bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect Of Smoking On Treatment Outcome Among Tuberculosis Patients In Malaysia; A Multicentre Study
Authors: Khan Amer Hayat , Sulaiman Syed Azhar Syed , Hassali Mohamed Azmi , Khan Kashif Ullah , Ming Long Chiau , Mateen Umer , Malik Obaid Ullah
Published: January 2020

Background : Smoking plays a key role in the development of tuberculosis (TB) infection and is also a predictor of poor TB treatment prognosis and outcomes. Objectives: To determine the prevalence of smoking and to assess the effects of smoking on treatment outcomes among TB patients. Methods : A multi-center retrospective study design was used to collect data from TB patients in four different states of Malaysia, namely Penang, Sabah, Sarawak, and Selangor. The study included medical records of TB patients admitted to the selected hospitals in the period from January 2006 to March 2009. Medical records with incomplete data were not included. Patient demographics and clinical data were collected using a validated data collection form. Results: Of all patients with TB (9337), the prevalence of smokers was 4313 (46.2%). Among smoker’s, 3584 (83.1%) were associated with pulmonary TB, while 729 (16.9%) were associated with Extra-pulmonary TB. Male gender (OR= 1.43, 95% CI 1.30-1.58), Chinese ethnicity (OR= 1.23, 95% CI 1.02-1.49), Sarawak indigenous ethnicity (OR= 0.74, 95% CI 0.58-0.95), urban residents (OR= 1.46, 95% CI 1.33-1.61), employed individuals (OR= 1.21, 95% CI 1.09-1.34), alcoholics (OR= 4.91, 95% CI 4.04-5.96), drug abusers (OR= 7.43, 95% CI 5.70-9.60) and presence of co-morbid condition (OR= 1.27, 95% CI 1.16-1.40) showed significant association with smoking habit. This study found that 3236 (75.0 %) patients were successfully treated in the smoker group, while 4004 (79.7 %) patients were non-smokers. The proportion of death rate 283 (6.6%), defaulters 284 (6.6%) and treatment interruption 204 (4.7%) was high in the smoker's group. Conclusions: Smoking had a strong influence on TB and is a major barrier towards treatment success (OR= 0.76, 95% CI 0.69-0.84, p< 0.001). Therefore, the findings point out that smoking cessations are an effective way to decrease treatment failure and drug resistance.
INTERGROWTH21st vs customized fetal growth curves in the assessment of the neonatal nutritional status: a retrospective cohort study of gestational diabetes
Authors: Alba Juan Jesus Fernández , Pazos Estefania Soto , Cortes Rocio Moreno , Sanchez Angel Vilar , Macias Carmen Gonzalez , Lara Maria Castillo , Corral Luis Moreno , Bueno Jose Antonio Sainz
Published: January 2020

Background
Gestational diabetes mellitus is associated with increased incidence of adverse perinatal outcomes including newborns large for gestational age, macrosomia, preeclampsia, polyhydramnios, stillbirth, and neonatal morbidity. Thus, fetal growth should be monitored by ultrasound to assess for fetal overnutrition, and thereby, its clinical consequence, macrosomia. However, it is not clear which reference curve to use to define the limits of normality. Our aim is to determine which method, INTERGROWTH21st or customized curves, better identifies the nutritional status of newborns of diabetic mothers.
Methods
This retrospective cohort study compared the risk of malnutrition in SGA newborns and the risk of overnutrition in LGA newborns using INTERGROWTH21st and customized birth weight references in gestational diabetes. Additionally, to determine the ability of both methods in the identification of neonatal malnutrition and overnutrition, we calculate sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios.
Results
231 pregnant women with GDM were included in the study. The rate of SGA indentified by INTERGROWTH21st was 4.7% vs 10.7% identified by the customized curves. The rate of LGA identified by INTERGROWTH21st was 25.6% vs 13.2% identified by the customized method. Newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH21st. (RR 4.24 vs 2.5). LGA newborns according to the customized method also showed a higher risk of overnutrition than those classified as LGA according to INTERGROWTH21st. (RR 5.26 vs 3.57). In addition, the positive predictive value of the customized method was superior to that of INTERGROWTH21st in the identification of malnutrition (32% vs 27.27%), severe malnutrition (22.73% vs 20%), overnutrition (51.61% vs 32.20%) and severe overnutrition (28.57% vs 14.89%).
Conclusions
In pregnant women with DMG, the ability of personalized fetal growth curves to identify newborns with alterations in nutritional status could exceed that of INTERGROWTH21st.
Minimally invasive versus conventional fixation of tracer in robot-assisted pedicle screw insertion surgery: a randomized control trial
Authors: Yongqi Li , Dehua Zhang , Hongzi Wu , Ke Zhang , Rui Yang , Zhou Fang , Shaobo Wang , Liao yi
Published: January 2020

