bluuebunny/crossref_metadata_2025 huggingface dataset:
Spatio-temporal variation of malaria hotspots in central Senegal, 2008-2012
Authors: DIENG Sokhna , Ba El Hadj , Cissé Badara , Sallah Kankoe , Guindo Abdoulaye , Ouedraogo Boukary , Piarroux Martine , Rebaudet Stanislas , Piarroux Renaud , Landier Jordi , Sokhna Cheikh , Gaudart Jean
Published: August 2019

Background

In malaria endemic areas, identifying spatio-temporal hotspots is becoming an important element of innovative control strategies targeting transmission bottlenecks. The aim of this work was to describe the spatio-temporal variation of malaria hotspots in central Senegal, and to identify the meteorological, environmental, and preventive factors that influence this variation.

Methods

The weekly incidence of malaria cases recorded from 2008 to 2012 in 575 villages of central Senegal (total population 523,908) during a trial of Seasonal Malaria Chemoprevention (SMC), were analysed. Data on weekly rainfall and annual vegetation types were obtained for each village from remote sensing data. The time series of weekly cumulative malaria incidence for the entire study area was divided into periods of high and low transmission using change-point analysis. Malaria hotspots were detected for each period with the SaTScan method. The effects of rainfall, vegetation type, and SMC intervention on the spatio-temporal variation of malaria hotspots were assessed using a General Additive Mixed Model.

Results

The cumulative malaria incidence rate for the entire area ranged from 0 to 115.34 cases/100,000 person weeks during the study period. During high transmission periods, the cumulative malaria incidence rate varied between 7.53 and 38.1 cases/100,000 person-weeks, and the number of hotspot villages varied between 62 and 147. During low transmission periods, the cumulative malaria incidence rate varied between 0.83 and 2.73 cases/100,000 person-weeks, and the number of hotspot villages varied between 10 and 43. Villages with SMC were less likely to be hotspots (OR=0.48, IC95%: 0.33-0.68). According to the spatial interpolation, 2 zones located in the south of the study area had the highest risk of being a hotspot (ORmin=1.90, 95%CI: 1.02-3.56; ORmax=60.65, 95%CI: 26.86-136.95). The association between rainfall and hotspot status was non-linear and depended on vegetation type and the amount of rainfall.

Conclusion

In our study, malaria hotspots varied over space and time according to a combination of meteorological, environmental, and preventive factors. Our analysis shows also the importance of adapting control strategies to the local context and dynamic patterns. Moreover, the issue of spatial hotspots and foci of malaria persistence during LTPs needs to be further addressed.
Global trends in survival from brain tumours in adolescents and young adults: a systematic review.
Authors: Girardi Fabio , Allemani Claudia , Coleman Michel P
Published: August 2019

Background
Brain tumours represent an important cause of cancer-related death in adolescents and young adults. Most are diagnosed in low-income and middle-income countries. We aimed to conduct the first systematic review of time trends and geographical variation in survival in this age group.

Methods
We included observational studies describing population-based survival from astrocytic tumours in patients aged 15-39 years. We queried six electronic databases from database inception to 30 September 2018. This review is registered with PROSPERO, number CRD42018111981.

Results
Among 5,245 retrieved records, 20 studies fulfilled the inclusion criteria. Only one study was partly conducted in middle-income countries. Five-year survival from astrocytoma (broad morphology group) varied between 48% and 71% (1973-2004), without clear trends or geographic differences. Adolescents with astrocytoma had better outcomes than young adults, but survival values were similar when non-malignant tumours were excluded.

During 2002-2007, five-year survival for WHO grade I-II tumours was in the range 75-93% in England, Germany, and the US, but lower in South-Eastern Europe (59%).

Five-year survival for anaplastic astrocytoma varied between 40% and 55% (2002-2007). Five-year survival from glioblastoma was in the range 15-23% (1991-2009).

Conclusions
Survival from astrocytic tumours remained somewhat steady over time, with little change between 1973 and 2009. Survival disparities were difficult to examine, because nearly all the studies were conducted in affluent countries. Studies often adopted the International Classification of Childhood Cancer, which, however, did not allow to accurately describe variation in survival. Larger studies are warranted, including under-represented populations and providing more recent survival estimates.

Keywords
Population-based survival, brain tumours, adolescents, young adults, time trends.
Clinicopathological characteristics and cancer-specific survival prediction of Large cell lung cencer: a population-based study
Authors: Shi Yafei , Chen Wei , Li Chunyu , Qi Shuya , Zhou Xiaowei , Zhang Yujun , Li Ying , Li Guohui
Published: August 2019

