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Ararsa GG, Getachew MT, Diddana TZ, Alemayehu FR. Prevalence of undernutrition and associated factors among children aged 6-23 months: a cross-sectional analysis from South-East Ethiopia. J Nutr Sci 2023; 12:e127. [PMID: 38155807 PMCID: PMC10753458 DOI: 10.1017/jns.2023.109] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
To meet the 2030 goal to end all types of malnutrition, thoroughly investigating and addressing context-specific factors of undernutrition is crucial. Therefore, this study assessed the prevalence of undernutrition and associated factors among children aged 6-23 months in South-East Ethiopia. A community-based cross-sectional study was conducted on 580 randomly sampled mother-child pairs in February 2022. Socio-demographic, dietary intake, household food security (HFS), maternal knowledge and practices of child feeding, and the child's weight and height data were collected. A multivariable logistic regression analysis was done. The prevalence of stunted, wasted, and underweight children was 32⋅1, 7, and 9 %, respectively. Being male (AOR = 1⋅75), not using the growth monitoring and promotion (GMP) service (AOR = 1⋅50), household food insecurity (HFI) (AOR = 1⋅67), lack of improved water (AOR = 2⋅26), and bottle-feeding (AOR = 1⋅54) were significantly associated with stunting. Being male (AOR = 3⋅02), having low maternal knowledge on child-feeding practices (AOR = 3⋅89), not listening to the radio/television (AOR = 3⋅69), having a history of fever (AOR = 3⋅39), bottle-feeding (AOR = 3⋅58), and HFI (AOR = 3⋅77) were significantly predicted wasting. Being male (AOR = 3⋅44), not using GMP service (AOR = 2⋅00), having a history of fever (AOR = 4⋅24), lack of knowledge on optimal breastfeeding duration (AOR = 3⋅58), low maternal knowledge on child feeding (AOR = 2⋅21), HFI (AOR = 2⋅04), and lack of improved water (AOR = 3⋅00) showed significant association with underweight. In conclusion, stunting is alarmingly common while wasting and underweight are sub-optimal. Prevention of infectious disease, providing basic education for fathers, ensuring HFS; enhancing media access, maternal knowledge about IYCFP and improving water access; and GMP service utilisation are crucial to improve child nutrition.
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Key Words
- 6–23 months aged children
- ANC, antenatal care
- AOR, adjusted odds ratio
- ARI, acute respiratory illness
- ASF, animal source food
- BF, breastfeeding
- CF, complementary feeding
- COR, crude odds ratio
- DDS, dietary diversity score
- EDHS, Ethiopian Demographic and Health Survey
- GMP, growth monitoring and promotion
- HAZ, height/length-for-age Z-score
- HIFAS, household food insecurity access score
- IYCFP, infant and young child feeding practices
- Lemubilbilo
- MAD, Minimum acceptable diet
- OFSP, orange fleshed sweet potato
- ORS, oral rehydration solution
- PNC, postnatal care
- South-east Ethiopia
- Undernutrition
- WAZ, weight-for-age Z-score
- WHO, World Health Organisation
- WHZ, weight-for-height/length Z-score
- mm, millimeter
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Affiliation(s)
- Gosa Girma Ararsa
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Meheret Tena Getachew
- Ethiopia Civil Society Coalition for Scaling Up Nutrition (ECSC-SUN), Scaling Up Nutrition (SUN), Civil Society Network, P.O. Box 384, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Tona Zema Diddana
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Fikadu Reta Alemayehu
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
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Nkonde H, Mukanga B, Daka V. Male partner influence on Women's choices and utilisation of family planning services in Mufulira district, Zambia. Heliyon 2023; 9:e14405. [PMID: 36950585 PMCID: PMC10025139 DOI: 10.1016/j.heliyon.2023.e14405] [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: 10/19/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023] Open
Abstract
Background Family planning services are essential in reducing maternal deaths as well as improving the reproductive and sexual health of women. Although family planning services are frequently focused on women, men are often the primary decision-makers. We conducted a study to explore male partner influence on women's choices and utilisation of family planning services in Mufulira district, Zambia. Methods A qualitative explorative study design that utilised two focus group discussions (n = 20) and in-depth interviews (n = 30) involving women of reproductive age was conducted. Convenient sampling was employed to select participants. In-depth interviews and focus group discussions were recorded, translated, and transcribed verbatim. Content analysis was utilised through code classification and theme identification. Data were imported into NVivo.×64 for coding and node generation. Findings The study revealed key themes on male partner influence on contraception use such as fear of infidelity, fear of physical abuse, preference for a large family size , disruption of sexual pleasure, and perceived side effects of contraceptives. These themes highlight the influence of culturally driven gender and power dynamics on male partner attitudes towards contraception. Participants described how their male partners exhibited prenatal attitudes and control over them thereby limiting their decision-making power on contraception use. Undesirable contraception side effects such as reduced vaginal lubrication contributed to sexual pleasure disruption among men. Concerns that women's use of contraception can lead to infidelity also contributed to male partner disapproval of contraception use. Conclusions Understanding barriers to contraception utilisation presented by male partners is essential in preventing contraception discontinuation and can increase contraception uptake among women. Our findings highlight the influence of culturally driven gender and power dynamics on male partner attitudes towards contraception. Therefore, male partner education on family planning services is key. Also, men need to be incorporated as key stakeholders when planning and implementing family planning programmes.
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Key Words
- Contraception
- FGD, Focus group discussions
- FP, Family planning
- Family planning
- HIV, human immunodeficiency virus
- IDI, Indepth Interviews
- IUD, Intra uterine devices
- LAM, Lactational Amenorrhea Method
- LMIC, Low middle income countries
- Male partner
- SSA, Subsaharan Africa
- STIs, Sexually transmitted Infections
- TDRC, Tropical Diseases Research Centre
- WHO, World Health Organisation
- Zambia
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Ramakrishnan M, Poojari PG, Rashid M, Nair S, Pulikkel Chandran V, Thunga G. Impact of COVID-19 pandemic on medicine supply chain for patients with chronic diseases: Experiences of the community pharmacists. Clin Epidemiol Glob Health 2023; 20:101243. [PMID: 36743947 PMCID: PMC9885111 DOI: 10.1016/j.cegh.2023.101243] [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] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/16/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Problem considered Coronavirus disease(COVID-19) outbroke towards the end of December 2019 in China, soon it started spreading rapidly to various countries leading to an outburst of pandemic. Due to the restrictions imposed to control the spread of the infection, globally the manufacturing, import and export of medicine and the healthcare services to patients with chronic illness had been affected. This study aimed to explore the perspectives of the pharmacists on the medicine supply chain for patients with chronic diseases during COVID-19 pandemic in India. Methods This study is a prospective, qualitative research involving telephonic, semi-structured in-depth interviews. An interview guide for pharmacists was prepared and validated using "Interview Protocol Refinement" method. Purposive sampling method was used to recruit the pharmacists; a telephonic oral consent was obtained. The interview session was audio recorded and the recordings were transcribed verbatim. Further, transcripts were validated and later analysed using NVivo software. Results A total of 8 participants were interviewed during our study. Thematic analysis of the transcripts resulted in seven main themes. The study showed that there was deficiency in medicine supply during the COVID-19 pandemic and the pharmacists faced several challenges in procuring and storing the medication, arranging for unavailable medicines, medication dispensing and provision of the services such as medicine delivery, patient counselling. There was also scarcity of manpower leading to extra workload and working overtime. Conclusion Uninterrupted supply of essential medicine is the backbone of health care system. An effective plan and appropriate strategies are vital to combat such future emergencies.
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Affiliation(s)
- Manasvini Ramakrishnan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Pooja Gopal Poojari
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sreedharan Nair
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Viji Pulikkel Chandran
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Ngwira GM, Bolaane B, Parida BP. Investigating the trend of road traffic fatalities in Malawi using Mann-Kendall statistic. Heliyon 2023; 9:e13700. [PMID: 36852033 PMCID: PMC9957775 DOI: 10.1016/j.heliyon.2023.e13700] [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: 06/07/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
Fatalities due to road accidents remain a major challenge worldwide. In the recent years, Malawi, one of the developing African countries with a total population of about 19 million has also been witnessing a very high fatality rate [of about 31 crash deaths per 100,000 population in 2016] compared to most of its neighbours in the region. This seems to be continuously increasing even with several intervention measures, such as, speed and alcohol impairment laws, and laws for mandatory seatbelt and helmet use. In view of this, the study attempted to investigate the trend of road fatalities in Malawi, such that effectiveness of the existing measures can be established. For this, archived crash data of road fatalities between years 2000-2021 were used to undertake intervention and trend analyses. The method of Cumulative Summation was used to identify intervention points in the series, followed by the Mann-Kendall statistic (τ) to determine the trend during the intervened period using the non-parametric Rank-Sum test to support the findings. The results showed that the trend has been decreasing in the early years of legislating policy measures [2000-2012] and, thereafter [2013-2021], increased significantly [τ = 0.8333]. This suggests that there was acceptance of the measures by the motorists/public in the early years of implementation [2000-2012], which might have been overshadowed by vehicle population growth and weak enforcement mechanism that have seen the trend increasing lately. The study therefore suggests that there is still a scope to review the intervention measures in their effective implementation as well as regular monitoring.
