bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of a prediction model for unsuccessful treatment outcomes in patients with multi-drug resistance tuberculosis
Authors: Ma J-B , Zeng L-C , Ren F , Dang L-Y , Luo H , Wu Y-Q , Yang X-J , Li R , Yang H , Xu Y
Published: May 2023

Background

The World Health Organization has reported that the treatment success rate of multi-drug resistance tuberculosis is approximately 57% globally. Although new drugs such as bedaquiline and linezolid is likely improve the treatment outcome, there are other factors associated with unsuccessful treatment outcome. The factors associated with unsuccessful treatment outcomes have been widely examined, but only a few studies have developed prediction models. We aimed to develop and validate a simple clinical prediction model for unsuccessful treatment outcomes in patients with multi-drug resistance pulmonary tuberculosis (MDR-PTB).

Methods

This retrospective cohort study was performed between January 2017 and December 2019 at a special hospital in Xi’an, China. A total of 446 patients with MDR-PTB were included. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to select prognostic factors for unsuccessful treatment outcomes. A nomogram was built based on four prognostic factors. Internal validation and leave-one-out cross-validation was used to assess the model.

Results

Of the 446 patients with MDR-PTB, 32.9% (147/446) cases had unsuccessful treatment outcomes, and 67.1% had successful outcomes. After LASSO regression and multivariate logistic analyses, no health education, advanced age, being male, and larger extent lung involvement were identified as prognostic factors. These four prognostic factors were used to build the prediction nomograms. The area under the curve of the model was 0.757 (95%CI 0.711 to 0.804), and the concordance index (C-index) was 0.75. For the bootstrap sampling validation, the corrected C-index was 0.747. In the leave-one-out cross-validation, the C-index was 0.765. The slope of the calibration curve was 0.968, which was approximately 1.0. This indicated that the model was accurate in predicting unsuccessful treatment outcomes.

Conclusions

We built a predictive model and established a nomogram for unsuccessful treatment outcomes of multi-drug resistance pulmonary tuberculosis based on baseline characteristics. This predictive model showed good performance and could be used as a tool by clinicians to predict who among their patients will have an unsuccessful treatment outcome.
Profile of partners who completed HIV testing and received a new HIV diagnosis in Ukraine’s HIV index testing program: a retrospective cohort study to inform program improvement
Authors: Puttkammer Nancy , Ihnatiuk Alyona , Shapoval Anna , Kazanzhy Anna , Secor Andrew , Shotorbani Solmaz , McDowell Misti , Golden Matthew
Published: May 2023

Background

Approximately one-third of people living with HIV in Ukraine are unaware of their HIV status. Index testing (IT) is an evidence-based HIV testing strategy that supports voluntary notification of partners with HIV risk, so they can receive HIV testing, prevention, and treatment services.

Methods

Ukraine scaled up IT services in 2019. This observational study of Ukraine’s IT program covered 39 health facilities located in 11 regions with high HIV burden. The study used routine program data from January—December 2020 to describe the profile of named partners and explore index client (IC) and partner factors associated with two outcomes: 1) completing testing; and 2) HIV case finding. Analysis used descriptive statistics and multilevel linear mixed regression models.

Results

The study included 8,448 named partners, of whom 6,959 had unknown HIV status. Among them,72.2% completed HIV testing and 19.4% of those tested were newly diagnosed with HIV. Two-thirds of all new cases were among partners of ICs who were recently diagnosed and enrolled in care (< 6 months), while one third were among partners of established ICs. In adjusted analysis, partners of ICs with unsuppressed HIV viral load (VL) were less likely to complete HIV testing (adjusted odds ratio [aOR] = 0.11,p < 0.001), but more likely to receive a new HIV diagnosis (aOR = 1.92,p < 0.001). Partners of ICs who cited injection drug use or having a known HIV + partner as their own reason for testing were more likely to receive a new HIV diagnosis (aOR = 1.32,p = 0.04 and aOR = 1.71,p < 0.001 respectively). Involving providers in the partner notification process was associated with completed testing (aOR = 1.76,p = 0.001) and HIV case finding (aOR = 1.64,p < 0.01), compared with notification by ICs.

Conclusion

HIV case detection was highest among partners of recently diagnosed ICs, but IT participation among established ICs still yielded an important share of all newly-identified HIV cases. Areas for improvement in Ukraine’s IT program include completing testing for partners of ICs with unsuppressed HIV VL, with history of injection drug use or discordant partnerships. Using intensified follow-up for the sub-groups at risk of incomplete testing may be practical. Greater use of provider-assisted notification could also accelerate HIV case finding.
Associations between macular retinal vasculature and severity of idiopathic epiretinal membrane
Authors: Hsia Yun , Hsieh Yi-Ting
Published: May 2023

Background

To demonstrate the associations between the morphology of macular retinal vasculature and disease severity of idiopathic epiretinal membrane (ERM).

Methods

Macular structures were assessed using optical coherence tomography (OCT), and were classified as “with pseudohole” or “without pseudohole”. The 3 × 3 mm macular OCT angiography images were analyzed using the Fiji software to obtain the vessel density, skeleton density, average vessel diameter, vessel tortuosity, fractal dimension, and foveal avascular zone (FAZ)-related parameters. The correlations between these parameters and ERM grading as well as visual acuity were analyzed.