Background This study evaluated the minimal invasiveness, safety, and accuracy of robot-assisted pedicle screw placement procedure using a modified tracer fixation device. Methods Patients were randomly assigned to conventional fixation group (25 patients) and modified fixation group (27 patients). Results No baseline statistical difference was observed between the groups ( P >0.05). The length of unnecessary incision, amount of bleeding, and fixation duration for tracer fixation respectively were 6.08±1.02 mm, 1.46±0.84 ml, and 1.56±0.32 min in the modified fixation group and 40.28±8.52 mm, 12.02±2.24 ml, and 5.08±1.06 min in the conventional group. The difference between both groups was significant ( P <0.05). However, no significant difference between the two groups was observed in terms of the accuracy of pedicle screw placement ( P >0.05). Conclusions The modified minimally invasive procedure for tracer fixation results in minimal trauma and is simple, reliable, and highly safe. Additionally, the procedure does not compromise the accuracy of pedicle screw placement. Thus, it has great clinical applicable value.
Identification of promoter elements in the Dolichospermum circinale AWQC131C saxitoxin gene cluster and the experimental analysis of their use for heterologous expression.
Authors: D'Agostino Paul Michael , Al-Sinawi Bakir , Mazmouz Rabia , Muenchhoff Julia , Neilan Brett Anthony , Moffitt Michelle
Published: January 2020

Background: Dolichospermum circinale is a filamentous bloom-forming cyanobacterium responsible for biosynthesis of the paralytic shellfish toxins (PST), including saxitoxin. PSTs are neurotoxins and in their purified form are important analytical standards for monitoring the quality of water and seafood and biomedical research tools for studying neuronal sodium channels. More recently, PSTs have been recognised for their utility as local anaesthetics. Characterisation of the transcriptional elements within the saxitoxin ( sxt ) biosynthetic gene cluster (BGC) is a first step towards accessing these molecules for biotechnology. Results: In D. circinale AWQC131C the sxt BGC is transcribed from two bidirectional promoter regions encoding five individual promoters. These promoters were identified experimentally using 5ʹ RACE and their activity assessed via coupling to a lux reporter system in E. coli and Synechocystis sp. PCC 6803. Transcription of the predicted drug/metabolite transporter (DMT) encoded by sxtPER was found to initiate from two promoters, P sxtPER1 and P sxtPER2 . In E. coli, strong expression of lux from P sxtP , P sxtD and sxtPER1 was observed while expression from P orf24 and P sxtPER2 was remarkably weaker. In contrast, heterologous expression in Synechocystis sp. PCC6803 showed that expression of lux from P sxtP , P sxtPER , and P orf24 promoters was statistically higher compared to the non-promoter control, while P sxtD showed poor activity under the described conditions. Conclusions: Both of the heterologous hosts investigated in this study exhibited high expression levels from three of the five sxt promoters. These results indicate that the majority of the native sxt promoters appear active in different heterologous hosts, simplifying initial cloning efforts. Therefore, heterologous expression of the sxt BGC in either E. coli or Synechocystis could be a viable first option for producing PSTs for industrial or biomedical purposes.
Effects of iron on the growth, biofilm formation and virulence of Klebsiella pneumoniae causing liver abscess
Authors: Chen Tao , Dong Guofeng , Zhang Siqin , Zhang Xiucai , Zhao Yajie , Cao Jianming , Zhou Tieli , Wu Qing
Published: January 2020

Background: Klebsiella pneumoniae is considered the most clinically relevant species of Enterobacteriaceae, known to cause severe infections including liver abscesses. To the best of our knowledge, a large proportion of iron in the human body is accumulated and stored in the liver. We hypothesize that increased iron availability is an important factor driving liver abscess formation and we therefore aim to understand the effects of iron on K. pneumoniae causing liver abscesses.

