystals. This study was performed to investigate hydroxy-L-proline (HLP), a common ingredient of many diets, as a hyperoxaluria-inducing agent. In rats, HLP has been shown to induce CaOx nephrolithiasis in only hypercalciuric conditions. Five percent HLP mixed with chow was given to male Sprague-Dawley rats for 63 days, resulting in hyperoxaluria, CaOx crystalluria, and nephrolithiasis. Crystal deposits were surrounded by ED-1-positive inflammatory cells. Cell injury and death was followed by regeneration, as suggested by an increase in proliferating cell nuclear antigen-positive cells. Both osteopontin (OPN) and CD44 were upregulated. Staining for CD44 and OPN was intense in cells lining the tubules that contained crystals. Along with a rise in urinary Ox and lactate dehydrogenase, there were significant increases in 8-isoprostane and hydrogen peroxide excretion, indicating that the oxidative stress induced cell injury. Thus, HLP-induced hyperoxaluria alone can induce CaOx nephrolithiasis in rats.