Results

For ERM with or without a pseudohole, increased average vessel diameter, decreased skeleton density, and decreased vessel tortuosity were all associated with inner retinal folding and thickened inner nuclear layer, indicating more severe ERM. In 191 eyes without a pseudohole, the average vessel diameter increased, fractal dimension decreased and vessel tortuosity decreased with increasing ERM severity. The FAZ was not associated with ERM severity. Decreased skeleton density (r = -0.37), vessel tortuosity (r = -0.35), and increased average vessel diameter (r = 0.42) were correlated with worse visual acuity (All P < 0.001). In 58 eyes with pseudoholes, a larger FAZ was associated with a smaller average vessel diameter (r = -0.43, P = 0.015), higher skeleton density (r = 0.49, P < 0.001), and vessel tortuosity (r = 0.32, P = 0.015). However, none of the retinal vasculature parameters correlated with visual acuity and central foveal thickness.

Conclusion

Increased average vessel diameter, decreased skeleton density, decreased fractal dimension and decreased vessel tortuosity were good indicators of ERM severity and associated visual impairment.
Acute phase clinical manifestations of patients with Vogt-Koyanagi-Harada disease in Southern China
Authors: Zhang Chuhua , Wang Yun , Chen Yun , Zhou Hui , Hong Qiuxia , Yu Xiuying , Ng Tsz Kin , Cen Ling-Ping
Published: May 2023

Backgrounds

To characterize the acute phase clinical manifestations and visual outcomes of the patients with Vogt-Koyanagi Harada (VKH) disease in southern China.

Methods

In total, 186 patients with acute-onset VKH disease were recruited. The demographic data, clinical signs, ophthalmic examinations, and visual outcomes were analyzed.

Results

Among the 186 VKH patients, 3 were diagnosed as complete VKH, 125 as incomplete VKH, and 58 as probable VKH. All patients visited the hospital within 3 months of onset and complained of decreased vision. For the extraocular manifestations, 121 patients (65%) referred neurological symptoms. Anterior chamber activity was negative in most eyes within an onset of 7 days, which increased slightly with onset beyond 1 week. Exudative retinal detachment (366 eyes, 98%) and optic disc hyperaemia (314 eyes, 84%) were commonly observed at presentation. A typical ancillary examination helped with the diagnosis of VKH. Systemic corticosteroid therapy was prescribed. The logMAR best-corrected visual acuity improved significantly from 0.74 ± 0.54 at baseline to 0.12 ± 0.24 at the 1-year follow-up visit. The recurrence rate was 18% in the follow-up visits. Erythrocyte sedimentation rate and C-reactive protein were significantly correlated to VKH recurrences.

Conclusion

Posterior uveitis, followed by mild anterior uveitis, is the typical initial manifestation in the acute phase of Chinese VKH patients. Visual outcome improvement is promising in most patients receiving systemic corticosteroid therapy in the acute phase. Detection of the clinical features at the initial onset of VKH could facilitate early treatment and better vision improvement.
Effects of online social media on improving mothers’ behaviors towards preventing their children’s otitis media based on the PRECED model: a randomized educational intervention trial
Authors: Moradi Atefeh , Soltani Raheleh , Shamsi Mohsen , Moradzadeh Rahmatallah
Published: May 2023

Background

Otitis media is one of the most common diseases in children, especially those under 2 years of age. This study aimed to investigate the effect of educational intervention based on the PRECEDE model on mothers’ preventive behaviors of middle ear infections in infants.

Methods

This study was conducted as an educational randomized controlled trial on 88 mothers with infants referred to health centers in Arak, Iran. Sampling from September 2021 to February 2022 selected trough stratified random sampling who were assigned to two groups of experimental = 44 and control = 44. The data collection tool was a reliable and valid questionnaire that included demographic information, constructs of PRECEDE model regarding otitis media, and preventive behaviors. The experimental group received 4 training sessions (each session 60 min) through WhatsApp social network. Information was collected through an online questionnaire before and 3 months after the educational intervention from both groups. Data analysis was also performed with SPSS version 23.

Results

Before the educational intervention there was no significant difference between the experimental and control groups in the otitis media preventive behaviors and structures of PRECEDE model (p > 0.05). After the educational intervention, in the experimental group the average score of knowledge from 0.49 to 0.81, attitude from 4.01 to 4.58, enabling factors from 0.72 to 0.85, reinforcing factors from 3.31 to 3.91 and behavior from 3.25 to 3.66 increased significantly (p < 0.001).

Conclusions

PRECEDE-based education with controlling, monitoring and follow-up during the program was effective in promoting the preventive behaviors of otitis media. Therefore, due to the side effects of otitis media, especially in vulnerable periods such as childhood, it is recommended that trainings based on this model be carried out in other health care centers and clinics in order to maintain children health.

Trial registration

This trial has been registered at the Iranian Registry of Clinical Trials, IRCT20210202050228N1. Prospectively registered at 2021-May-21, (2021/05/21) available at: URL: https://en.irct.ir/trial/54073.
The coexistence of stunting and overweight or obesity in Ethiopian children: prevalence, trends and associated factors
Authors: Sahiledengle Biniyam , Mwanri Lillian , Kumie Abera , Beressa Girma , Atlaw Daniel , Tekalegn Yohannes , Zenbaba Demisu , Desta Fikreab , Kene Chala , Seyoum Kenbon , Gomora Degefa , Woldeyohannes Demelash , Agho Kingsley Emwinyore
Published: May 2023

Background

Double burden of childhood malnutrition is a condition where undernutrition (stunting) along with overweight and obesity coexist within individuals, households, and populations. It reflects a new layer of malnutrition and an understudied phenomenon in many low-income settings. To date, the prevalence and factors that are associated with concurrent stunting and overweight or obesity (overweight/obesity) (CSO) in the same children have not been well researched in Ethiopia. Hence, this study aimed to assess the prevalence, trends, and factors associated with the coexistence of stunting and overweight or obesity among children aged 0–59 months in Ethiopia.