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Affiliation(s)
| | | | - Bhagabat P. Parida
- Botswana International University of Science and Technology, Department of Civil & Environmental Engineering, Palapye, Botswana
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Venkatesh V, Pati GK, Uthansingh K, Mallick P, Narayan J, Mishra D, Sahu MK. Knowledge, Awareness and Prevalence of Hepatitis B Among Urban Slum Dwellers and Residents of Social Welfare Home: A Cross sectional Study From Eastern India. J Clin Exp Hepatol 2023; 13:31-36. [PMID: 36647417 PMCID: PMC9840071 DOI: 10.1016/j.jceh.2022.10.003] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
Background/aims In view of limited data on the knowledge and awareness of hepatitis B virus (HBV) and the available preventive strategies at the community level, it was aimed to analyse the knowledge and awareness of HBV in the community. Methods A cross-sectional questionnaire-based survey was conducted among residents of an urban slum and a social welfare home in Bhubaneswar, Odisha, from October 2019 to April 2021. The prevalence of HBV infection was also measured by testing the serum positivity for hepatitis B surface antigen using rapid point-of-care test kits. The statistical analysis was done by using the software SPSS version 20. Results A total of 370 individuals (mean age 38.7 ± 14.9 years, males: 55.1%) were assessed. Although 18.1% (67) had good knowledge, only 16.7% (62) had good awareness about HBV. Approximately 14.8% (55) knew that a vaccine is available in the country for HBV, and 6.2% (23) identified themselves as being vaccinated. Educational status was a significant independent predictor of knowledge and awareness such that people with education level of matriculation and above had odds of 11.05 (95% confidence interval: 5.3-22.7) and 14.7 (95% confidence interval: 6.5-33.1) for having good knowledge and awareness regarding HBV, respectively. A total of 10 participants tested positive for hepatitis B surface antigen contributing to a point prevalence rate of 2.7%. The proportion of individuals with an education status of matriculation and above was higher in the slum area when compared with the welfare home (67% vs 33%; P < 0.001), the knowledge (71.6% vs 28.4%; P < 0.001) and so was the awareness (71% vs 29%; P < 0.001) about HBV as well. Conclusion The relatively low figures of knowledge and awareness identified in our study undermine the need for intensification of health education and promotion activities regarding the prevalence of hepatitis B infection on a large scale at the community level.
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Affiliation(s)
- Vybhav Venkatesh
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Girish K Pati
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Kanishka Uthansingh
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Pradeep Mallick
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Jimmy Narayan
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Debakanta Mishra
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Manoj K Sahu
- Department of Gastroenterology and Hepatobiliary Sciences, IMS and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
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Verma S, Bhupali NR, Singh SP, Kumar V, Verma RK. Orthodontic emergencies and mental health of patients undergoing orthodontic treatment during COVID-19 pandemic: A questionnaire study. J Oral Biol Craniofac Res 2023; 13:177-185. [PMID: 36573125 PMCID: PMC9773783 DOI: 10.1016/j.jobcr.2022.12.007] [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] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives To evaluate the impact of COVID-19 pandemic on orthodontic treatment and mental health of patients undergoing orthodontic treatment and to compare their mental health with the age-matched control group. Materials and methods 484 orthodontic patients (245 males and 239 females) and 200 age-matched control subjects were divided into two age groups. Group 1 had 14-18 years of adolescents (N = 274) and 100 control participants (Group 2) and Group 3 comprised of 19 years above adults (N = 210) and 100 control participants (Group 4). Group 1 and 3 patients filled the 4 sections of the questionnaire related to orthodontic emergencies (Sections 1-3) and mental distress (Kessler Psychological Distress Scale-Section 4), while groups 2 and 4 were asked to fill only Section-4. The comparison of mental distress on high/low Kessler scores was made using the Chi-Square test/Fisher's exact test. The factors which came out to be significant were put to bivariate logistic regression analysis. Results The percentage of patients with high Kessler scores among Group 1 and Group 3 were 9.9% and 17.2% respectively, and their differences with age-matched control groups were non-significant. The mean differences of Kessler score were significantly higher for Group 3 compared to group 1. The higher Kessler score was associated with age, higher education, a feeling of concern for non-availability of appointments, increased treatment duration, its effect on the quality of treatment, and sabotaging of definitive future plans. Conclusions The orthodontic treatment and emergencies may not be a significant factor contributing to increased stress among patients during the lockdown.
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Affiliation(s)
- Sanjeev Verma
- Unit of Orthodontics & Dentofacial Orthopaedics, OHSC, PGIMER, Chandigarh, India
| | | | - Satinder Pal Singh
- Unit of Orthodontics & Dentofacial Orthopaedics, OHSC, PGIMER, Chandigarh, India,Corresponding author
| | - Vinay Kumar
- Unit of Orthodontics & Dentofacial Orthopaedics, OHSC, PGIMER, Chandigarh, India
| | - Raj Kumar Verma
- Unit of Orthodontics & Dentofacial Orthopaedics, OHSC, PGIMER, Chandigarh, India
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Mitchell T, Nayagam JS, Dusheiko G, Agarwal K. Health inequalities in the management of chronic hepatitis B virus infection in patients from sub-Saharan Africa in high-income countries. JHEP Rep 2022; 5:100623. [PMID: 36636709 PMCID: PMC9829705 DOI: 10.1016/j.jhepr.2022.100623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Chronic hepatitis B virus disproportionately affects migrant communities in high-income countries, reflecting increased migration from sub-Saharan Africa. Chronic hepatitis B virus is endemic in sub-Saharan Africa, yet the natural history of chronic infection experienced by patients remains incompletely understood, with evidence of variability across genotypes and regions within sub-Saharan Africa. Clinical guidelines recommending treatment thresholds are not specific to sub-Saharan African patients and are based on natural history studies from Western Pacific Asian countries. Access to standard of care treatment is available for sub-Saharan African people with chronic hepatitis B virus infection in high-income countries; however, the evidence base for these treatments was not established in this cohort and areas of uncertainty remain, particularly regarding HCC surveillance and treatment discontinuation. Participation in phase III clinical trials for chronic hepatitis B therapies is almost non-existent amongst sub-Saharan African patients, even when residing in high-income countries that participate in multicentre trials. Engagement with sub-Saharan African patients with chronic hepatitis B in high-income countries is challenging because of the stigma associated with the diagnosis, absence of routine screening systems and the complexities involved in navigating the healthcare system. Nonetheless, improved engagement is critical if we are to achieve global hepatitis B virus elimination.
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Affiliation(s)
- Tim Mitchell
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom,Gastroenterology and Hepatology Department, Royal Perth Hospital, Perth, Australia,Corresponding author. Address: Gastroenterology and Hepatology Department, Level 8 A Block, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia 6000, Australia; Tel.: +61 8 9224 2179.
| | - Jeremy S. Nayagam
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom,Department of Inflammation Biology, King’s College London, London, UK
| | - Geoffrey Dusheiko
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom,University College London Medical School, London, UK
| | - Kosh Agarwal
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom
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Dwivedi LK, Banerjee K, Sharma R, Mishra R, Ramesh S, Sahu D, Mohanty SK, James K. Quality of anthropometric data in India's National Family Health Survey: Disentangling interviewer and area effect using a cross-classified multilevel model. SSM Popul Health 2022; 19:101253. [PMID: 36268139 PMCID: PMC9576578 DOI: 10.1016/j.ssmph.2022.101253] [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: 12/16/2021] [Revised: 09/01/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
India has adopted a target-based approach to reduce the scourge of child malnourishment. Because the monitoring and evaluation required by this approach relies primarily on large-scale data, a data quality assessment is essential. As field teams are the primary mode of data collection in large-scale surveys, this study attempts to understand their contribution to variations in child anthropometric measures. This research can help disentangle the confounding effects of regions/districts and field teams on the quality of child anthropometric data. The anthropometric z-scores of 2,25,002 children below five years were obtained from the fourth round of India's National Family and Health Survey (NFHS-4), 2015–16. Unadjusted and adjusted standard deviations (SD) of the anthropometric measures were estimated to assess the variations in measurements. In addition, a cross-classified multilevel model (CCMM) approach was adopted to estimate the contribution of geographical regions/districts and teams to variations in anthropometric measures. The unadjusted SDs of the measures of stunting, wasting, and underweight were 1.7, 1.4, and 1.2, respectively. The SD of stunting was above the World Health Organisation threshold (0.8–1.2), as well as the Demographic and Health Survey mark. After adjusting for team-level characteristics, the SDs of all three measures reduced marginally, indicating that team-level workload had a marginal but significant role in explaining the variations in anthropometric z-scores. The CCMM showed that the maximum contribution to variations in anthropometric z-scores came from community-level (Primary Sampling Unit (PSU)) characteristics. Team-level characteristics had a higher contribution to variations in anthropometric z-scores than district-level attributes. Variations in measurement were higher for child height than weight. The present study decomposes the effects of district- and team-level factors and highlights the nuances of introducing teams as a level of analysis in multilevel modelling. Population size, density, and terrain variations between PSUs should be considered when allocating field teams in large-scale surveys. Unadjusted standard deviation for child malnourishment indicators are above the recommended level of DHS data quality standards. Variation in stunting is directly proportional to workload measured by number of eligible children in the PSUs. Cross-classified multilevel models show significant team-level contribution in explaining variations in anthropometric scores. Team-level contribution to explaining variations in child anthropometric measures is larger than district-level factors. The number of days assigned to gather anthropometric measurements should be dependent on the number of eligible respondents in a PSU, which may be identified at the time of mapping & listing, rather than being a fixed number of days across all the states of India.
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Key Words
- Anthropometric measures
- CCMM, cross-classified multilevel model
- Children
- Cross-classified multilevel model
- Data quality
- HAZ, height-for-age z-score
- NFHS, National Family Health Survey
- NFHS-4
- POSHAN, Prime Minister's Overarching Scheme for Holistic Nutrition
- PSU, Primary Sampling Unit
- SD, standard deviation
- SDGs, Sustainable Development Goals
- Standard deviation
- Team-level variation
- WAZ, weight-for-age z-score
- WHO, World Health Organisation
- WHZ, weight-for-height z-score
- Workload of health investigators
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Affiliation(s)
- Laxmi Kant Dwivedi
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India,Corresponding author.