Background:The features and survival outcome large cell lung cancer(LCLC) are scarce reported due to its low incidence,as a result, the prognoses of LCLC remain unclear.The aim of this study was to describe the demographic and clinical characteristics of large cell lung cancer with a population-base database and find the prognosis factors for cancer-specific survival(CSS) of the LCLC patients.Besides,a nomogram would be developed and independently validated to predict the CSS for LCLC based on the found prognosis factors.
Methods: We extracted LCLC patients information from the Surveillance, Epidemiology, and End Results(SEER) database(2005-2014) and summarized the characteristic of the extracted factors.We used the Cox proportional hazards regression to find the prognosis factors for LCLC patients and develop the nomogram based on these in a splitted train cohort from the extracted data.The validation of the developed nomogram would be performed in an independent validation cohort from the extracted data, in which the C-index and the average of the time-dependent area under the receiver operating characteristic curve(time-dependent AUC) for CSS in 1-year, 3-year and 5-year would be calculated.The calibration curves would be drawn to visualize the performance of the established nomogram.
Results: In result,4936 patients with LCLC were identified from the SEER database. Nearly half of LCLC patients were diagnosis with stage IV,only approximately 20% of patients was performed surgery.The prognosis factors influence the LCLC patients included age, sex,American Joint Committee on Cancer (AJCC) stage,race,surgery, tumour size and marital status.The calculated C-index was 0.701±0.01,mean time-dependent AUC for CSS in 1-year, 3-year and 5-year was 0.88.The calibrate curve showed that the gap between the predicted and observed CSS for 1-year, 3-year and 5-year was small.
Conclusions:Sex,age,race,marital status,AJCC stage, surgery and tumour size are all the independent prognostic factors for CSS of the LCLC.The established nomogram can provide more precise evaluation for the survival of LCLC patients,and help the clinicians to make individual management.
Cardiac biomarkers for early detection of cardiac involvement in children with Kawasaki disease: a cross-sectional study
Authors: Molaei Akbar , Khomahani Azizollah , Ghaffari Shamsi , Sadeghi-Shabestari Mahnaz , Sadat-Ebrahimi Seyyed-Reza
Published: August 2019

Background

Kawasaki disease (KD), which is the second most prevalent vasculitis disease in children after IgA vasculitis, can cause serious cardiovascular complications. Early detection of cardiac involvement in KD is an essential part in managing and preventing the cardiac sequels. Although some cardiac biomarkers such as cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) have recently been suggested for early diagnosis of cardiac involvement in patients with KD, their applicability is still unclear. Thus, this study aimed to compare the levels of cTnI and NT-proBNP in KD child patients with or without cardiac involvement.

Methods

In this cross sectional study, 32 children with KD who were admitted to the children teaching hospital of Tabriz University of Medical Sciences between April 2015 and April 2018, were consecutively included in the study. For all involved children, the coronary artery involvement defined as coronary artery aneurysm or perivascular brightness of coronary arteries was examined by transthoracic echocardiography, and their serum levels of NT-proBNP and cTnI were measured.

Results

Of 32 enrolled patients, 4 (9.4%) had cardiac involvement including 3 patients with perivascular brightness of coronary arteries and 1 patient with small aneurysm of the coronary arteries. In all study patients, the cTnI levels were lower than 0.35 and the NT-proBNP assessments revealed an average of 678.5 pg/ml. Children with cardiac involvement had significantly higher NT-proBNP (p-value, 0.001). ROC analysis for power of the NT-proBNP in predicting the cardiac involvement, revealed an excellent power for NT-proBNP (AUC=1.000, p=0.001). Both sensitivity and specificity of NT-proBNP at the optimum cut-off point of 1354 pg/ml were 100 percent.

Conclusion

Unlike the cTnI, the NT-proBNP can serve as an excellent objective test for early detection of cardiac involvement. Therefore, in KD-patients with high levels of NT-proBNP additional therapy and closer follow up should be considered.
Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan: evidence from two longitudinal cohort studies 15 years apart
Authors: Hansen Chelsea L , McCormick Benjamin JJ , Azam Syed Iqbal , Ahmed Khalil , Baker Julia M , Hussain Ejaz , Jahan Assis , Jamison Alexandra F , Knobler Stacey L , Samji Nahida , Shah Wasiat , Spiro David , Thomas Elizabeth D , Viboud Cecile , Rasmussen Zeba A
Published: August 2019

Background

Oshikhandass is a rural village in northern Pakistan where a verbal autopsy study from 1989-1991 showed that diarrhea and pneumonia were the top causes of under-5 mortality. Intensive surveillance, active community health education and child health interventions were delivered in 1989-1996; here we assess if any improvements in under-5 mortality, diarrhea, and pneumonia over this period continued 15 years later.

Methods

Two open-cohort studies in Oshikhandass from 1989-1996 (Study 1) and 2011-2014 (Study 2) enrolled all children under age 60 months. Study staff trained using WHO guidelines conducted weekly household surveillance and promoted knowledge on causes and management of diarrhea and pneumonia. Information about household characteristics and socioeconomic status was collected. Hurdle models were constructed to examine putative risk factors for diarrhea and pneumonia.

Results

Against a backdrop of considerable change in the socioeconomic status of the community, under-5 mortality, which declined over the course of Study 1 (from 114.3 to 79.5 deaths/1000 live births between 1989 and 1996), exceeded Sustainable Development Goal 3 by Study 2 (19.6 deaths/ 1000 live births). Reductions in diarrhea prevalence (20.3 to 2.2 days/ Child Year [CY]), incidence (2.1 to 0.5 episodes/ CY), and number of bloody diarrhea episodes (18.6% to 5.2%) seen during Study 1, were sustained in Study 2. Pneumonia incidence was 0.5 episodes /CY in Study 1 and 0.2/CY in Study 2; only 5% of episodes were categorized as severe or very severe in both studies. While no individual factors predicted a statistically significant difference in diarrhea or pneumonia episodes, the combined effect of water, toilet and house construction was associated with a significant decrease in diarrhea; higher household income was the most protective factor for pneumonia.