Methods

Pooled data from 2005, 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 23,756 (weighted sample) children aged 0–59 months were included in the study. Height-for-age z-scores (HAZ) less than − 2 SD and weight-for-height z-scores (WHZ) above 2 SD were calculated, and children were classified as stunted and overweight/obese, respectively. A child who is simultaneously stunted and overweight/obese was considered as having HAZ below − 2 SD and WHZ above 2 SD computed into a variable named CSO, and reported as a binary outcome (yes or no). Multilevel logistic regression analysis that adjusts for sampling weights and clustering was used to identify factors associated with CSO.

Results

The prevalence of stunting, overweight or obesity, and CSO among under-five children was 43.12% [95% CI: (42.50, 43.75%)], 2.62% [95% CI: (2.42, 2.83%)], and 1.33% [95% CI: (1.18, 1.48%)], respectively. The percentage of CSO children was reported to have declined from 2.36% [95% CI: (1.94–2.85)] in 2005 to 0.87% [95%CI: (0.07–1.07)] in 2011, and the same appeared to have increased slightly to 1.34% [95%CI: (1.13–1.59)] in 2016. Children who were currently breastfeeding [AOR: 1.64, 95%CI: (1.01–2.72)], born to an overweight mother [AOR: 2.65, 95%CI: (1.19–5.88)], and lived in families with 1–4 household members [AOR: 1.52, 95%CI: (1.02–2.26)] were significantly associated with CSO. At the community level the odds of having CSO were higher among children included from EDHS-2005 [AOR: 4.38, 95%CI: (2.42–7.95)].

Conclusion

The study revealed that less than 2% of children had CSO in Ethiopia. CSO was linked to factors at both the individual (i.e. breastfeeding status, maternal overweight, and household size) and community-levels. Overall, the study findings indicated the necessity of focused interventions to simultaneously address double burden of childhood malnutrition in Ethiopia. To further combat the double burden of malnutrition, early identification of at-risk children, including those born to overweight women and children living with multiple household members, is indispensable.
Safety culture and perception of warning signs of chemical hazards among hospital cleaning workers: a cross-sectional study
Authors: Mehrifar Younes , Ramezanifar Soleiman , Khazaei Parvaneh , Azimian Afsane , khadiv Elahe , Dargahi-Gharehbagh Ozra , Sahlabadi Ali Salehi
Published: May 2023

Background

Due to the type of activities and the long-term exposure to chemicals, hospital cleaning workers require the necessary knowledge about the chemicals used and proper safety culture. This study aimed to evaluate the safety culture and perception of hospital cleaning workers' warning signs of chemical hazards.

Methods

This cross-sectional study was conducted in 2022 with the participation of 68 cleaning workers with the mean age ± (SD) and work experience ± (SD) of 36.19 ± (7.619) and 9.21 ± (5.462), respectively, in four selected Tehran hospitals in Iran. After ensuring the confidentiality of the received information and completing the demographic information checklist, each participant completed Global Harmonization System (GHS) sign perception and the safety culture questionnaires in this survey. Data were analyzed using regression and Pearson correlation tests.

Results

This study showed that the participant's correct perception in nine cases (81.8%) of presented GHS signs was lower than the ANSI Z535.3 standard. Among the investigated signs, "Flammable substances" and "Harmful to the environment" signs had the highest, and "Skin irritant" signs had the lowest correct perception. In addition, it was found that 55 people (80.9%) had an overall positive attitude toward the safety culture. The levels of "Work environment" (83.8%) and "Information exchange" (76.5%) had the highest and lowest positive scores for safety culture. Furthermore, there is a direct and significant relationship between the overall score of safety culture and the overall perception of the symptoms of GHS (CC = 0.313, P = 0.009).

Conclusion

According to the obtained results, it is recommended to take the necessary measures to increase the employees' perception of the signs of chemical substances and improve their safety culture.
Using generalized structured additive regression models to determine factors associated with and clusters for COVID-19 hospital deaths in South Africa
Authors: Maposa Innocent , Welch Richard , Ozougwu Lovelyn , Arendse Tracy , Mudara Caroline , Blumberg Lucille , Jassat Waasila
Published: May 2023

Background

The first case of COVID-19 in South Africa was reported in March 2020 and the country has since recorded over 3.6 million laboratory-confirmed cases and 100 000 deaths as of March 2022. Transmission and infection of SARS-CoV-2 virus and deaths in general due to COVID-19 have been shown to be spatially associated but spatial patterns in in-hospital deaths have not fully been investigated in South Africa. This study uses national COVID-19 hospitalization data to investigate the spatial effects on hospital deaths after adjusting for known mortality risk factors.

Methods

COVID-19 hospitalization data and deaths were obtained from the National Institute for Communicable Diseases (NICD). Generalized structured additive logistic regression model was used to assess spatial effects on COVID-19 in-hospital deaths adjusting for demographic and clinical covariates. Continuous covariates were modelled by assuming second-order random walk priors, while spatial autocorrelation was specified with Markov random field prior and fixed effects with vague priors respectively. The inference was fully Bayesian.