| | - Kajori Banerjee
- SVKM's Narsee Monjee Institute of Management Studies (NMIMS), Mumbai, India
| | - Radhika Sharma
- International Institute for Population Sciences, Mumbai, India
| | | | | | - Damodar Sahu
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Sanjay K. Mohanty
- Department of Population & Development, International Institute for Population Sciences, Mumbai, India
| | - K.S. James
- International Institute for Population Sciences, Mumbai, India
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9
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Goodall S, Gale N, Thorne D, Hadley S, Prasad K, Gilmour I, Miazzi F, Proctor C. Evaluation of behavioural, chemical, toxicological and clinical studies of a tobacco heated product glo™ and the potential for bridging from a foundational dataset to new product iterations. Toxicol Rep 2022; 9:1426-1442. [PMID: 36561950 PMCID: PMC9764197 DOI: 10.1016/j.toxrep.2022.06.014] [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: 12/21/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/25/2022] Open
Abstract
Background Tobacco Heating Products (THPs) are tobacco products that heat rather than burn tobacco with temperatures less than 350 °C. Because of this operating principle, they produce substantially fewer and lower levels of tobacco smoke toxicants than combustible cigarette smoke produced when tobacco is burnt, which occurs at much higher temperatures of around 900 °C. This paper analyses data on a THP, glo™, and assesses whether its use would result in reduced health risks compared to the health risks of smoking cigarettes. It also looks at the possibility of bridging datasets across the different variants of the glo™ product. Methods The approach is to consider whether datasets from behavioural, chemical, toxicological and clinical studies provide consistent findings of reductions in toxicant exposure with glo™ use by subjects who switch completely from smoking cigarettes to using glo™ and whether these reductions are similar to those who stop smoking cigarettes without switching to glo™ or any other tobacco or nicotine product. We also examine the similarities and differences of different versions of the glo™ product and benchmark it against a THP from another manufacturer. Results The studies indicate that the use of the glo™ results in substantial and prolonged reductions in toxicant exposure for smokers who switch to glo™ completely. A long-term clinical study shows substantial reductions in toxicant exposure over a period of time, similar to reduction of some biomarkers of exposure found following smoking cessation without switching to glo™ or any other tobacco product, and biomarkers of potential harm trending in a favourable manner for both groups that switch to glo™ and that quit all tobacco and nicotine use. Data suggests that all iterations of glo™ result in substantial reductions in toxicant exposure compared to smoking cigarettes and that bridging across datasets is feasible. Conclusions Given the accumulated scientific data summarised in this paper, and particularly the findings from a long-term clinical study, the data demonstrate that glo™ is a reduced exposure product compared to combustible cigarettes and is reasonably deemed to reduce the risk of smoking-related diseases and supports the conclusion that smokers who would have otherwise continued to smoke and instead switch entirely to THP glo™ use, will reduce their relative risk of developing smoking-related diseases as compared to continued smoking. The extent of reduction in risk compared to continuing to smoke is likely to vary by smoking-related disease and by an individuals' smoking history, other risk factors and an individual's susceptibility to disease. Use of the THP will present some level of increased health risk as compared to cessation of tobacco and nicotine products and will cause dependence. As long as the principles of heat-not-burn are maintained, THP use will result in substantially reduced exposure to smoke toxicants as compared to continued conventional cigarette smoking. It is possible to use bridging or read across to apply these conclusions to new iterations of the glo™ product, extending the utility and validity of the evidence generated through study of prior iterations.
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Ong GYK, Ang AJF, Chen ZJ, Chan YH, Tang PH, Fong ESS, Tan JY, Aurangzeb AS, Pek JH, Maconochie I, Ng KC, Nadkarni V. Should paediatric chest compression depth targets consider body habitus? - A chest computed tomography imaging study. Resusc Plus 2022; 9:100202. [PMID: 35118434 PMCID: PMC8792407 DOI: 10.1016/j.resplu.2022.100202] [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: 10/27/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 01/03/2023] Open
Abstract
AIM This study explored how body habitus in the paediatric population might potentially affect the use of one-third external anterior-posterior (APD) diameter when compared to age-appropriate absolute chest compression depth targets. It also explored how body habitus could potentially affect the relationship between one-third external and internal APD (compressible space) and if body habitus indices were independent predictors of internal APD at the lower half of the sternum. METHODS This was a secondary analysis of a retrospective study of chest computed tomography (CT) scans of infants and children (>24-hours-of-life to less-than-18-years-old) from 2005 to 2017. Patients' scan images were reviewed for internal and external APDs at the mid-point of the lower half of the sternum. Body habitus and epidemiological data were extracted from the electronic medical records. RESULTS Chest CT scans of 193 infants and 398 children were evaluated. There was poor concordance between one-third external APD measurements and age-specific absolute chest compression depth targets, especially in infants and overweight/obese adolescents. There was a co-dependent relationship between one-third external APD and internal APD measurements. Overweight/obese children's and adolescents' internal and external APDs were significant different from the normal/underweight groups. Body-mass-index (BMI) of children and adolescents (p = 0.009), but not weight-for-length (WFL) of infants (p = 0.511), was an independent predictor of internal APD at the compression landmark. CONCLUSION This study demonstrated correlations between external and internal APDs which were affected by BMI but not WFL (infants). Clinical studies are needed to validate current chest compression guidelines especially for infants and overweight/obese adolescents.(250 words).
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Affiliation(s)
- Gene Yong-Kwang Ong
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Medical School, Singapore,Corresponding author at: Children’s Emergency, KK Women’s and Children’s Hospital (KKH), Singapore.
| | | | - Zhao Jin Chen
- Biostatistics Unit, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, National University of Singapore, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic Imaging, KK Women’s and Children’s Hospital, Singapore
| | | | - Jun Yuan Tan
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore
| | | | - Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Ian Maconochie
- Accident and Emergency Service, St Mary’s Hospital, London, United Kingdom,Department of Medicine, Imperial College, Kensington, London, United Kingdom
| | - Kee Chong Ng
- Children’s Emergency, KK Women’s and Children’s Hospital, Singapore,Duke-NUS Medical School, Singapore
| | - Vinay Nadkarni
- Center for Pediatric Resuscitation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, United States of America
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11
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Crouch SH, Soepnel LM, Kolkenbeck-Ruh A, Maposa I, Naidoo S, Davies J, Norris SA, Ware LJ. Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis. EClinicalMedicine 2022; 43:101229. [PMID: 34917909 PMCID: PMC8665406 DOI: 10.1016/j.eclinm.2021.101229] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa. METHODS We searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I2 statistic. FINDINGS In the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (0·2%-38·9%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I2=98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I2=99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines. INTERPRETATION Compared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity. FUNDING This research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
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Affiliation(s)
- Simone H. Crouch
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Larske M. Soepnel
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Correspondence and reprint to: Dr. Larske M. Soepnel. Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Huispost nr. STR 6.131 P.O. Box 85500 3508 GA, Utrecht, The Netherlands
| | - Andrea Kolkenbeck-Ruh
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa School of Public Health
| | - Sanushka Naidoo
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justine Davies
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Human Development, University of Southampton, Southampton, United Kingdom
| | - Lisa J. Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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12
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Flay KJ, Yang DA, Wilson MT, Lee SH, Bhardwaj V, Hill FI, Pfeiffer DU. Absence of serological or molecular evidence of Leptospira infection in farmed swine in the Hong Kong Special Administrative Region. One Health 2021; 13:100321. [PMID: 34504940 PMCID: PMC8411228 DOI: 10.1016/j.onehlt.2021.100321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 03/31/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022] Open
Abstract
Leptospirosis is an important zoonotic disease with several maintenance host species including swine. A cross sectional survey was undertaken between January to October 2020 to investigate the prevalence of leptospirosis in farmed swine in the Hong Kong Special Administrative Region (HKSAR) of China. Serum samples were collected from swine on seven farms (15 swine per farm; ten multiparous sows and five twelve-week-old weaners), while kidney samples were collected from 64 swine submitted for routine post-mortem (26 farms; average 2.4 swine per farm, range 1-6). Microscopic agglutination tests (MAT) to a panel of 24 Leptospira antigens did not reveal any evidence of seroconversion at a titre of 1:100. Polymerase chain reaction (PCR) testing of the kidney samples for Leptospira DNA did not detect any evidence of infection. Bayesian methods were used to compute the probability that the leptospirosis prevalence in farmed swine in the HKSAR was <3%, given none of the 105 swine sampled were positive on the MAT. The results of this study demonstrate no serological or molecular evidence of leptospirosis in farmed swine in the HKSAR. Subsequent statistical analysis supports the conclusion that the prevalence of leptospirosis in farmed swine in the HKSAR is negligible at present.
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Affiliation(s)
- Kate J. Flay
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Dan A. Yang
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Michael T. Wilson
- CityU Centre for Applied One Health Research and Policy Advice, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Song H. Lee
- CityU Centre for Applied One Health Research and Policy Advice, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Vidya Bhardwaj
- CityU Veterinary Diagnostic Laboratory Co, Ltd, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Fraser I. Hill
- CityU Veterinary Diagnostic Laboratory Co, Ltd, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Dirk U. Pfeiffer
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong, China
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13
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Rao ACA, Ng ACC, Sy RW, Chia KKM, Hansen PS, Chiha J, Kilian J, Kanagaratnam LB. Electrocardiographic QRS duration is influenced by body mass index and sex. Int J Cardiol Heart Vasc 2021; 37:100884. [PMID: 34660881 PMCID: PMC8503593 DOI: 10.1016/j.ijcha.2021.100884] [Citation(s) in RCA: 4] [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] [Received: 07/12/2021] [Revised: 09/05/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022]
Abstract
In a large group of subjects without overt conduction system disease, there was a positive association between increasing BMI and electrocardiographic QRS duration that was independent of other covariates such as sex and age. Females had narrower QRS complex than the males at similar age and in the similar BMI category. Findings of this research should prompt further studies to explore the underlying mechanisms for these observations and potential reversibility of the conduction abnormality with weight loss
Background Electrocardiogram (ECG) measured QRS duration has been shown to influence cardiovascular outcomes. However, there is paucity of data on whether ECG QRS duration is influenced by obesity and sex in large populations. Methods All ECGs performed by a pathology provider over a 2-year period were included. ECGs with confounding factors and those not in sinus rhythm were excluded from the primary analysis. Results Of the 76,220 who met the inclusion criteria, 41,685 (55%) were females. The median age of the study cohort was 61 years (interquartile [IQR] range 48–71 years). The median QRS duration was 86 ms (IQR 80–94 ms). The median BMI was 27.6 kg/m2 (IQR 24.2–31.8 kg/m2). When stratified according to the World Health Organization classification of BMI < 18.50 kg/m2, 18.50–24.99 kg/m2, 25.00–29.99 kg/m2, and ≥ 30.00 kg/m2, the median QRS durations were 82 ms (IQR 76–88 ms), 86 ms (IQR 80–92 ms), 88 ms (IQR 80–94 ms) and 88 ms (IQR 82–94 ms), respectively (p < 0.001 for linear trend). Median QRS duration for females was 84 ms (IQR 78–88 ms); for males, it was 92 ms (IQR 86–98 ms), p < 0.001. Compared to males, females had narrower QRS complexes at similar age and similar BMI. In multiple linear regression analysis, BMI correlated positively with QRS duration (standardized beta 0.095, p < 0.001) independent of age, sex, and heart rate. Conclusions In this large cohort there was a positive association between increasing BMI and QRS duration. Females had narrower QRS duration than males at similar age and similar BMI.