Conclusions

We report a 2-3-fold decrease in childhood morbidity and mortality from diarrhea and pneumonia in a remote rural village in Pakistan. Household water and sanitation predicted small differences in diarrhea morbidity, but the decrease in disease burden over the first study suggests that promoting tight linkages between health workers and the community to increase knowledge and management of child health can lead to sustainable reductions in child morbidity and mortality.
Prenatal sFlt-1/PlGF value for prediction of adverse neonatal outcome of isolated ultrasonic small-for-gestational-age fetus in normotensive pregnant women: A prospective cohort study
Authors: Shim So Hyun , Jeon Haeng Jun , Ryu Hye Jin , Kim So Hyun , Min Seung Gi , Kang Min Kyu , Park Hee Jin , Cha Dong Hyun
Published: August 2019

Background

Not only preeclampsia but also small-for-gestational-age (SGA) neonates in the absence of preeclampsia are at increased risk of morbidity and mortality. Early recognition of fetuses at increased risk of being growth-restricted enables more appropriate surveillance and optimization of management for reduced risk of adverse neonatal outcomes. We investigated potential value of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio, estimated in late-second and early-third trimester respectively, for prediction of SGA neonates with poor neonatal outcome.

Methods

Included in this case control study were 530 singleton pregnant women who had attended the prenatal screening program at single institution between January 2011 and March 2012. The maternal serum levels of sFlt-1 and PlGF at 24 to 28+6weeks and 29 to 36+6weeks of gestation were measured for comparing control and SGA group.

Results

After excluding 22 preeclampsia cases, 47 SGA group and 461 control-group were included. Mean gestational age at delivery in SGA group was 37.76 ± 2.05weeks, which showed no significant difference comparing to control group (38.43 ± 2.1weeks, p=0.122). The sFlt-1/PlGF ratios at late-second trimester and early-third trimester were both higher in the SGA group than control group (7.62 vs 3.74, p=0.63; 28.62 vs 14.42, p=0.037) and especially sFlt-1/PlGF ratio at early-third trimester was significantly higher in the SGA group. Among SGA group, 17 neonates had adverse neonatal outcome (36.1%, 17/47). Both sFlt-1/PlGF ratios in each trimester were also higher in poor SGA group than control group (6.73 vs 3.77, p = 0.379; 109.12 vs 15.27, p=0.002). As gestational age advances, rapid increase in sflt-1/PlGF ratio detected in poor SGA group comparing to SGA group with no adverse outcome. A cutoff value of 28.15 for the sFlt-1/PlGF ratio at 29 to 36+6weeks significantly predicted SGA neonates who had adverse outcome, with sensitivity and specificity of 76.9% and 88%, respectively.

Conclusion

In this study, sFlt-1/PlGF ratio of SGA with adverse neonatal outcome group was significantly higher than control group. This study suggests the feasibility of the sFlt-1/PlGF ratio as helpful objective measurement for predicting the adverse SGA neonatal outcome by providing sFlt-1/PlGF cutoff value, besides ultrasound biometry measurement.
The First Study of Successful Pregnancies in Chinese patients with Phenylketonuria
Authors: Lin Wang , Fang Ye , Hui Zou , Kundi Wang , Zhihua Chen , Qin Hui , Bingjuan Han , Weimin Yu , Chun He , Xiaowen Li , Ming Shen
Published: August 2019

Since the inception of newborn screening programs in China in the 1990s, pregnancy among patients with inherited, metabolic disorders has become more common. This study explores the management and outcomes of planned, full-term pregnancies in patients with phenylketonuria (PKU). Married patients from 2012 to 2017 were enrolled to receive prenatal counseling and their partners were screened for heterozygous genes of phenylalanine hydroxylase (PAH). Daily intake of phenylalanine (Phe), blood Phe, obstetrical data, and offspring outcomes (e.g. developmental quotients [DQs]) were recorded. None of the paternal parents were heterozygous for PAH. A total of 6 neonates were successfully delivered, 5 males and 1 female. The mean ±SD (range) age of the mother at delivery was 26.3±4.7 (range:21.1-32.5) years old. The mean duration of Phe control before pregnancy was 5.5±1.3 (range:3.1-6.5) months. During pregnancy, the proportion of time during which blood Phe concentrations were within the clinically-recommended target range (120–360 μmol/L) was 63.2-83.5%. For the two babies born to patients with <70% of their pregnancy within the blood Phe target range, both birth weight and DQs were lower than the other four births. This is the first report of women in China with PKU who successfully gave birth to clinically healthy babies. Infant outcomes were related to maternal blood Phe management prior to and during pregnancy. In maternal PKU patients with poor compliance to dietary treatment, sapropterin dihydrochloride（6R-BH4）may be an option to improve the management of blood Phe levels.
Knowledge of Preconception Care and Associated Factors among Pregnant Mothers with Pre-existing Diabetes Mellitus in selected Governmental Hospitals, Addis Ababa Ethiopia
Authors: Kassie Aychew , Gebretensaye Tigistu Gebreyohannis , Abebe Mesfin
Published: August 2019