Results

The risk of COVID-19 in-hospital mortality increased with patient age, with admission to intensive care unit (ICU) (aOR = 4.16; 95% Credible Interval: 4.05–4.27), being on oxygen (aOR = 1.49; 95% Credible Interval: 1.46–1.51) and on invasive mechanical ventilation (aOR = 3.74; 95% Credible Interval: 3.61–3.87). Being admitted in a public hospital (aOR = 3.16; 95% Credible Interval: 3.10–3.21) was also significantly associated with mortality. Risk of in-hospital deaths increased in months following a surge in infections and dropped after months of successive low infections highlighting crest and troughs lagging the epidemic curve. After controlling for these factors, districts such as Vhembe, Capricorn and Mopani in Limpopo province, and Buffalo City, O.R. Tambo, Joe Gqabi and Chris Hani in Eastern Cape province remained with significantly higher odds of COVID-19 hospital deaths suggesting possible health systems challenges in those districts.

Conclusion

The results show substantial COVID-19 in-hospital mortality variation across the 52 districts. Our analysis provides information that can be important for strengthening health policies and the public health system for the benefit of the whole South African population. Understanding differences in in-hospital COVID-19 mortality across space could guide interventions to achieve better health outcomes in affected districts.
Prevalence of genetic mutations in alpha-1 antitrypsin deficiency (aatd) in patients with chronic obstructive pulmonary disease in Colombia
Authors: Alí-Munive Abraham , Leidy Prada , Proaños Nadia Juliana , Pedrozo-Pupo John , Giraldo Angela , Cano Diana , Diaz-Bossa Claudia , Mosquera Ricardo , Paul Hector , Gonzalez-García Mauricio , Aguirre-Franco Carlos , López-Campos José Luis , Casas-Herrera Alejandro
Published: May 2023

Background

Alpha-1 antitrypsin deficiency (AATD) is an underrecognized genetic disorder associated mainly with pulmonary emphysema and Chronic Obstructive Pulmonary Disease (COPD). All individuals with COPD regardless of age or ethnicity should be tested for AATD, but in Colombia its prevalence in unknown.

Main objective

To determine the prevalence of the genetic mutations, present in AATD in adult patients with COPD in Colombia, using a genotyping test on cells from the oral mucosa.

Methods

This was a multicentre, observational, cross-sectional study which included adult patients attending seven COPD care centres in Colombia. Demographic data, medical history, including history of exposure to smoking and biomass smoke, most recent spirometry, pharmacological and non-pharmacological treatment received, serum AAT levels, and mutations detected by the genotyping test were recorded for all the recruited patients. For the comparison of variables between the groups with and without mutation, we used the X2 test for the qualitative variables and the Student’s t-test or Mann-Whitney U test according to their distribution.

Main findings

We collected a sample of 1,107 patients, the median age was 73.8 years (87.6–79.9). Mutations were documented in 144 patients (13.01%), the majority had the M/S mutation (78.50%), followed by M/Z (9.72%). One patient had a ZZ mutation and two patients had null alleles. In total, 23 patients had mutations associated with serum AAT deficiency (levels below 60 mg/dl).

Conclusions

Genetic mutations were documented in 13.01% of patients with COPD in Colombia and 2.07% were AATD-related, showing that there is a significant number of underdiagnosed patients.
Clinical outcomes of immune checkpoint inhibitors to treat non-small cell lung cancer patients harboring epidermal growth factor receptor mutations
Authors: Si Jinfei , Hao Yue , Wei Jingwen , Xiang Jing , Xu Chunwei , Shen Qiuping , Song Zhengbo
Published: May 2023

Background

We aimed to determine the clinical. outcomes of various immune checkpoint inhibitor (ICI) combinations for the treatment of non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations. The results predicted the treatment efficacy of these combinations.

Methods

From July 15, 2016 to March 22, 2022, 85 NSCLC patients with EGFR mutations, enrolled at the Zhejiang Cancer Hospital, received ICI combinations after resistance to prior EGFR-tyrosine kinase inhibitors (EGFR-TKIs). These patients were diagnosed with EGFR mutations using an amplification refractory mutation system PCR (ARMS-PCR) and next-generation sequencing (NGS). Survival times were analyzed using the Kaplan–Meier method and log-rank test.

Results

Patients who received ICIs combined with anti-angiogenic therapy had longer progression-free survival (PFS) and overall survival (OS) than patients who received ICIs combined with chemotherapy. There was no significant difference in survival time between patients who received ICIs combined with chemotherapy and anti-angiogenic therapy and patients who received ICIs combined with anti-angiogenic therapy or ICIs combined with chemotherapy, which was due to the limitation sample size of patients who received ICIs combined with chemotherapy and anti-angiogenic therapy. Patients with L858R mutations had a longer PFS and OS than patients with exon 19 deletions. T790M negative patients benefited more from ICI combinations, compared with T790M positive patients. In addition, there was no significant difference in PFS and OS between patients with TP53 co-mutations and patients without a TP53 co-mutation. We also found that patients with prior first-generation EGFR-TKI resistance had longer PFS and OS than prior third-generation EGFR-TKI resistance patients. There was no new adverse event in this study.