Results: All tested K. pneumoniae clinical isolates, including those isolated from liver abscesses and other abdominal invasive infection sites, grew optimally when cultured in LB broth supplemented with 50 μM iron and exhibited the strongest biofilm formation ability under those conditions. Decreased growth and biofilm formation ability were observed in all tested strains when cultured with an iron chelator (P<0.05). The infection model of G. mellonella larvae indicated the virulence of liver abscess-causing K. pneumoniae (2/3) cultured in LB broth with additional iron was significantly higher than those under iron-restricted conditions (P<0.05). The relative expression levels of the four siderophore genes (iucB, iroB, irp1, entB) in K. pneumoniae strains isolated from liver abscesses cultured with additional iron were lower than those under iron-restricted conditions (P<0.05).

Conclusions: It is suggested by our research that iron in the environment can promote growth, biofilm formation and enhance virulence of K. pneumoniae causing liver abscesses. A lower expression of siderophore genes correlates with increased virulence of liver abscess-causing K. pneumoniae. Further deeper evaluation of these phenomena is warranted.
Epidemiology of intestinal parasitic infections in Ethiopian children: A systematic review and meta-analysis
Authors: Chelkeba Legese , Mekonnen Zeleke , Alemu Yonas , Emana Daniel
Published: January 2020

Background : Numerous studies have been carried out on assessing the prevalence of intestinal parasites infections (IPIs) among preschool and school-age children in Ethiopia, but there is lack of study systematically gathered and analyzedinformation for policymakers. Therefore, the aim of this systematic review and meta-analysis was to provide a summary on prevalence, geographical distribution and trends of IPIs among preschool and school-age childrenin Ethiopia.
Methods :The search were carried out in Medline via PubMed, Scopus, Science Direct, Web of Science, and Google Scholar from 1996to July2019 for studies describing prevalence of IPIs among preschooland school-age children. We conducted meta-regression to understand the trends and the source of heterogeneity and pooled the prevalence using ‘metaprop’ command using STATA software version 14.
Results : Eighty-three(83) studies examining 56,786 fecal specimens were included. The prevalence of IPIs was 48 %( 95%CI: 42% to 53%) and showedsignificantly decreasing trends 17% (95% CI: 2.5% to 32%) for each consecutive 6 years) and was similar in males and females. The pooled prevalence in years 1997–2002, 2003–2008, 2009–2014 and >2014 was 71% (95% CI: 57% to 86%), 42% (95% CI: 27% to 56%), 48% (95% CI: 40% to 56%) and 42% (95% CI: 34% to 49%), respectively. Poly-parasitism was observed in 16% (95% CI: 13% to 19 %,) of the cases.
Conclusion: Intestinal parasite infections are highly prevalent among preschool and school-age children and well distributed across the regional states of Ethiopia. Southern and Amhara regional states carry the highest burden.We observed significant decreasing trends in prevalence of IPIs among preschool and school-age Ethiopian children over the last two decades.Therefore, this study is important to locate the geographical distribution and identified high risk areas that should be prioritized further interventions, which complement global efforts towards elimination of IPIs infections by 2020
Fluoroquinolone resistance and mutational profile of gyrA gene in pulmonary MDR tuberculosis patients
Authors: Kabir Saba , Tahir Zarfishan , Mukhtar Nadia , Sohail Muhammad , Saqalein Muhammad , Rehman Abdul
Published: January 2020