Background: Many women with diabetes mellitus experience high rates of unintended pregnancies, infant morbidity and mortality and preventable birth defects.Thus, preconception care offers the potential for earlier risk assessment and intervention that can benefit women before pregnancy and ensure the healthiest possible start for the newborn child. The aim of this study is to assess the knowledge and experience of preconception care and associated factors among pregnant mothers with pre-existing diabetes mellitus.
Methods: Facility based quantitative cross-sectional study design was employed among 142 conveniently selected pregnant women between March 11and April 12, 2018. Logistic regression including bivariate and multivariate analysis considering 95% CI was utilized to examine association between dependent and independent variables. P-value < 0.05 was considered statistically significant.
Result: this study found that 67(42.7%) of pregnant women with pre-existing diabetes mellitus had good knowledge on preconception care. Educational level, occupation and duration of diabetes was associated with knowledge about preconception care AOR= 0.24 [0.065, 0.828], AOR= 0.042[0.102(0.011-0.918] and AOR= 0.035 [3.599(.095-11.833] respectively.
Conclusion: women’s knowledge on preconception care in this study is low. Education, occupation and duration of diabetes were factors associated with knowledge of preconception care. Establishment of preconception care strategies addressing all components of the care and increasing women’s knowledge about preconception care is an important component to ensure prevention of potential risks.
Implementation of a new program of gestational diabetes screening and management in Morocco: A qualitative exploration of health workers’ perceptions
Authors: Utz Bettina , Assarag Bouchra , Lekhal Touria , Damme Wim Van , De Brouwere Vincent
Published: August 2019

Background

Gestational diabetes mellitus (GDM) is associated with an increased risk for a future diabetes mellitus in women and their children. As linkage between maternal health and non-communicable diseases, antenatal care plays a key role in the primary and secondary prevention of GDM associated adverse outcomes. While implementing a locally adapted GDM screening and management approach through antenatal care services at the primary level of care, we assessed its acceptability by the implementing health care providers.

Methods

As part of a larger implementation effectiveness study assessing a decentralized gestational diabetes screening and management approach in the prefecture of Marrakech and the rural district of Al Haouz in Morocco, we conducted four focus group discussions with 29 primary health care providers and seven in-depth interviews with national and regional key informants. Looking at the main themes screening, diagnosis, treatment and service organization, we thematically analyzed the data using a combined de- and inductive approach.

Results

The intervention of screening and managing women with gestational diabetes added value to existing antenatal care services but presented an additional workload for first line health care providers. Lack of knowledge about gestational diabetes in the community but also by private health care providers demanded more time for counseling. Nurses had to adapt recommendation on diet to the socio-economic context of patients. Despite the additional task, especially nurses and midwives felt motivated by their gained capacity to detect and manage gestational diabetes and the ability to take decisions on follow-up.

Conclusions

Detection and initial management of gestational diabetes is an acceptable strategy to extend the antenatal care service offer in Morocco and to facilitate service access for affected pregnant women. Despite its additional workload, gestational diabetes management can contribute to the professional motivation of primary level health care providers.
Low Proportion of Women who came knowing their HIV Status at First Antenatal Care Visit, Uganda, 2012-2016: A Descriptive Analysis of Surveillance Data
Authors: Nakanwagi Miriam , Bulage Lilian , Kwesiga Benon , Ario Alex Riolexus , Birungi Doreen Agasha , Lukabwe Ivan , Matovu John Bosco , Taasi Geoffrey , Nabitaka Linda , Mugerwa Shaban , Musinguzi Joshua
Published: August 2019

Background

HIV testing is the cornerstone for all HIV care and support services, including Prevention of Mother to Child Transmission of HIV (PMTCT). The earlier women of reproductive age know their HIV status, the better informed their reproductive decisions and their infants’ outcomes may be. We analyzed trends in known current HIV status among pregnant women attending their first antenatal care visit (ANC1) in Uganda, 2012-2016.

Methods

We conducted secondary data analysis using District Health Information Software2 data on all pregnant women who came for ANC1 during 2012-2016. Women who brought documentation with them to ANC1 of an HIV test within the previous four weeks or an HIV care card as evidence of being in HIV care were considered as knowing their HIV status in antenatal care clinics. We calculated proportions of women with known current HIV status at ANC1, and described the linear trends both nationally and regionally. We used improved Poisson regression with generalized linear models to test the statistical significance of the trend.

Results

There was no significant difference in the number of women that attended ANC1 visits over the years 2012 to 2016. The proportion of women that came with known HIV status was highest at 6.9% in 2016 and this was an increasing trend (p<0.001). Most of the regions had an increase in trend except the West Nile and Mid-Eastern (p<0.001). The proportion of women that came knowing their HIV positive status at ANC1 is slightly higher than that of women that were newly tested HIV positive at ANC1 in 2015 and 2016.

Conclusion

Although the gap in women that come at ANC1 without knowing their HIV positive status might be reducing, still a large proportion of women who were infected with HIV did not know their status before their ANC1 HIV test, indicating a major public health gap. Therefore, more efforts are still required to achieve full PMTCT. In light of the considerable number that comes not knowing their HIV positive status at ANC1, we recommend advocacy for early ANC attendance and hence HIV testing so that timely PMTCT interventions can be made.
Age-related anxiety and self-assessment of perinatal depression risk: A web-based study
Authors: shibata Ayako , Shigemi Daisuke , Maruo Nobuyuki
Published: August 2019