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Key Words
- Age
- BMI
- BMI, Body Mass Index
- CRP, C Reactive Protein
- CRT, Cardiac Resynchronisation therapy
- Cx 43, Connexin 43
- ECG QRS duration
- ECG, Electrocardiogram
- EDV, End Diastolic Volume
- ESV, End Systolic Volume
- IQR, Interquartile range
- Population health
- QTc, Corrected QT interval
- Sex
- WHO, World Health Organisation
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Affiliation(s)
- Anupam C A Rao
- Department of Cardiology, Ryde Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia
| | - Austin C C Ng
- Department of Cardiology, Concord Repatriation General Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia
| | - Raymond W Sy
- Department of Cardiology, Concord Repatriation General Hospital, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia
| | - Karin K M Chia
- Department of Cardiology, Royal North Shore Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia.,Douglas Hanly Moir Pathology, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia.,Douglas Hanly Moir Pathology, Australia
| | - Joseph Chiha
- Department of Cardiology, Bankstown Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia.,Douglas Hanly Moir Pathology, Australia
| | - Jens Kilian
- Department of Cardiology, Bankstown Hospital, Australia.,University of New South Wales, Australia.,Douglas Hanly Moir Pathology, Australia
| | - Logan B Kanagaratnam
- Department of Cardiology, Ryde Hospital, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia.,Douglas Hanly Moir Pathology, Australia
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14
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Nair M, MaatHRI writing group, on behalf of the MaatHRI collaborators. Reproductive health crisis during waves one and two of the COVID-19 pandemic in India: Incidence and deaths from severe maternal complications in more than 202,000 hospital births. EClinicalMedicine 2021; 39:101063. [PMID: 34585123 PMCID: PMC8461242 DOI: 10.1016/j.eclinm.2021.101063] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic in India has adversely affected many aspects of population health. We need detailed evidence of the impact on reproductive health in India so that lessons can be learnt. METHODS Hospital-based repeated monthly survey of nine severe maternal complications and death in 15 hospitals across five states in India covering a total of 202,986 hospital births, December-2018 through to May-2021. We calculated incidence rates (with 95% confidence intervals (CIs)) per 1000 hospital births, case-fatality and rate ratios (RR) with 95% CIs. Linear regression was used to examine the association between the Government Response Stringency Index (GRSI) for India and changes in hospital births, incidence and case-fatality. FINDINGS There was a significant decrease in hospital births per month during the pandemic period with a 4.8% decrease per 10% increase in the GRSI scores (p < 0.001). The overall incidence of severe complications in the pandemic period was not significantly different from the pre-pandemic period, but hospital admissions from septic abortion was 56% higher (RR=1.56; 95% CI=1.22-1.99; p < 0.001). The overall case-fatality of complications increased by 23% (RR=1.23; 95% CI=1.03-1.46; p = 0.022) and remained high across the different phases of the pandemic with a notable significant increase in deaths from heart failure in pregnancy. INTERPRETATION Our study supports the legitimacy of the calls made to maintain sexual and reproductive health services as essential services during the pandemic. Lessons learnt should be used to avert the ongoing reproductive health crisis while India plans to manage a third wave of the pandemic. FUNDING The MaatHRI platform and this study are funded by a Medical Research Council Career Development Award to MN (Ref:MR/P022030/1). The funder has no role in the study design, data collection, analysis, or writing the paper.
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Key Words
- CIs, Confidence Intervals
- Case-fatality
- DIC, Disseminated intravascular coagulation
- FIGO, International Federation of Gynaecology and Obstetrics
- GRSI, Government Response Stringency Index
- Incidence
- India
- MaatHRI, Maternal and perinatal Health Research collaboration, India
- Maternal complications
- Maternal death
- PPH, Postpartum haemorrhage
- RR, Rate ratios
- SARS-CoV-2
- SARS-CoV-2, Severe acute respiratory syndrome caused by the Coronavirus 2
- Septic abortion
- WHO, World Health Organisation
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15
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Dixon RV, Skaria E, Lau WM, Manning P, Birch-Machin MA, Moghimi SM, Ng KW. Microneedle-based devices for point-of-care infectious disease diagnostics. Acta Pharm Sin B 2021; 11:2344-2361. [PMID: 34150486 PMCID: PMC8206489 DOI: 10.1016/j.apsb.2021.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 10/30/2020] [Revised: 11/25/2020] [Accepted: 01/28/2021] [Indexed: 02/08/2023] Open
Abstract
Recent infectious disease outbreaks, such as COVID-19 and Ebola, have highlighted the need for rapid and accurate diagnosis to initiate treatment and curb transmission. Successful diagnostic strategies critically depend on the efficiency of biological sampling and timely analysis. However, current diagnostic techniques are invasive/intrusive and present a severe bottleneck by requiring specialist equipment and trained personnel. Moreover, centralised test facilities are poorly accessible and the requirement to travel may increase disease transmission. Self-administrable, point-of-care (PoC) microneedle diagnostic devices could provide a viable solution to these problems. These miniature needle arrays can detect biomarkers in/from the skin in a minimally invasive manner to provide (near-) real-time diagnosis. Few microneedle devices have been developed specifically for infectious disease diagnosis, though similar technologies are well established in other fields and generally adaptable for infectious disease diagnosis. These include microneedles for biofluid extraction, microneedle sensors and analyte-capturing microneedles, or combinations thereof. Analyte sampling/detection from both blood and dermal interstitial fluid is possible. These technologies are in their early stages of development for infectious disease diagnostics, and there is a vast scope for further development. In this review, we discuss the utility and future outlook of these microneedle technologies in infectious disease diagnosis.
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Key Words
- AC, alternating current
- APCs, antigen-presenting cells
- ASSURED, affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free and deliverable to end-users
- Biomarker detection
- Biosensor
- CMOS, complementary metal-oxide semiconductor
- COVID, coronavirus disease
- COVID-19
- CSF, cerebrospinal fluid
- CT, computerised tomography
- CV, cyclic voltammetry
- DC, direct current
- DNA, deoxyribonucleic acid
- DPV, differential pulse voltammetry
- EBV, Epstein–Barr virus
- EDC/NHS, 1-ethyl-3-(3-dimethylaminoproply) carbodiimide/N-hydroxysuccinimide
- ELISA, enzyme-linked immunosorbent assay
- GOx, glucose oxidase
- HIV, human immunodeficiency virus
- HPLC, high performance liquid chromatography
- HRP, horseradish peroxidase
- IP, iontophoresis
- ISF, interstitial fluid
- IgG, immunoglobulin G
- Infectious disease
- JEV, Japanese encephalitis virus
- MN, microneedle
- Microneedle
- NA, nucleic acid
- OBMT, one-touch-activated blood multidiagnostic tool
- OPD, o-phenylenediamine
- PCB, printed circuit board
- PCR, polymerase chain reaction
- PDMS, polydimethylsiloxane
- PEDOT, poly(3,4-ethylenedioxythiophene)
- PNA, peptide nucleic acid
- PP, polyphenol
- PPD, poly(o-phenylenediamine)
- PoC, point-of-care
- Point-of-care diagnostics (PoC)
- SALT, skin-associated lymphoid tissue
- SAM, self-assembled monolayer
- SEM, scanning electron microscope
- SERS, surface-enhanced Raman spectroscopy
- SWV, square wave voltammetry
- Skin
- TB, tuberculosis
- UV, ultraviolet
- VEGF, vascular endothelial growth factor
- WHO, World Health Organisation
- cfDNA, cell-free deoxyribonucleic acid
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Affiliation(s)
- Rachael V. Dixon
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
| | - Eldhose Skaria
- Wellcome Trust Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
| | - Wing Man Lau
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
| | - Philip Manning
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
| | - Mark A. Birch-Machin
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
| | - S. Moein Moghimi
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
| | - Keng Wooi Ng
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
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Khanna V, Nashikkar PS, Mahajan R, Tripathi S. Impact of Covid-19 pandemic on arthroplasty services and early experience after resuming surgeries at a 'non Covid' center. J Clin Orthop Trauma 2021; 21:101515. [PMID: 34334980 PMCID: PMC8312088 DOI: 10.1016/j.jcot.2021.101515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aim of this study is to assess the impact of Covid-19 crisis on hip and knee joint replacement surgeries at a high volume tertiary care hospital in the Indian National Capital Region and to evaluate the early experience of resumption of arthroplasty services. METHODS Institutional records of the arthroplasty cases, operated between 1st March to 31 August of 2019 (Group A, pre-Covid) and 2020 (Group B, pandemic year) were compared retrospectively over numerous parameters including the complications within six weeks of surgery. RESULTS There was a significant drop (by 82.53 %) in the total number of arthroplasty surgeries in Group B (62) as compared with Group A (355). Average number of arthroplasties per month were 59.17 ± 12.93 and 10.67 ± 13.29 in Group A and Group B respectively (p < 0.001). There was a significant increase in postoperative complication rate 7/355 (1.97 %) in Group A vs 7/62 (11.29 %) in Group B during pandemic (p < 0.002), along with a higher 30-days mortality rate 2/355 (3.22 %) vs 2/62 (0.56 %). Pandemic year also saw an increased readmission rate (4.83 %) vs (0.56 %) and postoperative ICU transfer rate (1.61 %) vs (0.56 %) in comparison with pre-Covid year. CONCLUSION In the pandemic, arthroplasty services got severely affected at our center. With nearly six fold increase in complication rates, higher 30-days mortality and increased readmission rates, caution is advised in resuming arthroplasty surgeries without robust evaluation of cases. Whether undetected Covid-19 infection or poor pre-existing disease control due to lockdown can be linked to these results is a matter of further research with larger multicenter studies.
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Affiliation(s)
- Varun Khanna
- Corresponding author. B1/52(Ground floor), Safdarjung enclave, New Delhi, 110029, India.