Background Flouroquinolones (FQs) are the potential drugs that inhibit DNA synthesis and used in the treatment of MDR-TB and anti-TB short term regimens. In recent year’s high proportion of flouroquinolone (FQs) resistance in Mycobacterium tuberculosis isolates has been observed. The development of FQs resistance among multidrug resistant TB (Pre-XDR TB) negatively impact patient treatment outcome and is a serious threat to control TB. Methods A total of 562 samples were included in the study from patients with pulmonary TB which had been on anti-tuberculosis therapy. MTBDRsl assay was performed for molecular detection of mutations. Sequence analysis was performed for characterization and mutational profiling of FQ resistant isolates. Results FQs resistance was observed in 104 (18.5%) samples and most of them were previously treated and treatment failure cases. A total of 102 isolates had mutations in gyrA gene. While gyrB gene mutations were observed in only two isolates. Mutational analysis showed that the mutations mostly alter protein at codon 94 (D94G) (represents the replacement of aspartic acid with glycine) and 90 (A90V) (substitution of alanine with valine). In MDR and treatment failure cases, the FQs-R was most commonly associated with D94G mutation. Whereas, a high proportion of A90V mutation was observed in MTB isolates which were newly diagnosed. Conclusion The findings suggest that the genotypic studies for FQs resistance should be carried out at time of initial diagnosis, before starting treatment, to rule out all type of mutations and its potential use in the treatment and to control resistance.
Association of Cognitive Impairment and Elderly Mortality: Differences between two cohorts ascertained 6-years apart in China
Authors: Duan Jun , Lv Yue-Bin , Gao Xiang , Zhou Jin-Hui , Kraus Virginia Byers , Zeng Yi , Su Hong , Shi Xiaoming
Published: January 2020

Background: Cognitive impairment is a major contributor to mortality among the elderly. However, the relationship between cognitive impairment evaluating by educational levels and mortality and the trend between cognitive impairment and mortality with time are unclear. We aim to evaluate the differences in associations of cognitive impairment, taking the stratification by educational levels into account, with all-cause mortality and explore the relationship of cognitive impairment with mortality in different age and sex groups in two cohorts ascertained 6 years apart in China.

Methods: A total of 13906 and 13873 Chinese elderly aged 65 years and older were included in the 2002-2008 and 2008-2014 cohorts from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Mortality data was ascertained from interviews with family members or relatives of participants. Cognitive function, evaluated by the Mini-Mental State Examination (MMSE), were defined by different cut-offs taking educational background into account. Cox models were used to explore the relationship of cognitive impairment with mortality.

Results: For the 2002-2008 and 2008-2014 cohorts, 55277 and 53267 person-years were followed up, and the mean (SD) age were 86.5 (11.6) and 87.2 (11.3) years, respectively. Compared to normal cognition, cognitive impairment was independently associated with higher mortality risk after controlling for potential confounders, with hazard ratios (HRs) of 1.32 (95% confidence interval [CI], 1.25-1.39) in 2002-2008 cohort and 1.26 (95% CI, 1.19-1.32) in 2008-2014 cohort, stratified by educational levels. The trend of cognitive impairment with all-cause mortality risk decreased from 2002-2008 to 2008-2014 cohort, while no significant interaction of cognitive impairment with cohort for all-cause mortality was observed. The associations of cognitive impairment and mortality were decreased with age in the two cohorts.

Conclusions: Cognitive impairment evaluated by different cut-offs were associated with increased risk of mortality, especially among those aged 65-79 years in the two cohorts; this advocates that periodic screening for cognitive impairment among the elderly is warranted.
Access to CKD Care in Rural Communities of India: A Qualitative Study Exploring the Barriers and Potential Facilitators
Authors: Jafar Tazeen , Ramakrishnan Chandrika , John Oommen , Tewari Abha , Cobb Benjamin , Legido-Quigley Helena , Sungwon Yoon , Jha Vivekanand
Published: January 2020