Purpose: To investigate the relationship between pre- and postpartum anxiety and self-assessment of perinatal depression (PD) risk in pregnant women.
Methods: We recruited volunteers for an anonymous questionnaire survey using an app service for pregnant and nursing mothers (Luna Luna Baby, MTI Co Ltd) from November 19 to 30, 2018. The questionnaire consists of 30 items on anxiety during and after pregnancy. Multivariate logistic regression analysis was performed with age, occupation, history of pregnancy, and self-assessment of PD risk as explanatory variables. All statistical analyses were performed using Stata software, Version 15.0. The study was approved by the ethics committee.
Results: A total of 1987 pregnant women responded. In both pregnancy and postpartum periods, women aged 19 years or younger felt the most anxious about their financial situation (17/25, 68%). Women in their 20's to 30's were the most worried about the baby’s safety (1162/1893,60.1%). Those with a higher self-estimated risk of PD tended not to list the baby’s safety as an anxiety item, but listed money, financial situation, and mother's own health as concerns. The percentage of those who worried about the baby’s safety was significantly lower in women with a self-assessed PD risk of 90% or higher.
Conclusions: The causes of the anxiety in the pregnancy and postpartum periods a may be correlated with age and risk of PD. Health care providers may need to consider the possibility of PD development in pregnant women with high anxiety regarding their financial conditions, health, or raising children.
Mortality rate and associated factors among preterm babies born in Moshi, north – Tanzania: A prospective cohort study
Authors: Chengo Rose , Mowo Frida , Tarimo Clifford Silver , Mahande Michael Johnson
Published: August 2019

Introduction

Globally, approximately 15 million babies are born before term each year. Of these, more than 1 million die within the first 28 days of their life. Understanding the mortality rate and its predictors during neonatal period among preterm babies is crucial to help designing interventions to avert the situation. This study aimed to determine the neonatal mortality rate and associated factors among preterm babies born in Moshi Municipality, Tanzania.

Methodology

A prospective cohort study was conducted in three hospitals in Moshi Municipality from December 2016 to May 2017. All live births at gestational age of <37 weeks and those of <24 hours were studied. Babies who died prior to gestation age assessment and those whose mother did not consent were excluded. Cox regression model was used to estimate maternal and fetal factors associated with neonatal mortality. A p-value of <0.05 was considered statistically significant.

Results

A total of 311 of preterm babies were recruited from 265 mothers and were followed for 28 days. The neonatal mortality rate was 6.5deaths per 1,000 preterm live births (95% CI: 4.83-8.61). It was higher among extremely preterm babies compared to very preterm ones (HR: 38.24; 95% CI: 16.62-87.96) versus (HR: 8.01; 95% CI: 3.96-16.20) respectively. Apgar score of <7 at 1st minute (HR: 14.03; 95% CI: 7.27-27.06), respiratory distress syndrome (HR: 8.14; 95% CI: 4.27-15.54) and antepartum hemorrhage (HR: 3.32; 95% CI: 1.49-7.39) were significantly associated with neonatal mortality.

Conclusion

Preterm birth complication is the major cause of neonatal death in the study setting. Interventions to address the identified risk factors may reduce neonatal mortality among preterm babies.
Burden of stillbirths and associated factors in Yirgalem Hospital, Southern Ethiopia: a facility based cross-sectional study
Authors: Mengesha Sintayehu , Dangisso Mesay Hailu
Published: August 2019

Abstract
Background
Stillbirth is an adverse pregnancy outcome of public health importance causing considerable psychosocial burden for parents and their family. Studies on stillbirth are scarce in southern Ethiopia. An assessment of stillbirths and associated factors in health care settings helps in devising strategies for tailored interventions. Therefore, we assessed the burden of stillbirths and associated factors in Yirgalem Hospital, southern Ethiopia
Methods: A facility based cross-sectional study was conducted between 1 August 2015 and 30 July 2016. We randomly selected medical records of women from a hospital delivery registry. The data were coded, entered, cleaned, and analysed by SPSS version 20. Bivariate analysis was employed to assess the association between independent and dependent variables. Multivariate logistic regression was used to identify independent risk factors for stillbirths and to control for confounding. The ethical clearance for the study was obtained from the Institutional Review Board of College of Medicine and Health Sciences, Hawassa University.
Results: Of 374 reviewed records of women, 370 were included for the study. The magnitude of stillbirths was 92 per 1000 births. Majority, 15 (44.1%) of fetal deaths occurred after admission to the hospital. In multivariate logistic regression, stillbirths were higher among low birth-weight babies (<2500grams) (AOR: 10.70, 95% CI 3.18-35.97) than normal birth-weight babies (2500-<4000). Women who experienced a prolonged labour for more than 48 hours were 12 times (AOR: 12.15, 95% CI 1.76-84.12) more likely to have stillbirths than women without a prolonged labour. Women with obstetric complications were 19.8 times more likely to have stillbirths than women without obstetric complications. Similarly, women with at least 2 pregnancies were more likely to have stillbirths than women with less than two pregnancies (AOR: 4.39, 95% CI 1.21-15.85).
Conclusion: We found a higher proportion of stillbirths than the National report and studies from other countries. Modifiable risk factors contributed to a higher risk of stillbirths in the study setting. Therefore, early identification and management of complications and reducing delays in getting care at each level of health system could avert preventable stillbirths.
Key words: stillbirths, pregnancy outcomes, maternal health, Sothern Ethiopia
Systematic review of the effectiveness of aromatherapy in labor
Authors: Suzuki Hitomi , Kato Mika , Shinozaki Katsuko , Lopes Katharina da Silva , Ota Erika
Published: August 2019

Background

Clinical practice with aromatherapy has become an expanding area for nursing, and is considered one of the most popularly used complementary treatments. However, there is insufficient evidence about the benefits of aromatherapy for pain management and other related discomforts in labor. We aimed to evaluate the effects of aromatherapy for women during delivery particularly for pain relief.