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Owen KB, Bellew B, Foley BC, Bauman A, Reece LJ. Body mass Index of children and adolescent participants in a voucher program designed to incentivise participation in sport and physical activity: A cross-sectional study. Prev Med Rep 2021; 22:101349. [PMID: 34141526 PMCID: PMC8186661 DOI: 10.1016/j.pmedr.2021.101349] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/12/2021] [Accepted: 02/20/2021] [Indexed: 11/02/2022] Open
Abstract
There has been limited population-level success in tackling overweight and obesity. The Active Kids program is a universal intervention that aims to increase participation in structured physical activity and sport among children and adolescents in New South Wales (NSW), Australia. This study examined the prevalence of overweight and obesity across subgroups and by social disadvantage in this large broadly representative sample. A cross-sectional study was conducted including all children (n = 671,375) who registered for an Active Kids Program voucher in 2018. The child's height and weight were obtained from an online registration form. Among children and adolescents who registered in the Active Kids Program, the prevalence of overweight and obesity was 17.2% and 7.6%, respectively. A large number of children and adolescents who lived in the most disadvantaged areas (n = 99,583; 14.8%) registered for the program. There was a clear socio-economic gradient for obesity prevalence across areas of increasing disadvantage, with children and adolescents living in the most disadvantaged area being 1.87 (95% CIs 1.82, 1.93) times more likely to be overweight or obese. The Active Kids program successfully reached a substantial proportion of children who are overweight and obese from socio-economically disadvantaged areas, providing financial support and opportunities for these children to participate in structured sport and physical activity. However, the program did not reach all children, and additional physical activity promotion strategies may be needed in a comprehensive approach. Nonetheless, these findings support government investment in reaching children who are overweight or obese with large-scale programs.
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Affiliation(s)
- Katherine B. Owen
- SPRINTER, Prevention Research Collaboration, Charles Perkins Centre,
School of Public Health, Faculty of Medicine and Health, The University of
Sydney, Australia
| | - Bill Bellew
- SPRINTER, Prevention Research Collaboration, Charles Perkins Centre,
School of Public Health, Faculty of Medicine and Health, The University of
Sydney, Australia
| | - Bridget C. Foley
- SPRINTER, Prevention Research Collaboration, Charles Perkins Centre,
School of Public Health, Faculty of Medicine and Health, The University of
Sydney, Australia
| | - Adrian Bauman
- SPRINTER, Prevention Research Collaboration, Charles Perkins Centre,
School of Public Health, Faculty of Medicine and Health, The University of
Sydney, Australia
| | - Lindsey J. Reece
- SPRINTER, Prevention Research Collaboration, Charles Perkins Centre,
School of Public Health, Faculty of Medicine and Health, The University of
Sydney, Australia
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Takla M, Jeevaratnam K. Chloroquine, hydroxychloroquine, and COVID-19: Systematic review and narrative synthesis of efficacy and safety. Saudi Pharm J 2020; 28:1760-1776. [PMID: 33204210 PMCID: PMC7662033 DOI: 10.1016/j.jsps.2020.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/28/2020] [Accepted: 11/08/2020] [Indexed: 01/10/2023] Open
Abstract
The COVID-19 pandemic has required clinicians to urgently identify new treatment options or the re-purposing of existing drugs. Of particular interest are chloroquine (CQ) and hydroxychloroquine (HCQ). The aims of this systematic review are to systematically identify and collate 24 studies describing the use of CQ and HCQ in human clinical trials and to provide a detailed synthesis of evidence of its efficacy and safety. Of clinical trials, 100% showed no significant difference in the probability of viral transmission or clearance in prophylaxis or therapy, respectively, compared to the control group. Among observational studies employing an endpoint specific to efficacy, 58% concurred with the finding of no significant difference in the attainment of outcomes. Three-fifths of clinical trials and half of observational studies examining an indicator unique to drug safety discovered a higher probability of adverse events in those treated patients suspected of, and diagnosed with, COVID-19. Of the total papers focusing on cardiac side-effects, 44% found a greater incidence of QTc prolongation and/or arrhythmias, 44% found no evidence of a significant difference, and 11% mixed results. The strongest available evidence points towards the inefficacy of CQ and HCQ in prophylaxis or in the treatment of hospitalised COVID-19 patients.
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Key Words
- COVID-19
- COVID-19, Coronavirus Disease 2019
- CQ, chloroquine
- Chloroquine
- CoV, coronavirus
- Efficacy
- FDA, Food and Drug Administration
- HCQ, hydroxychloroquine
- Hydroxychloroquine
- ICU, intensive care unit
- MERS, Middle East Respiratory Syndrome
- PICOT, Population, intervention, comparison, outcome, time
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- QTcF, The corrected QT interval by Fredericia
- SARS, Severe Acute Respiratory Syndrome
- Safety
- VT, ventricular tachyarrythmia
- WHO, World Health Organisation
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Affiliation(s)
- Michael Takla
- Faculty of Health and Medical Science, University of Surrey, Guildford GU2 7AL, United Kingdom
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Science, University of Surrey, Guildford GU2 7AL, United Kingdom
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Gbadamosi AQ, Oyedele L, Olawale O, Abioye S. Offsite Construction for Emergencies: A focus on Isolation Space Creation (ISC) measures for the COVID-19 pandemic. Prog Disaster Sci 2020; 8:100130. [PMID: 34173448 PMCID: PMC7586928 DOI: 10.1016/j.pdisas.2020.100130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 05/13/2023]
Abstract
The outbreak of a pandemic of global concern, the Corona Virus Disease 2019 (COVID-19) has tested the capacity of healthcare facilities to the brim in many developed countries. In a minacious fashion of rapid spread and extreme transmission rate, COVID-19 has triggered a shortage of healthcare facilities such as hospital bed spaces and ventilators. Various strategies have been adopted by the worst-hit countries to slacken or halt the spread of the virus. Common Isolation Space Creation (ISC) measures for the COVID-19 pandemic containment includes self-isolation at home, isolation at regular hospitals, isolation at existing epidemic hospitals, isolation at retrofitted buildings for an emergency, isolation at Temporary Mobile Cabins (TMCs), isolation at newly constructed temporary hospitals for COVID-19. This study evaluates the ISC measures and proposes offsite and modular solutions for the construction industry and built environment to respond to emergencies. While this study has proposed a solution for creating emergency isolation spaces for effective containment of such pandemic, other critical COVID-19 challenges such as the shortage of healthcare staff and other facilities are not addressed in this study.
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Key Words
- COVID-19, Corona Virus Disease 2019
- Covid-19
- ECDC, European Centre for Disease Control and Prevention
- Emergency
- HBS, Hospital Bed Spaces
- Healthcare facilities
- Hospitals
- ICU, Intensive Care Unit
- ISC, Isolation Space Creation
- NCDC, Nigerian Center for Disease control
- NHS, National Health Service, UK
- Offsite construction
- TMC, Temporary Mobile Cabin
- WHO, World Health Organisation
- WMHC, Wuhan Municipal Health Center
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Affiliation(s)
- Abdul-Quayyum Gbadamosi
- Big Data Enterprise and Artificial Intelligence Laboratory (Big-DEAL), Bristol Business School, University of West of the England, Bristol, United Kingdom
| | - Lukumon Oyedele
- Big Data Enterprise and Artificial Intelligence Laboratory (Big-DEAL), Bristol Business School, University of West of the England, Bristol, United Kingdom
| | - Oladimeji Olawale
- Big Data Enterprise and Artificial Intelligence Laboratory (Big-DEAL), Bristol Business School, University of West of the England, Bristol, United Kingdom
| | - Sofiat Abioye
- Big Data Enterprise and Artificial Intelligence Laboratory (Big-DEAL), Bristol Business School, University of West of the England, Bristol, United Kingdom
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Bhatt A, Arora P, Prajapati SK. Occurrence, fates and potential treatment approaches for removal of viruses from wastewater: A review with emphasis on SARS-CoV-2. J Environ Chem Eng 2020; 8:104429. [PMID: 32895629 PMCID: PMC7467108 DOI: 10.1016/j.jece.2020.104429] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 05/03/2023]
Abstract
The world is combating the emergence of Coronavirus disease 2019 (COVID-19) caused by novel coronavirus; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Further, due to the presence of SARS-CoV-2 in sewage and stool samples, its transmission through water routes cannot be neglected. Thus, the efficient treatment of wastewater is a matter of utmost importance. The conventional wastewater treatment processes demonstrate a wide variability in absolute removal of viruses from wastewater, thereby posing a severe threat to human health and environment. The fate of SARS-CoV-2 in the wastewater treatment plants and its removal during various treatment stages remains unexplored and demands immediate attention; particularly, where treated effluent is utilised as reclaimed water. Consequently, understanding the prevalence of pathogenic viruses in untreated/treated waters and their removal techniques has become the topical issue of the scientific community. The key objective of the present study is to provide an insight into the distribution of viruses in wastewater, as well as the prevalence of SARS-CoV-2, and its possible transmission by the faecal-oral route. The review also gives a detailed account of the major waterborne and non-waterborne viruses, and environmental factors governing the survival of viruses. Furthermore, a comprehensive description of the potential methods (physical, chemical, and biological) for removal of viruses from wastewater has been presented. The present study also intends to analyse the research trends in microalgae-mediated virus removal and, inactivation. The review also addresses the UN SDG 'Clean Water and Sanitation' as it is aimed at providing pathogenically safe water for recycling purposes.