Conclusions

EGFR-mutated patients who received ICIs combined with anti-angiogenic therapy had longer PFS and OS than patients with ICIs combined with chemotherapy. Patients with L858R or without T790M mutation benefited more from ICI combinations. Besides, patients with prior first-generation EGFR-TKI resistance could benefit more from ICIs combinations than prior third-generation EGFR-TKI resistance patients.
Single use Negative Pressure Wound Therapy (NPWT) system in the management of knee arthroplasty
Authors: Chau Wai-Wang , Lo Kelvin Chin-Hei , Lau Lawrence Chun-Man , Ong Michael Tim-Yun , Ho Kevin Ki-Wai
Published: May 2023

Background

Wound complication, skin blister formation in particular, causes devastating consequences after total knee arthroplasty (TKA). Negative Pressure Wound Therapy (NPWT) tries to improve wound management leading to decrease length of hospital stay and better clinical outcomes. Low body mass index (BMI) could play a part in wound recovery management although lacking evidence. This study compared length of hospital stay and clinical outcomes between NPWT and Conventional groups, and factors affected and how BMI affected.

Methods

This was a retrospective clinical record review of 255 (160 NPWT and 95 Conventional) patients between 2018 and 2022. Patient demographics including body mass index (BMI), surgical details (unilateral or bilateral), length of hospital stay, clinical outcomes including skin blisters occurrence, and major wound complications were investigated.

Results

Mean age of patients at surgery was 69.95 (66.3% were female). Patients treated with NPWT stayed significantly longer in the hospital after joint replacement (5.18 days vs. 4.55 days; p = 0.01). Significantly fewer patients treated with NPWT found to have blisters (No blisters: 95.0% vs. 87.4%; p = 0.05). In patients with BMI < 30, percentage of patients requiring dressing change was significantly lower when treated with NPWT than conventional (0.8% vs. 33.3%).

Conclusion

Percentage of blisters occurrence in patients who underwent joint replacement surgery is significantly lower using NPWT. Patients using NPWT stayed significantly longer in the hospital after surgery because significant proportion received bilateral surgery. NPWT patients with BMI < 30 were significantly less likely to change wound dressing.
The effect of probiotic supplementation on episiotomy wound healing among primiparous women: a triple-blind randomized clinical trial
Authors: Abdollahpour Derakhshan , Homayouni-Rad Aziz , Nourizadeh Roghaiyeh , Hakimi Sevil , Mehrabi Esmat
Published: May 2023

Background

Probiotics increase the defense power of immune system and accelerate the wound healing process by anti-inflammatory mechanisms at the wound site. The present study aimed at evaluating the effect of Lactobacillus casei oral supplementation on episiotomy wound healing among primiparous women.

Methods

This triple-blind randomized clinical trial was performed on 74 primiparous women delivered in Alzahra Hospital, Tabriz, Iran. Participants with mediolateral episiotomy (incision length equal to and less than 5 cm) were randomly assigned to the probiotic and placebo groups. The probiotic group received Lactobacillus casei 431 with 1.5 * 109 colony-forming unit /capsule once a day from the day after birth to 14 days. Wound healing as a primary outcome was measured by Redness, Edema, Ecchymosis, Discharge, Approximation and pain as a secondary outcome by the Visual Analogue Scale before discharge, 5 ± 1 and 15 ± 1 days after birth. The data were analyzed using independent t-test and repeated measures one way analysis of variance.

Results

The mean (standard deviation: SD) score of wound healing in the probiotic group altered from 4.91(1.86) before discharge to 1.55 (0.99) during 5 ± 1 days after birth and reached to 0.95 (0.27) during 15 ± 1 days after birth. Further, the mean (SD) score of wound healing in the placebo group altered from 4.62 (1.99) before discharge to 2.80 (1.20) during 5 ± 1 days after birth and reached to 1.45(0.71) during 15 ± 1 days after birth (adjusted mean difference: -0.50, confidence interval 95%: -0.96 to -0.05, P = 0.03).

Conclusion

Lactobacillus casei oral supplementation is effective in healing episiotomy wounds. It is suggested to evaluate the effect of topical use of Lactobacillus casei on episiotomy repair and pain in further studies.

Trial registration

Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N7. Date of registration: 11/08/2021.
De-identified Bayesian personal identity matching for privacy-preserving record linkage despite errors: development and validation
Authors: Cardinal Rudolf N. , Moore Anna , Burchell Martin , Lewis Jonathan R.
Published: May 2023

Background

Epidemiological research may require linkage of information from multiple organizations. This can bring two problems: (1) the information governance desirability of linkage without sharing direct identifiers, and (2) a requirement to link databases without a common person-unique identifier.

Methods

We develop a Bayesian matching technique to solve both. We provide an open-source software implementation capable of de-identified probabilistic matching despite discrepancies, via fuzzy representations and complete mismatches, plus de-identified deterministic matching if required. We validate the technique by testing linkage between multiple medical records systems in a UK National Health Service Trust, examining the effects of decision thresholds on linkage accuracy. We report demographic factors associated with correct linkage.