Methods

AMED, ClinicalTrials.Gov, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, and WHO ICTRP were searched in August 2017. For updates, these databases were searched from July 2017 to July 2018. This study included randomized controlled trials (RCTs) and quasi-RCTs for normal pregnancy women who were experiencing labor onset, and compared aromatherapy with standard care or control.

Results

Six RCTs from six reports, and four quasi-RCTs from five reports were included (1238 pregnant women). The trials found significant difference between groups for the primary outcomes of pain relief on the latent (MD -1.56, 95%CI: -2.45 to -0.67, low certainty of evidence) and early active phase (MD -1.69, 95%CI: -2.50 to -0.89, low certainty of evidence). However, there were no significant differences for the primary outcomes of pain relief on the late active phase, and anxiety relief on the early and late active phases.

Conclusions

This meta-analysis found evidence that the use of inhalation aromatherapy for term pregnancy women is associated with reduction of labor pain. However, there is insufficient evidence to confirm pain relief on the late active phase, anxiety relief, and other outcomes following aromatherapy.

Trial registration

We registered the study protocol with PROSPERO (CRD42017077617).
Perceptions of pregnant women on reasons for late initiation of antenatal care: A qualitative interview study
Authors: Warri Denis , George Asha
Published: August 2019

Background: Antenatal care serves as a key entry point for a pregnant woman to receive a broad range of services and should be initiated at the onset of pregnancy. The aim of the study was to understand the reasons for late initiation of antenatal by pregnant women in Nkwen Baptist Health Center, Cameroon.
Methods: The study applied purposive sampling to recruit eighteen pregnant women and three key informants for data collection through individual interviews. Pregnant women who initiated antenatal care after the first trimester were recruited during antenatal care clinics and interviewed in a room at the antenatal care unit. Key informants were midwives working at the antenatal care unit. Participation in the study was voluntary. Participants were explained the purpose of the study and signed a consent form if they were willing to participate in the research. Data was collected using an audio tape and analyzed using Thematic Coding Analysis.
Results: Pregnant women place low value on early antenatal care due to the fact that they perceive pregnancy as a normal health condition or not a serious issue that requires seeking health care. Furthermore previous pregnancy outcomes that were positive regardless of accessing care made them less motivated to initiate antenatal care early. The booking system is perceived as user-unfriendly with overcrowded conditions, long waiting times and rudeness of some service providers. Cost of services and distance to health facilities with uncomfortable transport and poor road network were identified as perceived barriers. The absence of effective community health programmes, perceived lack of support from parents and spouses, fear of bewitchment and stigma due to cultural beliefs about early initiation of antenatal care were also identified as variables influencing late initiation.
Conclusion: Pregnant women lack information on the purpose of early antenatal care. Health facility barriers as well as socio cultural beliefs also have significant influence on timing of antenatal care initiation. The government of Cameroon should strengthen the health system and implement activities that engage communities to improve timing of care seeking for antenatal care and thereby improve the maternal health status of women.
Genetic diversity and characteristics of gyrA gene in Neisseria spp
Authors: Zhao Pan , Zhang Aiyu , Zhu Bingqing , Xu Li , shao zhujun
Published: August 2019

Background

Neisseria meningitidis bacteria characterized by clonal complex (CC4821) showed a high resistance rate to quinolones. The aim of this study was to assess whether the DNA gyrase A gene from N.meningitidis CC4821 strains collected in China featured any specific characteristics compared to other Neisseria species. Two hundred fifty two gyrase gene sequences were analyzed, among them 77 generated in this study from N.meningitidis CC4821 strains collected in China between 1978 and 2016.

Results

The quinolone resistance-related gene, coding for the DNA gyrase subunit A (GyrA) protein, was highly divergent within the N.meningitidis strains whereas N. gonorrhoeae and N.lactamica counterparts appeared well conserved. Only one position, 91 (83 in E.coli gyrA gene), was linked to quinolone resistance, all resistant strains featuring the substitution T91I. The E.coli position 87, which was mutated in quinolone-resistant strains, was also divergent (position 95) in some Neisseria resistant strains. Moreover, twenty eight additional putative resistance markers were identified. Finally, putative recombination events between N.meningitidis and either N.subflava, or N.lactamica or N.cinerea as well as between N.meningitidis strains were reported.

Conclusions

Analyzing the evolution of gyrA gene within Neisseria spp. is critical to monitor the quinolone resistance phenotype and the acquisition of new resistance markers. Such studies are necessary for the control of the meningococcal disease and the development of new drugs targeting DNA gyrase.
Prevalence of mobile antimicrobial resistance genes carrying and toxin producing pathogens in retail beef and mutton
Authors: liu ying , Cui Yifang , Peng Wenjing , Huang Baoyong , Ma Lichao , Zheng Min , Ding Shuangyang , Zhu Kui
Published: August 2019

Background

Food safety has always been the global issue. In addition to food poisoning problems caused by toxin-producing strains, the arising of widely spread antimicrobial resistant bacteria have become a major issue that impacts food safety. The purpose of this study is to assess the safety of retail meat in the last link of sales.

Results

A total number of 134 samples were collected and 674 strains were isolated. There are different bacterial compositions distributed in meat, environmental and human-derived samples. The major pathogens in meat and environmental or human samples are Klebsiella spp. and Staphylococcus spp.. The resistance to amoxicillin + clavulanate (with the resistance rate of 46.78%), tetracycline (44.66%) and erythromycin (32.73%) are major resistant phenotypes of the isolates. According to the whole genome analysis, two K. pneumoniae strains harboring the extended spectrum beta-lactamase genes which are located on mobile elements and two Aeromonas hydrophila isolates carrying mcr-7.1 like genes have been detected. The major toxin genes of Bacillus cereus, and adhesion or invasion related virulence factors were also shared among the isolates.