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Key Words
- ASP, Activated Sludge Process
- COVID-19
- COVID-19, Coronavirus Disease 2019
- DUV-LED, Deep Ultraviolet Light-Emitting Diode
- E.coli, Escherichia coli
- EPS, Exopolysaccharide
- LRV, Log Reduction Value
- MBR, Membrane Bioreactor
- MERS-CoV, Middle East Respiratory Syndrome Coronavirus
- MLSS, Mixed Liquor Suspended Solids
- Microalgaee
- PMR, Photocatalytic Membrane Reactor
- Phycoremediationn
- RH, Relative Humidity
- SARS-CoV, Severe Acute Respiratory Syndrome Coronavirus
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- SBBGR, Sequencing Batch Biofilter Granular Reactor
- SEM, Scanning Electron Microscopy
- SSF, Slow Sand Filtration
- UASB, Upflow Anaerobic Sludge Blanket
- UN SDG, United Nations Sustainable Development Goal
- UV, Ultraviolet
- WHO, World Health Organisation
- WWTP, Wastewater Treatment Plant
- Waterbornee
- dsDNA, Double stranded Deoxyribonucleic Acid
- dsRNA, Double stranded Ribonucleic acid
- ssRNA, Single stranded Ribonucleic Acid
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Affiliation(s)
- Ankita Bhatt
- Environment and Biofuel Research Lab (EBRL), Hydro and Renewable Energy Department, Indian Institute of Technology (IIT) Roorkee, Roorkee, Uttarakhand, 247667, India
| | - Pratham Arora
- Hydro and Renewable Energy Department, Indian Institute of Technology (IIT) Roorkee, Roorkee, Uttarakhand, 247667, India
| | - Sanjeev Kumar Prajapati
- Environment and Biofuel Research Lab (EBRL), Hydro and Renewable Energy Department, Indian Institute of Technology (IIT) Roorkee, Roorkee, Uttarakhand, 247667, India
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Gluud LL, Jeyaraj R, Morgan MY. Outcomes in Clinical Trials Evaluating Interventions for the Prevention and Treatment of Hepatic Encephalopathy. J Clin Exp Hepatol 2019; 9:354-361. [PMID: 31360028 PMCID: PMC6637116 DOI: 10.1016/j.jceh.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 02/06/2019] [Indexed: 12/12/2022] Open
Abstract
Randomised clinical trials and systematic reviews of research findings can provide high-quality evidence for decision-making in the management of patients with hepatic encephalopathy. A large number of clinical trials have been undertaken, over the last 50 years, relative to the prevention and treatment of this condition. However, changes have been made, during this time, in the classification of hepatic encephalopathy, diagnostic criteria and assessment measures. These temporally based changes and the consequent lack of standardisation make it difficult to compare interventions and to evaluate their comparative efficacy and safety. While some consensus has been reached in relation to the diagnostic evaluation, classification and monitoring of patients in clinical trials, there is less surety about the choice of clinical endpoints. These outcome measures should be universally applicable, easily measured and clinically relevant. This article reviews the current recommendations regarding outcome selection and outlines some of the potential problems and pitfalls inherent in clinical trial evaluating interventions for the management of hepatic encephalopathy.
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Affiliation(s)
- Lise L. Gluud
- Gastrounit, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650 Hvidovre Denmark
| | - Rebecca Jeyaraj
- UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, Hampstead, London, NW3 2PF, UK
| | - Marsha Y. Morgan
- UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, Hampstead, London, NW3 2PF, UK
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Curtis K, Fulton E, Brown K. Factors influencing application of behavioural science evidence by public health decision-makers and practitioners, and implications for practice. Prev Med Rep 2018; 12:106-115. [PMID: 30233998 PMCID: PMC6140308 DOI: 10.1016/j.pmedr.2018.08.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 11/03/2022] Open
Abstract
The National Institute of Health and Care Excellence (NICE) in the UK recommends behavioural science evidence underpins public health improvement services. In practice, level of implementation varies. This study is the first to explore factors affecting use of behaviour-specific evidence by public health decision-makers and practitioners for design and delivery of health improvement services. Twenty semi-structured interviews were conducted, along with a review of the commissioning cycle with public health decision-makers and practitioners across a range of health improvement fields (e.g. weight management). Interviews were informed and analysed using the Theoretical Domains Framework (TDF). Limited comprehension of behaviour change, challenges identifying specific behaviour change strategies and translating research into practice were prevalent. Local authority processes encouraged uptake of evidence to justify solutions as opposed to evidence-driven decision-making. Some decision-makers perceived research evidence may stifle innovation and overwhelm practitioners. Potential facilitators of research use included: ensuring uptake and implementation of evidence is compulsory within commissioning and its potential to show value for money. A strong belief in local evidence and achieving outcomes were identified as barriers to research evidence uptake. Social and environmental challenges included cultural, political, and workload pressures and journal article accessibility. Embedding behavioural science systematically into public health practice requires changes throughout the public health system; from priorities set by national public health leaders to the way in which relevant evidence is disseminated. Framing factors affecting use of behavioural science evidence using the TDF is helpful for identifying the range of interventions and support needed to affect change.
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Key Words
- BCTs, behaviour change techniques
- Behaviour change
- Behavioural science
- COP, communities of practice
- EBPH, evidence based public health
- EIDM, evidence informed decision making
- Evidence
- NCD, non-communicable disease
- NICE, National Institute for Health and Care Excellence
- PPI, patient and public involvement
- Public health
- Research translation
- TDF, Theoretical Domains Framework
- TUPE, transfer of undertakings (protection of employment)
- Theoretical Domains Framework
- WHO, World Health Organisation
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Affiliation(s)
| | | | - Katherine Brown
- Health Behaviour & Interventions Research, Centre for Advances in Behavioural Science, Faculty of Health & Life Sciences, Coventry University (Joint with Public Health Warwickshire), United Kingdom of Great Britain and Northern Ireland
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Abstract
As the cirrhosis progresses, development of complication like ascites, hepatic encephalopathy, variceal bleeding, kidney dysfunction, and hepatocellular carcinoma signify increasing risk of short term mortality. Malnutrition and muscle wasting (sarcopenia) is yet other complications that negatively impact survival, quality of life, and response to stressors, such as infection and surgery in patients with cirrhosis. Conventionally, these are not routinely looked for, because nutritional assessment can be a difficult especially if there is associated fluid retention and/or obesity. Patients with cirrhosis may have a combination of loss of skeletal muscle and gain of adipose tissue, culminating in the condition of "sarcopenic obesity." Sarcopenia in cirrhotic patients has been associated with increased mortality, sepsis complications, hyperammonemia, overt hepatic encephalopathy, and increased length of stay after liver transplantation. Assessment of muscles with cross-sectional imaging studies has become an attractive index of nutritional status evaluation in cirrhosis, as sarcopenia, the major component of malnutrition, is primarily responsible for the adverse clinical consequences seen in patients with liver disease. Cirrhosis is a state of accelerated starvation, with increased gluconeogenesis that requires amino acid diversion from other metabolic functions. Protein homeostasis is disturbed in cirrhosis due to several factors such as hyperammonemia, hormonal, and cytokine abnormalities, physical inactivity and direct effects of ethanol and its metabolites. New approaches to manage sarcopenia are being evolved. Branched chain amino acid supplementation, Myostatin inhibitors, and mitochondrial protective agents are currently in various stages of evaluation in preclinical studies to prevent and reverse sarcopenia, in cirrhosis.
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Key Words
- (PG) SGA, patient-generated SGA
- AMPK, 5′ adenosine monophosphate-activated protein kinase
- ASPEN, American Society of Parenteral and Enteral Nutrition
- ATP, adenosine triphosphate
- Akt/PKB, serine/threonine-specific protein kinase B
- BIA, bio-electric impedance analysis
- BMC, bone mineral content
- BMI, body mass index
- CT, computed tomography
- DDLT, deceased donor liver transplantation
- DRM, disease-related malnutrition
- DXA, dual X-ray absorptiometry
- ESPEN, European Society of Parenteral and Enteral Nutrition
- FFI, Fried Frailty Index
- FFM, fat free mass
- FFMI, fat free mass index
- FM, fat mass
- HE, hepatic encephalopathy
- LDLT, living donor liver transplant
- LST, lean soft tissue
- MAC, mid arm circumference
- MAMC, mid arm muscle circumference
- MELD, model for end-stage liver disease
- MNA, Mini Nutritional Assessment
- MRI, magnetic resonance imaging
- NASH, non-alcoholic steatohepatitis
- PCM, protein-calorie nalnutrition
- REE, resting energy expenditure
- RQ, respiratory quotient (or RQ or respiratory coefficient)
- SGA, Subjective Global Assessment
- SMI, Skeletal Muscle Index
- SPPB, Short Physical Performance Battery
- TIPS, trans jugular intrahepatic portocaval shunts
- TNF, tumour necrosis factor
- TSF, triceps skin fild thickness
- WHO, World Health Organisation
- YPA, total psoas area
- aKG, alfa keto glutarate
- cirrhosis
- mTORC1, mammalian target of rapamycin complex 1
- nutrition
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Affiliation(s)
- Anil C. Anand
- Address for correspondence: Anil C. Anand, Senior Consultant (Gastroenterology & Hepatology), Indraprastha Apollo Hospital, New Delhi 110076, India.Anil C. Anand, Senior Consultant (Gastroenterology & Hepatology), Indraprastha Apollo HospitalNew Delhi110076India
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24
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Shariff MIF, Kim JU, Ladep NG, Gomaa AI, Crossey MME, Okeke E, Banwat E, Waked I, Cox IJ, Williams R, Holmes E, Taylor-Robinson SD. The Plasma and Serum Metabotyping of Hepatocellular Carcinoma in a Nigerian and Egyptian Cohort using Proton Nuclear Magnetic Resonance Spectroscopy. J Clin Exp Hepatol 2017; 7:83-92. [PMID: 28663670 DOI: 10.1016/j.jceh.2017.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/01/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Previous studies have observed disturbances in the 1H nuclear magnetic resonance (NMR) blood spectral profiles in malignancy. No study has metabotyped serum or plasma of hepatocellular carcinoma (HCC) patients from two diverse populations. We aimed to delineate the HCC patient metabotype from Nigeria (mostly hepatitis B virus infected) and Egypt (mostly hepatitis C virus infected) to explore lipid and energy metabolite alterations that may be independent of disease aetiology, diet and environment. METHODS Patients with HCC (53) and cirrhosis (26) and healthy volunteers (19) were recruited from Nigeria and Egypt. Participants provided serum or plasma samples, which were analysed using 600 MHz 1H NMR spectroscopy with nuclear Overhauser enhancement spectroscopy pulse sequences. Median group spectra comparison and multivariate analysis were performed to identify regions of difference. RESULTS Significant differences between HCC patients and healthy volunteers were detected in levels of low density lipoprotein (P = 0.002), very low density lipoprotein (P < 0.001) and lactate (P = 0.03). N-acetylglycoproteins levels in HCC patients were significantly different from both healthy controls and cirrhosis patients (P < 0.001 and 0.001). CONCLUSION Metabotype differences were present, pointing to disturbed lipid metabolism and a switch from glycolysis to alternative energy metabolites with malignancy, which supports the Warburg hypothesis of tumour metabolism.