Results

The system supports dates of birth (DOBs), forenames, surnames, three-state gender, and UK postcodes. Fuzzy representations are supported for all except gender, and there is support for additional transformations, such as accent misrepresentation, variation for multi-part surnames, and name re-ordering. Calculated log odds predicted a proband’s presence in the sample database with an area under the receiver operating curve of 0.997–0.999 for non-self database comparisons. Log odds were converted to a decision via a consideration threshold θ and a leader advantage threshold δ. Defaults were chosen to penalize misidentification 20-fold versus linkage failure. By default, complete DOB mismatches were disallowed for computational efficiency. At these settings, for non-self database comparisons, the mean probability of a proband being correctly declared to be in the sample was 0.965 (range 0.931–0.994), and the misidentification rate was 0.00249 (range 0.00123–0.00429). Correct linkage was positively associated with male gender, Black or mixed ethnicity, and the presence of diagnostic codes for severe mental illnesses or other mental disorders, and negatively associated with birth year, unknown ethnicity, residential area deprivation, and presence of a pseudopostcode (e.g. indicating homelessness). Accuracy rates would be improved further if person-unique identifiers were also used, as supported by the software. Our two largest databases were linked in 44 min via an interpreted programming language.

Conclusions

Fully de-identified matching with high accuracy is feasible without a person-unique identifier and appropriate software is freely available.
Ontology-driven and weakly supervised rare disease identification from clinical notes
Authors: Dong Hang , Suárez-Paniagua Víctor , Zhang Huayu , Wang Minhong , Casey Arlene , Davidson Emma , Chen Jiaoyan , Alex Beatrice , Whiteley William , Wu Honghan
Published: May 2023

Background

Computational text phenotyping is the practice of identifying patients with certain disorders and traits from clinical notes. Rare diseases are challenging to be identified due to few cases available for machine learning and the need for data annotation from domain experts.

Methods

We propose a method using ontologies and weak supervision, with recent pre-trained contextual representations from Bi-directional Transformers (e.g. BERT). The ontology-driven framework includes two steps: (i) Text-to-UMLS, extracting phenotypes by contextually linking mentions to concepts in Unified Medical Language System (UMLS), with a Named Entity Recognition and Linking (NER+L) tool, SemEHR, and weak supervision with customised rules and contextual mention representation; (ii) UMLS-to-ORDO, matching UMLS concepts to rare diseases in Orphanet Rare Disease Ontology (ORDO). The weakly supervised approach is proposed to learn a phenotype confirmation model to improve Text-to-UMLS linking, without annotated data from domain experts. We evaluated the approach on three clinical datasets, MIMIC-III discharge summaries, MIMIC-III radiology reports, and NHS Tayside brain imaging reports from two institutions in the US and the UK, with annotations.

Results

The improvements in the precision were pronounced (by over 30% to 50% absolute score for Text-to-UMLS linking), with almost no loss of recall compared to the existing NER+L tool, SemEHR. Results on radiology reports from MIMIC-III and NHS Tayside were consistent with the discharge summaries. The overall pipeline processing clinical notes can extract rare disease cases, mostly uncaptured in structured data (manually assigned ICD codes).

Conclusion

The study provides empirical evidence for the task by applying a weakly supervised NLP pipeline on clinical notes. The proposed weak supervised deep learning approach requires no human annotation except for validation and testing, by leveraging ontologies, NER+L tools, and contextual representations. The study also demonstrates that Natural Language Processing (NLP) can complement traditional ICD-based approaches to better estimate rare diseases in clinical notes. We discuss the usefulness and limitations of the weak supervision approach and propose directions for future studies.
Psychometric properties of Nursing Time Management Scale (NTMS), Arabic version
Authors: Zyoud Raj’a Nayef
Published: May 2023

Despite the presence of numerous generic time management instruments, relatively few research articles have assessed the validity and reliability of time management skills specific for the nursing profession. This study aimed at developing and validating a time management scale for nurses.

Method A self-administered questionnaire was administered to 715 nurses working in hospitals and clinics in the northern region of the West Bank, Palestine. The scale was examined through exploratory factor analysis, reliability measures, and correlations with other scales.

Results The scale revealed a 3-factor structure 1) organization of nursing work 2) planning and goal setting and 3) coordination of nursing work. The scale demonstrated excellent psychometric properties.

Conclusions The Nursing Time Management Scale (NTMS) is a valid and reliable measure that can be used in assessing time management skills of nurses and in evaluating interventions and training modules aiming at developing nurses’ time management skills.
Sustainability of community health programme using community-based organizations: a challenge for stakeholders
Authors: Donessouné F. M. Gisèle , Sossa G. Olivier , Kouanda Seni
Published: May 2023

A community tuberculosis programme was implemented in Burkina Faso with funding from the Global Fund to fight HIV tuberculosis and malaria. Three years after the end of the funding, it seemed necessary to examine what remains of this innovative programme, which used civil society organizations for implementation. The objective of this study was to assess the factors that influence the capacity for sustainability and the level of sustainability of the programme.

Methods The case study approach was used to retrospectively identify the factors that influence the capacity for sustainability and the level of sustainability of the programme. Semi structured interviews were conducted with key informants. The data were analysed according to the theoretical frameworks of Schell and Pluye. Data was analysed using NVivo 12.

Results Strong support at the national level enabled the acquisition of funding for this programme, while the instability of financial resources was a drawback to sustainability. The lack of leadership of some associations did not allow the continuation of activities after the end of the funding. The irregularity of funding and the failure to conduct a final evaluation of the programme were the weakest links in the sustainability of the programme. Thus, the analysis of our data showed precarious sustainability at the time of the study.