Conclusion

There are different pathogens distributed in meat, environment and human source at the final stage of meat consumption. The mobile ARGs are prevalent in strains isolates from meat samples. And toxin-producing strains can be isolated from human source. These factors consist potential risk for public health and need attention.
Admission pattern, Clinical outcomes and associated factors among patients admitted in medical intensive care unit at University of Gondar Comprehensive and specialized hospital, Northwest Ethiopia, 2019. A retrospective cross-sectional study.
Authors: Tessema Hailemariam Getachew , Lema Girmay Fitiwi , Mesfin Nebiyu , Fentie Demeke Yilkal , Arefaynie Nurhussien Rizke
Published: August 2019

Background: Intensive care unit (ICU) is a multidisciplinary staffed and specially equipped area of a hospital dedicated to providea care for patient with life-threatening illness. Provision of intensive care services to critically ill patients is a global enterprise. The care is advancing but in resource-limited settings, it is lagging far behind and ICU mortality is still higher due to various reasons.
Objective: We aimed to determine the admission patterns, clinical outcomes and associated factors among patients admitted medical intensive care unit (MICU).
Results: A total of 738 patients were admitted to MICU during September 2015- April 2019. Two hundred thirty four patients had incomplete data on the registries and their charts could not be located. So that, 504 (68%) of all ICU admissions had complete data and were analyzed. Out of the 504 patients, 268 (53.2%) patients were females. Cardiovascular disease 182(36.1%) was the commonest categorical admission diagnosis. The overall mortality rate of the MICU was 38.7 %. In the multivariate analysis, mortality was associated with need for mechanical ventilation (AOR=5.87, 95% CI: 3.24 - 10.65) and abnormal mental status at admission (AOR = 2.8.8, 95% CI: 1.83-4.29). Patients who stayed less than four days in MICU are 5 times more likely to dies than who stayed(AOR= 5.58, 95% CI: 3.58- 8.69). Therefore, we recommend improving the acute critical care through the expansion of the care, supply emergency equipment’s and medications and implementation of admission criteria protocols and other local guidelines.
Key words: admission, intensive care unit, Length of stay, Mortality, Outcome
Targeting claudin-4 enhances chemosensitivity of triple negative breast cancer
Authors: Luo Yi , Kishi Shingo , Sasaki Takamitsu , Ohmori Hitoshi , Fujiwara-Tani Rina , Mori Shiori , Goto Kei , Nishiguchi Yukiko , Mori Takuya , Kondo Masuo , Kuniyasu Hiroki
Published: August 2019

Background

Triple negative breast cancer (TNBC) possesses highly aggressive phenotype, treatment with limited options, and a poor prognosis. In this study, we examined the therapeutic effect of anti-claudin (CLDN)-4 extracellular domain antibody, 4D3, on TNBC.

Methods

The expression of CLDN4 and CLDN1 in invasive ductal carcinoma (IDC) was examined in 78 IDCs (from 2004 to 2009 in a single center). CLDN expression and the effect of 4D3 on proliferation were examined in in human IDC cell lines MCF-7 (luminal subtype) and MDA-468 (TNBC).

Results

In IDC cases, CLDN1 had lower expression than CLDN4 and correlated with histological grade. In contrast, expression of CLDN4 correlated with histological grade, receptor subtype, and stage. CLDN4 expression in the two cells was at the same level. In both cells, paclitaxel (PTX)-induced growth suppression was enhanced by 4D3. Furthermore, 4D3 increased both intracellular PTX concentration (in both cells) and apoptosis. In the mouse model, 4D3 promoted the antitumor effect of PTX on subcutaneous tumors and reduced lung metastasis. The combination of PTX and 4D3 reduced M2 macrophages and mesenchymal stem cells in the tumor. 4D3 also reduced stemness of the tumors in association with increase in the intratumoral pH. Moreover, concurrent treatment of 4D3, PTX, or tamoxifen; or with PTX and tamoxifen in MDA-468 also showed the same level of antitumor activity and survival as MCF-7. Furthermore, in bone metastasis model, combination of PTX and bisphosphonate with 4D3 promoted tumor growth in both cells.

Conclusions

CLDN4 targeting of the antibody facilitated existing therapeutic effects.
Head and Neck cancer patients’ preferences for individualized prognostic information: a focus group study
Authors: Hoesseini Arta , Dronkers Emilie A. C. , Sewnaik Aniel , Hardillo Jose A. U. , de Jong Robert J. Baatenburg , Offerman Marinella P. J.
Published: August 2019

Background

Head and Neck cancer (HNC) is characterized by significant mortality and morbidity. Treatment is often invasive and interferes with vital functions, resulting in a delicate balance between survival benefit and deterioration in quality of life (QoL). Therefore, including prognostic information during patient counseling can be of great importance. The first aim of this study was to explore HNC patients’ preferences for receiving prognostic information. The second aim of this study was to explore patients’ views on ‘’OncologIQ’’, a prognostic model developed to estimate overall survival in newly diagnosed HNC patients.