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Key Words
- 1-D, One-dimensional
- 1H NMR, proton nuclear magnetic resonance
- AFP, α-fetoprotein
- ALP, Alkaline phosphatase
- ALT, Alanine transaminase
- CT, Computed Tomography
- EDTA, Ethylenediaminetetraacetic acid
- ELISA, Enzyme-linked immunosorbent assay
- Egypt
- FID, Free induction decays
- HBV, Hepatitis B virus
- HBsAg, Hepatitis B surface antigen
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- IDL, Intermediate density lipoprotein
- IQR, Interquartile ranges
- JUTH, Jos University Teaching Hospital
- LDL, Low density lipoprotein
- MRI, Magnetic resonance imaging
- NOESY, Nuclear Overhauser enhancement spectroscopy
- Nigeria
- PC, Principal component
- PCA, Principal components analysis
- PLS-DA, Partial least squared discriminant analysis
- PPARα, Peroxisome proliferator-activated receptor α
- RD, Relaxation delay
- US, Ultrasonography
- VLDL, Very low density lipoprotein
- WHO, World Health Organisation
- hepatocellular carcinoma
- ppm, Parts per million
- proton nuclear magnetic resonance spectroscopy
- serum metabotype
- tm, Mixing time
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25
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Alikian M, Gale RP, Apperley JF, Foroni L. Molecular techniques for the personalised management of patients with chronic myeloid leukaemia. Biomol Detect Quantif 2017; 11:4-20. [PMID: 28331814 PMCID: PMC5348117 DOI: 10.1016/j.bdq.2017.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 12/28/2016] [Accepted: 01/18/2017] [Indexed: 12/25/2022]
Abstract
Chronic myeloid leukemia (CML) is the paradigm for targeted cancer therapy. RT-qPCR is the gold standard for monitoring response to tyrosine kinase-inhibitor (TKI) therapy based on the reduction of blood or bone marrow BCR-ABL1. Some patients with CML and very low or undetectable levels of BCR-ABL1 transcripts can stop TKI-therapy without CML recurrence. However, about 60 percent of patients discontinuing TKI-therapy have rapid leukaemia recurrence. This has increased the need for more sensitive and specific techniques to measure residual CML cells. The clinical challenge is to determine when it is safe to stop TKI-therapy. In this review we describe and critically evaluate the current state of CML clinical management, different technologies used to monitor measurable residual disease (MRD) focus on comparingRT-qPCR and new methods entering clinical practice. We discuss advantages and disadvantages of new methods.
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Key Words
- ABL1, Abelson murine leukaemia virus
- ALL, acute lymphoblastic leukaemia
- AP, accelerated phase
- ARQ, armored RNA Quant
- ATP, adenosine triphosphate
- BC, blast crisis
- BCR, breakpoint cluster region
- BM, bone marrow
- BMT, bone marrow transplantation
- Bp, base pair
- CAP, College of American Pathology
- CES, capillary electrophoresis sequencing
- CML
- CML, chronic myeloid leukaemia
- CMR, complete molecular response/remission
- CP, chronic phase
- DESTINY, De-Escalation and Stopping Treatment of Imatinib, Nilotinib or sprYcel in Chronic Myeloid Leukaemia
- DNA, deoxyribonucleic acid
- EAC, Europe Against Cancer
- ELN, European Leukaemia Net
- EURO-SKI, European Stop Tyrosine Kinase Inhibitor Study
- GUSB, glucuronidase beta gene
- IC, inhibotory concentration
- IRIS, interferon and cytarabine versus STI571
- IS, International Scale
- InDels, insertions and deletions
- KDa, Kilo Dalton
- Kbp, Kilo Base Pairs
- LPC, leukemic progenitor cells
- LSC, leukemic stem cell
- LoD, limit of detection
- LoQ, limit of quantification
- M-bcr, major-breakpoint cluster region
- MMR, major molecular response/remission
- MR, deep molecular response/remission
- MRD
- MRD, minimal residual disease
- Mbp, mega base pair
- Molecular monitoring
- NCCN, National Comprehensive Cancer Network
- NEQAS, National External Quality Assessement Service
- NGS
- NGS, next generation sequencing
- NTC, No Template Control
- PB, Peripheral Blood
- PCR, Polymerase Chain Reaction
- PFS, Progression Free Survival
- Ph, Philadelpia
- Q-PCR, quantitative polymerase chain reaction
- QC, Quality Control
- RT, reverse transcription
- RT-dPCR, reverse transcription-digital polymerase chain reaction
- RT-qPCR, reverse transcription-quantitative polymerase chain reaction
- SCT, stem cell transplant
- SMRT, single-molecule real-time sequencing
- STIM, stop imatinib
- TKD, tyrosine kinase domain
- TKI, tyrosine kinase inhibitor
- WHO, World Health Organisation
- ZMW, zero-mode wave-guided
- allo-SCT, Allogeneic Stem Cell Transplantation
- cDNA, coding or complimentary DNA
- dMIQE, Minimum Information for Publication of Quantitative Digital PCR Experiments
- dPCR
- dPCR, digital polymerase chain reaction
- emPCR, emulsion PCR
- gDNA, genomic deoxyribonucleic acid
- m-bcr, minor-breakpoint cluster region
- mRNA, messenger RNA
- nM, manomolar
- μ-bcr, micro-breakpoint cluster region
- μg, microgram
- μl, microliter
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Affiliation(s)
- Mary Alikian
- Centre for Haematology, Department of Medicine, Imperial College London Hammersmith Hospital, London UK; Imperial Molecular Pathology, Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Robert Peter Gale
- Centre for Haematology, Department of Medicine, Imperial College London Hammersmith Hospital, London UK
| | - Jane F Apperley
- Centre for Haematology, Department of Medicine, Imperial College London Hammersmith Hospital, London UK
| | - Letizia Foroni
- Centre for Haematology, Department of Medicine, Imperial College London Hammersmith Hospital, London UK
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26
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Turner HC, Truscott JE, Bettis AA, Hollingsworth TD, Brooker SJ, Anderson RM. Analysis of the population-level impact of co-administering ivermectin with albendazole or mebendazole for the control and elimination of Trichuris trichiura. Parasite Epidemiol Control 2016; 1:177-87. [PMID: 27430028 DOI: 10.1016/j.parepi.2016.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Soil-transmitted helminth (STH) infections are predominately controlled by providing children with preventive chemotherapy with either albendazole or mebendazole. However, neither has a high efficacy against Trichuris trichiura. This low efficacy limits the overall effectiveness of the current STH control programmes against T. trichiura. It has been demonstrated that co-administering ivermectin with albendazole or mebendazole significantly increases the efficacy of current treatments, which may increase the overall effectiveness of control programmes. Methods Using a STH transmission mathematical model, we evaluated the potential impact of co-administering ivermectin with albendazole or mebendazole to treat T. trichiura within a preventive chemotherapy programme targeting children (2–15 year olds). We evaluated the impact in terms of reduction in prevalent infections, mean worm burden, and prevalence of heavy infections. Results Although the current treatment strategy reduced T. trichiura worm burden and prevalence of heavy infections, due to their poor efficacy the long term impact of preventive chemotherapy for children was smaller compared to the other STH. Co-administering ivermectin increased the projected impact of the preventive chemotherapy programme in terms of all three of the explored metrics, practically in high transmission settings. Furthermore, ivermectin co-administration greatly increased the feasibility of and timeframe for breaking transmission. Conclusions Co-administering ivermectin notably increased the projected impact of preventive chemotherapy in high transmission settings and increased the feasibility for breaking transmission. This has important implications for control programmes, some of which may be shifting focus from morbidity control to interruption of transmission, and some of which may be logistically unable to provide preventive chemotherapy twice a year as recommended. However, the benefit of co-administering ivermectin is limited by the fact that 2–5 year olds are often ineligible to receive treatment. The impact of chemotherapy against Trichuris is smaller compared to what can be seen for the other soil-transmitted helminths. Co-administering ivermectin increases the projected impact of preventive chemotherapy. It also has the potential to interrupt transmission in some settings.
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Key Words
- ALB, albendazole
- Control
- ERRs, egg reduction rates
- Elimination
- IVM, ivermectin
- Ivermectin co-administration
- MBZ, mebendazole
- Mass drug administration
- Pre-SAC, preschool-aged
- R0, basic reproductive number
- SAC, school-aged children
- STH, soil-transmitted helminth
- Soil-transmitted helminth
- Trichuris trichiura
- WASH, water, sanitation and hygiene
- WHO, World Health Organisation
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Bradshaw G, Sutherland HG, Camilleri ET, Lea RA, Haupt LM, Griffiths LR. Genetic and epigenetic variants in the MTHFR gene are not associated with non-Hodgkin lymphoma. Meta Gene 2015; 6:91-5. [PMID: 26629414 PMCID: PMC4634355 DOI: 10.1016/j.mgene.2015.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 08/13/2015] [Revised: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
The methylenetetrahydrofolate reductase (MTHFR) gene codes for the MTHFR enzyme which plays a key role in the pathway of folate and methionine metabolism. Polymorphisms of genes in this pathway affect its regulation and have been linked to lymphoma. In this study we examined whether we could detect an association between two common non-synonymous MTHFR polymorphisms, 677C > T (rs1801133) and 1298A > C (rs1801131), and susceptibility to non-Hodgkin lymphoma (NHL) in an Australian case-control cohort. We found no significant differences between genotype or allele frequencies for either polymorphisms between lymphoma cases and controls. We also explored whether epigenetic modification of MTHFR, specifically DNA methylation of a CpG island in the MTHFR promoter region, is associated with NHL using blood samples from patients. No difference in methylation levels was detected between the case and control samples suggesting that although hypermethylation of MTHFR has been reported in tumour tissues, particularly in the diffuse large B-cell lymphoma subtype of NHL, methylation of this MTHFR promoter CpG island is not a suitable epigenetic biomarker for NHL diagnosis or prognosis in peripheral blood samples. Further studies into epigenetic variants could focus on genes that are robustly associated with NHL susceptibility.