Conclusion A well-designed community programme with a strong capacity for sustainability is not necessarily maintained after funding is withdrawn. The implementation of a community programme must ensure that it is integrated into the existing organizational system. The objectives and operating rules of the host structures must be in line with those of the programme to be implemented.
Vitamin K2 supplementation improves impaired glycemic homeostasis and insulin sensitivity for type 2 diabetes through gut microbiome and fecal metabolites
Authors: Zhang Yuntao , Liu Lin , Wei Chunbo , Wang Xuanyang , Li Ran , Xu Xiaoqing , Zhang Yingfeng , Geng Guannan , Dang Keke , Ming Zhu , Tao Xinmiao , Xu Huan , Yan Xuemin , Zhang Jia , Hu Jinxia , Li Ying
Published: May 2023

Background

There is insufficient evidence for the ability of vitamin K2 to improve type 2 diabetes mellitus symptoms by regulating gut microbial composition. Herein, we aimed to demonstrate the key role of the gut microbiota in the improvement of impaired glycemic homeostasis and insulin sensitivity by vitamin K2 intervention.

Methods

We first performed a 6-month RCT on 60 T2DM participants with or without MK-7 (a natural form of vitamin K2) intervention. In addition, we conducted a transplantation of the MK-7-regulated microbiota in diet-induced obesity mice for 4 weeks. 16S rRNA sequencing, fecal metabolomics, and transcriptomics in both study phases were used to clarify the potential mechanism.

Results

After MK-7 intervention, we observed notable 13.4%, 28.3%, and 7.4% reductions in fasting serum glucose (P = 0.048), insulin (P = 0.005), and HbA1c levels (P = 0.019) in type 2 diabetes participants and significant glucose tolerance improvement in diet-induced obesity mice (P = 0.005). Moreover, increased concentrations of secondary bile acids (lithocholic and taurodeoxycholic acid) and short-chain fatty acids (acetic acid, butyric acid, and valeric acid) were found in human and mouse feces accompanied by an increased abundance of the genera that are responsible for the biosynthesis of these metabolites. Finally, we found that 4 weeks of fecal microbiota transplantation significantly improved glucose tolerance in diet-induced obesity mice by activating colon bile acid receptors, improving host immune-inflammatory responses, and increasing circulating GLP-1 concentrations.

Conclusions

Our gut-derived findings provide evidence for a regulatory role of vitamin K2 on glycemic homeostasis, which may further facilitate the clinical implementation of vitamin K2 intervention for diabetes management.

Trial registration

The study was registered at https://www.chictr.org.cn (ChiCTR1800019663).
IL-6 and cfDNA monitoring throughout COVID-19 hospitalization are accurate markers of its outcomes
Authors: Bello Salvador , Lasierra Ana Belén , López-Vergara Lucía , de Diego Cristina , Torralba Laura , de Gopegui Pablo Ruiz , Lahoz Raquel , Abadía Claudia , Godino Javier , Cebollada Alberto , Jimeno Beatriz , Bello Carlota , Tejada Antonio , Torres Antoni
Published: May 2023

Background

Severe COVID-19 entails a dysregulated immune response, most likely inflammation related to a lack of virus control. A better understanding of immune toxicity, immunosuppression balance, and COVID-19 assessments could help determine whether different clinical presentations are driven by specific types of immune responses. The progression of the immune response and tissular damage could predict outcomes and may help in the management of patients.

Methods

We collected 201 serum samples from 93 hospitalised patients classified as moderately, severely, and critically ill. We differentiated the viral, early inflammatory, and late inflammatory phases and included 72 patients with 180 samples in separate stages for longitudinal study and 55 controls. We studied selected cytokines, P-selectin, and the tissue damage markers lactate dehydrogenase (LDH) and cell-free DNA (cfDNA).

Results

TNF-α, IL-6, IL-8, and G-CSF were associated with severity and mortality, but only IL-6 increased since admission in the critical patients and non-survivors, correlating with damage markers. The lack of a significant decrease in IL-6 levels in the critical patients and non-survivors in the early inflammatory phase (a decreased presence in the other patients) suggests that these patients did not achieve viral control on days 10–16. For all patients, lactate dehydrogenase and cfDNA levels increased with severity, and cfDNA levels increased in the non-survivors from the first sample (p = 0.002) to the late inflammatory phase (p = 0.031). In the multivariate study, cfDNA was an independent risk factor for mortality and ICU admission.

Conclusions

The distinct progression of IL-6 levels in the course of the disease, especially on days 10–16, was a good marker of progression to critical status and mortality and could guide the start of IL-6 blockade. cfDNA was an accurate marker of severity and mortality from admission and throughout COVID-19 progression.
Molecular detection of plasmid mediated blaTEM, blaCTX−M,and blaSHV genes in Extended Spectrum β-Lactamase (ESBL) Escherichia coli from clinical samples
Authors: Chaudhary Mahesh Kumar , Jadhav Indrani , Banjara Megha Raj
Published: May 2023

Background

Extended spectrum β-lactamases (ESBLs) are a group of beta-lactamase enzymes that confer resistance to the oxyimino-cephalosporins and monobactams. The emergence of ESBL - producing genes possesses a serious threat for treating infections since it is associated with multi-drug resistance. This study was focused to identify the ESBLs producing genes from Escherichia coli isolates from clinical samples from a referral-level tertiary care hospital in Lalitpur.

Methods

This was a cross-sectional study conducted from September 2018 to April 2020 at the Microbiology Laboratory of Nepal Mediciti Hospital. Clinical samples were processed, and culture isolates were identified and characterized following standard microbiological techniques. An antibiotic susceptibility test was performed by a modified Kirby-Bauer disc diffusion method as recommended by Clinical and Laboratory Standard Institute guidelines.Extended -spectrum beta-lactamases were phenotypically confirmed by the combined disc method. The ESBL-producing genes blaTEM, blaCTX−M and blaSHV were confirmed by PCR.