Methods

We conducted a single center qualitative study by organizing five focus groups with HNC patients (n= 21) and their caregivers (n= 19), categorized in: 1) small laryngeal carcinomas treated with radiotherapy or laser, 2) extensive oral cavity procedures, 3) total laryngectomy, 4) chemoradiation, 5) other treatments. The interview guide consisted of two main topics: life-expectancy and the prognostic model OncologIQ. All focus groups were recorded, transcribed and coded. Themes were derived using content analysis.

Results

All patients found it important to receive information about their life-expectancy. While disclosing prognostic information in general terms like ‘’the cancer is curable’’ gives enough reassurance for most patients, some also wanted numerical information like OncologIQ’s prognostic estimates. Overall, patients thought life-expectancy should not be discussed shortly after cancer diagnosis disclosure, as a certain time is needed to process the first shock. They had a stronger preference for receiving prognostic information in case of a poor prognosis. Prognostic information should also include information on the expected QoL. The pie chart was the most preferred chart for discussing survival rates.

Conclusions

HNC patients find it important to receive prognostic information. A tailor-made approach is necessary to provide customized prognostic information. A clinical practice guideline was developed to support professionals in sharing prognostic information, aiming to improve shared decision making and patient-centered care.
Risk factors for developing cardiac toxicities in cancer patients treated with panitumumab combination therapy
Authors: Qi Wei-xiang , zhao shengguang , Chen Jiayi
Published: August 2019

Background

Panitumumab, a novel anti-epidermal growth factor receptor (EGFR) monoclonal antibody (mAb), has been approved for the treatment of advanced colorectal cancer (CRC), and it is also being studied in other types of cancer. However, an increased risk of cardiac toxicities has been observed in some trials. The current study aims to evaluate the patterns and risk of cardiac toxicities by performing post hoc analyses of randomized controlled trials that evaluated treatment with or without panitumumab in advanced cancer patients.

Methods

Data were obtained from four randomized controlled trials (NCT00115765, NCT00339183, NCT00364013, and NCT00460265) which included a total of 3,243 patients with metastatic colorectal or head and neck carcinoma. The incidence of cardiac toxicity was assessed by simple incidence rates and rates per 100 person-years. Univariate and multivariate cox proportional hazards regression was conducted to investigate factors predicting the development of any cardiac event, cardiac arrhythmias and ischemic event.

Results

In comparison with controls, the use of panitumumab-containing therapy in cancer was associated with a significantly increased risk of developing cardiac arrhythmias (HR1.42, 95%CI: 1.02-1.96, p=0.036), but not for any cardiac event (HR1.16, 95%CI: 0.90-1.50, p=0.24) or ischemic event (HR 0.61, 95%CI: 0.35-1.07, p=0.087). The absolute rate of developing cardiac arrhythmia was 10.0 events per 100 person-years for those receiving combination therapy and 7.5 events per 100 person-years for those receiving chemotherapy alone. Within multivariate cox regression analysis for factors predicting any cardiac toxicity, pre-existing hypertension(p=0.0013) or history of cardiac diseases (p=0.01) were predictive for occurrence of any cardiac toxicity. Additionally, development of cardiac arrhythmias was associated with a pre-existing hypertension (p=0.033), history of cardiac disease (p=0.055) or panitumumab usage (p=0.046) in multivariate regression analysis.

Conclusion

The addition of panitumumab to chemotherapy increases the risk of developing cardiac arrhythmia, but not for any cardiac toxicity or ischemic events. Patients with pre-existing hypertension or history of cardiac diseases are at high risk for developing cardiac toxicities when receiving panitumumab treatment.
Nad(P) Dependent Steroid Dehydrogenase-Like, Involved In Cholesterol Biosynthesis, Regulates Proliferation And Metastasis In Breast Cancer
Authors: Yoon So hyun , Han Wonshik , Hong Bok Sil Hong , Kang EunJi , Kim Ryong Nam , Jung So-Youn , Lee Han-Byoel , Moon Hyeong-Gon , Noh Dong-Young
Published: August 2019

Background
Cholesterol biosynthesis pathway is a common upregulated pathway in breast cancer. NSDHL (NAD(P) Dependent Steroid Dehydrogenase-Like), a gene which is involved in cholesterol biosynthesis has not been elucidated for its role in breast cancer.

Methods
After knock-down of NSDHL in human breast cancer cell lines, cell proliferation assay, cell cycle analysis, 3D culture, clonogenic assay, migration and invasion assay, and wound healing assay were performed. We tested erlotinib as a target drug for NSDHL. Xenograft was developed with MDA-MB-231 transfected with NSDHL shRNA in NOD/SCID mice. Public gene expression databases were used for the analysis of prognostic role of NSDHL in breast cancer

Results
Both NSDHL mRNA and protein levels were higher in a Luminal (MCF7) and triple negative cells (MDA-MB-231, BT-20) than normal breast cancer cell (MCF10A). Silencing of NSDHL by siRNA inhibited cell cycle and proliferation, and also inhibited migration and invasion in MDA-MB-231 and BT-20 cells (p< 0.05). The sensitivity to erlotinib was significantly decreased in siNSDHL treated cells, especially in MDA-MB-231 (p<0.01). Additionally, we found that NSDHL regulated total cholesterol levels in breast cancer cells. In vivo xenograft model, NSDHL knock down in the cancer cell decreased the tumor growth and metastasis. Clinically, higher NSDHL expression in the tumor of 3951 breast cancer patients was associated with significantly lower recurrence-free survival.

Conclusions
In conclusion, we showed that NSDHL might have a role for the progression of breast cancer. Further studies are needed to clarify that NSDHL can be a therapeutic target in breast cancer.