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Key Words
- 1298A > C polymorphism
- 677C > T polymorphism
- Bp, base pairs
- CGIs, CpG Islands
- CIMP, CpG island methylator phenotype
- DLBCL, diffuse large b-cell lymphoma
- DNA methylation
- DNA, deoxyribose nucleic acid
- EDTA, ethylenediaminetetra acetic acid
- FL, follicular lymphoma
- HRM, high resolution melt
- MTHFR
- MTHFR, methylenetetrahydrofolate reductase
- NHL, non-Hodgkin lymphoma
- Non-Hodgkin lymphoma
- OR, odds ratio
- PCR, polymerase chain reaction
- RFLP, restriction fragment length polymorphism
- SD, standard deviation
- SNP, single nucleotide polymorphism
- THF, tetrahydrofolate
- WHO, World Health Organisation
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Affiliation(s)
| | | | | | | | | | - Lyn R. Griffiths
- Corresponding author at: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane QLD, Australia.Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneQLDAustralia
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Ruggiero A, De Spiegelaere W, Cozzi-Lepri A, Kiselinova M, Pollakis G, Beloukas A, Vandekerckhove L, Strain M, Richman D, Phillips A, Geretti AM. During Stably Suppressive Antiretroviral Therapy Integrated HIV-1 DNA Load in Peripheral Blood is Associated with the Frequency of CD8 Cells Expressing HLA-DR/DP/DQ. EBioMedicine 2015; 2:1153-9. [PMID: 26498496 PMCID: PMC4588402 DOI: 10.1016/j.ebiom.2015.07.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 05/29/2015] [Revised: 07/13/2015] [Accepted: 07/17/2015] [Indexed: 11/26/2022] Open
Abstract
Background Characterising the correlates of HIV persistence improves understanding of disease pathogenesis and guides the design of curative strategies. This study investigated factors associated with integrated HIV-1 DNA load during consistently suppressive first-line antiretroviral therapy (ART). Method Total, integrated, and 2-long terminal repeats (LTR) circular HIV-1 DNA, residual plasma HIV-1 RNA, T-cell activation markers, and soluble CD14 (sCD14) were measured in peripheral blood of 50 patients that had received 1–14 years of efavirenz-based or nevirapine-based therapy. Results Integrated HIV-1 DNA load (per 106 peripheral blood mononuclear cells) was median 1.9 log10 copies (interquartile range 1.7–2.2) and showed a mean difference of 0.2 log10 copies per 10 years of suppressive ART (95% confidence interval − 0.2, 0.6; p = 0.28). It was positively correlated with total HIV-1 DNA load and frequency of CD8+HLA-DR/DP/DQ+ cells, and was also higher in subjects with higher sCD14 levels, but showed no correlation with levels of 2-LTR circular HIV-1 DNA and residual plasma HIV-1 RNA, or the frequency of CD4+CD38+ and CD8+CD38+ cells. Adjusting for pre-ART viral load, duration of suppressive ART, CD4 cell counts, residual plasma HIV-1 RNA levels, and sCD14 levels, integrated HIV-1 DNA load was mean 0.5 log10 copies higher for each 50% higher frequency of CD8+HLA-DR/DP/DQ+ cells (95% confidence interval 0.2, 0.9; p = 0.01). Conclusions The observed positive association between integrated HIV-1 DNA load and frequency of CD8+DR/DP/DQ+ cells indicates that a close correlation between HIV persistence and immune activation continues during consistently suppressive therapy. The inducers of the distinct activation profile warrant further investigation. Data from a homogenously treated population with consistent virological suppression Integrated HIV-1 DNA load did not vary significantly by duration of therapy Integrated HIV-1 DNA load was not associated with markers of recent virus replication Integrated HIV-1 DNA load and CD8+HLA-DR/DP/DQ+ frequency were positively associated Subjects with top quartile integrated HIV-1 DNA load showed high sCD14 levels
Integrated HIV-1 DNA load remains constant in the peripheral blood of individuals receiving long-term suppressive antiretroviral therapy (ART). However, the mechanisms preventing decay of the reservoir remain unclear. We studied a cross-sectional population, defined by the duration of suppressive ART. Integrated HIV-1 DNA load did not differ significantly according to the duration of suppressive ART, and showed no association with direct or indirect markers of ongoing virus replication. Rather, there was an independent, positive association between integrated HIV-1 DNA load and the frequency of CD8 cells expressing the activation marker HLA-DR/DP/DQ. These cells appear to have important regulatory and effector function. Our findings add to growing evidence that immune activation sustains the HIV-1 reservoir during long-term suppressive ART.
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Key Words
- 2-LTR, 2-long terminal repeats
- ART, Anti-retroviral therapy
- Activation
- CMV, cytomegalovirus virus
- CRN, Clinical Research Network
- EBV, Epstein-Bar virus
- ELISA, enzyme-linked immune-enzymatic assay
- HIC, HIV-1 controllers
- HIV-1 VL, HIV-1 viral load
- HIV-1, Human Immunodeficiency Virus type 1
- HLA, Human Leukocyte Antigen
- Integration
- LPS, lipopolysaccharide
- NIHR, National Institute for Health Research
- NNRTI, Non-nucleoside reverse-transcriptase inhibitors
- NRTI, nucleoside/nucleotide reverse transcriptase inhibitors
- PBMCs, Peripheral blood mononuclear cells
- PCR, Polymerase chain reaction
- PFA, paraformaldehyde
- Persistence
- Reservoir
- Suppression
- VLS, Viral Load Suppression
- WHO, World Health Organisation
- sCD14, soluble CD14
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Affiliation(s)
- Alessandra Ruggiero
- Department of Clinical Infection, Microbiology and Immunology (CIMI), Institute of Infection and Global Health (IGH), University of Liverpool, 8 West Derby Street, Liverpool L697BE, United Kingdom
| | - Ward De Spiegelaere
- HIV Translational Research Unit, Department of Internal Medicine, Ghent University and University Hospital Ghent, De Pintelaan 1859000, Ghent, Belgium
| | - Alessandro Cozzi-Lepri
- Department of Infection and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW32PF, United Kingdom
| | - Maja Kiselinova
- HIV Translational Research Unit, Department of Internal Medicine, Ghent University and University Hospital Ghent, De Pintelaan 1859000, Ghent, Belgium
| | - Georgios Pollakis
- Department of Clinical Infection, Microbiology and Immunology (CIMI), Institute of Infection and Global Health (IGH), University of Liverpool, 8 West Derby Street, Liverpool L697BE, United Kingdom
| | - Apostolos Beloukas
- Department of Clinical Infection, Microbiology and Immunology (CIMI), Institute of Infection and Global Health (IGH), University of Liverpool, 8 West Derby Street, Liverpool L697BE, United Kingdom
| | - Linos Vandekerckhove
- HIV Translational Research Unit, Department of Internal Medicine, Ghent University and University Hospital Ghent, De Pintelaan 1859000, Ghent, Belgium
| | - Matthew Strain
- VA San Diego Healthcare System and Center for AIDS Research, University of California San Diego, La Jolla, CA 92093, United States
| | - Douglas Richman
- VA San Diego Healthcare System and Center for AIDS Research, University of California San Diego, La Jolla, CA 92093, United States
| | - Andrew Phillips
- Department of Infection and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW32PF, United Kingdom
| | - Anna Maria Geretti
- Department of Clinical Infection, Microbiology and Immunology (CIMI), Institute of Infection and Global Health (IGH), University of Liverpool, 8 West Derby Street, Liverpool L697BE, United Kingdom
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Houghton D, Wilcox MD, Chater PI, Brownlee IA, Seal CJ, Pearson JP. Biological activity of alginate and its effect on pancreatic lipase inhibition as a potential treatment for obesity. Food Hydrocoll 2015; 49:18-24. [PMID: 26146432 PMCID: PMC4429962 DOI: 10.1016/j.foodhyd.2015.02.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/13/2014] [Accepted: 02/15/2015] [Indexed: 12/18/2022]
Abstract
Alginates are classed as a dietary fibre and have been shown to inhibit digestive enzymes in vitro, and therefore could be used as an obesity treatment. The current study aims to assess whether alginate in a bread vehicle maintains its inhibition properties despite cooking and digestion, and may therefore be used as a potential treatment for obesity. After 180 min in a model gut that replicates digestion in the mouth, stomach and small intestines alginate bread (AB), control bread (CB), CB with Manucol® DM alginate, free DM alginate and model gut solution were collected. DM, LFR 5/60 and SF200 were heated at 37 °C and 200 °C, with DM also heated at 50, 100 and 150 °C. Samples from the model gut and heated alginate were assessed for molecular size and inhibition properties using viscosity, gel filtration and a lipase turbidity assay. AB does not significantly increase viscosity in the model gut. Viscosity of alginate reduces beyond 100 °C, although alginate retains its inhibition properties up to 150 °C. Cooking into the bread does not reduce the molecular size of the alginate or affect its inhibition properties. These data demonstrate the robustness of alginates lipase inhibition despite the cooking process and digestion. Therefore adding alginate to a bread vehicle may have the potential in the treatment for obesity. Alginate in bread is undigested and recoverable in an in-vitro model gut. Alginate molecular size appears unaffected by cooking, digestion and extraction. Alginate retains its inhibition properties despite being heated at 37, 50, 100 and 150 °C. Alginate extracted from the model gut retains its inhibition properties.
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Affiliation(s)
- David Houghton
- Institute for Cell and Molecular Bioscience, Medical School, Newcastle University, Catherine Cookson Building, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Matthew D Wilcox
- Institute for Cell and Molecular Bioscience, Medical School, Newcastle University, Catherine Cookson Building, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Peter I Chater
- Institute for Cell and Molecular Bioscience, Medical School, Newcastle University, Catherine Cookson Building, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Iain A Brownlee
- Institute for Cell and Molecular Bioscience, Medical School, Newcastle University, Catherine Cookson Building, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Chris J Seal
- Institute for Cell and Molecular Bioscience, Medical School, Newcastle University, Catherine Cookson Building, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom ; Human Nutrition Research Centre, School of Agriculture, Food & Rural Development, Newcastle University, Catherine Cookson Building, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Jeffrey P Pearson
- Institute for Cell and Molecular Bioscience, Medical School, Newcastle University, Catherine Cookson Building, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
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