Results

Of the 1449 total E. coli isolates, 22.29% (323/1449) isolates were multi-drug resistant (MDR). Among the total MDR E. coli isolates, 66.56% (215/323) were ESBL producers. The maximum number of ESBL E. coli was isolated from urine 90.23% (194) followed by sputum 5.58% (12), swab 2.32% (5), pus 0.93% (2), and blood 0.93% (2). The antibiotic susceptibility pattern of ESBL E. coli producers showed the highest sensitivity toward tigecycline (100%) followed by polymyxin b, colistin and meropenem. Out of 215 phenotypically confirmed ESBL E. coli, only 86.51% (186) isolates were found to be positive by PCR for either blaTEM or blaCTX−M genes. Among the ESBL genotypes, the most common were blaTEM 63.4% (118) followed by blaCTX−M 36.6% (68).

Conclusion

The emergence of MDR and ESBL – producing E. coli isolates with high antibiotic – resistant rates to commonly used antibiotics and increased predominance of major gene types blaTEM is a serious concern to the clinicians and microbiologists. Periodic monitoring of antibiotic susceptibility and associated genes would help guide the rationale use of antibiotics for treating the predominant pathogen E. coli in the hospitals and healthcare facilities of the communities.
Uncovering the Fate and Risks of Intravenously Injected Prussian Blue Nanoparticles in mice by an Integrated Methodology of Toxicology, Pharmacokinetics, Proteomics, and Metabolomics
Authors: Qu Haijing , Jin Xing , Cheng Wei , Wu Dongqi , Ma Boyu , Lou Chenmei , Zheng Jian , Jing Lijia , Xue Xiangdong , Wang Yang
Published: May 2023

Background

Prussian blue (PB) nanoparticles (NPs) have been intensively investigated for medical applications, but an in-depth toxicological investigation of PB NPs has not been implemented. In the present study, a comprehensive investigation of the fate and risks of PB NPs after intravenous administration was carried out by using a mouse model and an integrated methodology of pharmacokinetics, toxicology, proteomics, and metabolomics.

Results

General toxicological studies demonstrated that intravenous administration of PB NPs at 5 or 10 mg/kg could not induce obvious toxicity in mice, while mice treated with a relatively high dose of PB NPs at 20 mg/kg exhibited loss of appetite and weight decrease in the first two days postinjection. Pharmacokinetic studies revealed that intravenously administered PB NPs (20 mg/kg) underwent fast clearance from blood, highly accumulated in the liver and lungs of mice, and finally cleared from tissues. By further integrated proteomics and metabolomics analysis, we found that protein expression and metabolite levels changed significantly in the liver and lungs of mice due to the high accumulation of PB NPs, leading to slight inflammatory responses and intracellular oxidative stress.

Conclusions

Collectively, our integrated experimental data imply that the high accumulation of PB NPs may cause potential risks to the liver and lungs of mice, which will provide detailed references and guidance for further clinical application of PB NPs in the future.
Hepatic fibrosis: a manifestation of the liver disease evolution in patients with Ataxia-telangiectasia
Authors: Barreto Talita Lemos Neves , de Carvalho Filho Roberto José , Shigueoka David Carlos , Fonseca Fernando Luiz Affonso , Ferreira Ariel Cordeiro , Kochi Cristiane , Aranda Carolina Sanchez , Sarni Roseli Oselka Saccardo
Published: May 2023

Background

Ataxia-telangiectasia (A-T) is a DNA repair disorder characterized by changes in several organs and systems. Advances in clinical protocols have resulted in increased survival of A-T patients, however disease progression is evident, mainly through metabolic and liver changes.

Objective

To identify the frequency of significant hepatic fibrosis in A-T patients and to verify the association with metabolic alterations and degree of ataxia.

Methods

This is a cross-sectional study that included 25 A-T patients aged 5 to 31 years. Anthropometric data, liver, inflammatory, lipid metabolism and glucose biomarkers (oral glucose tolerance test with insulin curve—OGTT) were collected. The Cooperative Ataxia Rating Scale was applied to assess the degree of ataxia. The following were calculated: Homeostasis Model Assessment—Insulin Resistance, Homeostasis Model Assessment—Adiponectin (HOMA-AD), Matsuda index, aspartate aminotransferase (AST): platelet ratio index, nonalcoholic fatty liver disease fibrosis score and BARD score. Liver ultrasonography and transient liver elastography by FibroScan® were performed.

Results

Significant hepatic fibrosis was observed in 5/25 (20%). Patients in the group with significant hepatic fibrosis were older (p < 0.001), had lower platelet count values (p = 0.027), serum albumin (p = 0.019), HDL-c (p = 0.013) and Matsuda index (p = 0.044); and high values of LDL-c (p = 0.049), AST (p = 0.001), alanine aminotransferase (p = 0.002), gamma-glutamyl transferase (p = 0.001), ferritin (p = 0.001), 120-min glycemia by OGTT (p = 0.049), HOMA-AD (p = 0.016) and degree of ataxia (p = 0.009).

Conclusions

A non-invasive diagnosis of significant hepatic fibrosis was observed in 20% of A-T patients associated with changes in liver enzymes, ferritin, increased HOMA-AD, and the severity of ataxia in comparison with patients without hepatic fibrosis.