Background Despite the high and rising burden of chronic kidney disease (CKD) in South Asia, factors that influence access to CKD care at the community level have not been studied previously, especially in the rural areas. We conducted a mixed methods study and interviewed key stakeholders to explore the views and experiences of key stakeholders, and identify barriers and potential facilitators that influence access to CKD care at the primary care level in rural India. Methods A total of 21 stakeholders participated in the study. We conducted 15 in-depth interviews on a purposive sample of stakeholders (CKD patients, healthcare providers and health planners) and one focus group discussion with 6 community health workers. The interviews were audio-recorded and transcribed verbatim. We employed the Lévesque’s framework for access to care to base interview guides and structure the initial codes. By inductive and deductive approaches, thematic analysis was undertaken using QSR NVivo version 11. Results The major patient-level barriers to CKD care as reported by the most patients and healthcare providers was poor knowledge and awareness of CKD. Health system-level barriers included shortages of skilled healthcare professionals and medicines, fragmented referrals pathways to the specialists at the hospitals with inadequate follow up care. Many patients and healthcare providers, when asked about areas for improving access to CKD care, reported educational initiatives to increase awareness of CKD among healthcare providers and patients, provision of CKD related supplies, and a systems-level approach to care coordination including task shifting by engaging community health workers in CKD care, as potential facilitators. Conclusions We identified several barriers to access CKD care at the primary care level in rural India that need urgent attention. Targeted CKD screening programs and CKD specific educational initiatives may improve awareness of CKD. Additionally, primary care infrastructure needs to be strengthened for CKD care, ensuring trained staff, availability of essential diagnostics and medications, and creating efficient referral pathways for quality CKD care.
The association between individual perceptions of PM2.5 pollution and pulmonary function in Chinese middle-aged and elderly residents
Authors: Chen Qi , Zhang Jiayao , Xu Yan , Sun Hong , Ding Zhen
Published: January 2020

Background: PM2.5 pollution has become a major public health concern in urban China. Understanding the residents’ individual perceptions toward haze pollution is critical for policymaking and risk communication. However, the perceptions of middle-aged and elderly residents, who particularly vulnerable to haze pollution, are poorly understood. In this study, we aimed to explore their risk perception of haze pollution, and investigating its relationship with health status and pulmonary function parameters.
Methods: A cross-sectional study of 400 randomly sampled individuals (aged 40 to 90 years) was conducted in Wuxi, a typical PM2.5-polluted city in Jiangsu Province, China (daily average PM2.5 concentration was 52.73 μg/m3 between 2015-2017). Each participant’s demographic and health information, individual perception and pulmonary function outcomes were collected, and linear models were employed to explore the relationship between personal characteristics and pulmonary function parameters and perception factors.
Results: We found that the mean values for controllability (4.99 ± 2.78) and dread of risk to oneself (levels of fear for the haze-related harm to oneself) (6.90 ± 2.45) were the lowest and the highest values, respectively, in our study. Education and average family income were positively related with all individual perception factors, while age was negatively associated. A history of respiratory disease was positively associated with all individual perception factors except controllability. Significant positive associations were observed between PEF (coefficients ranged from 0.18 to 0.22) and FEF75% (coefficients ranged from 0.18 to 0.29) with a variety of individual perception factors.
Conclusions: There was a lack of concern and knowledge, weak self-protection consciousness and a strong dread of PM2.5 pollution among the middle-aged and elderly residents in Wuxi. Their individual perceptions were associated with age, education levels, average family income, history of respiratory disease and pulmonary function indexes PEF and FEF75%. Our findings may help policymakers develop effective policies and communication strategies to mitigate the hazards of haze among older residents.
Minimally invasive comprehensive treatment for granulomatous lobular mastitis
Authors: Wang Yaohuai , Song Junlong , Tu Yi , Chen Chuang , Sun Shengrong
Published: January 2020

Objective: To describe a minimally invasive comprehensive treatment for granulomatous lobular mastitis (GLM) and compare its effect with the existing methods, particularly in terms of its recurrence rate and esthetic outcomes. Methods: This retrospective study reviewed 69 GLM patients receiving the minimally invasive comprehensive treatment. Patients’ information, including age, clinical features, image characteristics, histopathological findings, mastitis history, treatment process, operative technique, recurrence, and esthetic effect, was evaluated. Results: All patients were female with a median age of 32 (range 17 - 55) years. Hospital stays ranged from 2 to 34 days, with a median of 6 days. The shortest time for complete rehabilitation was 2 days and the longest time was 365 days, with a median of 30 days. After a median follow-up of 391 days (range 162 - 690), 7 patients (10.14%) relapsed. The average cosmetic score was 2.62 ± 0.57 points and was mainly related to the past treatment, especially the surgical history. Conclusion: Minimally invasive comprehensive treatment is a new method for the treatment of GLM, ensuring a therapeutic effect while maintaining breast beauty.
Germline BRCA, Chemotherapy response scores, and survival in the neoadjuvant treatment of ovarian cancer
Authors: Lee Yong Jae , Kim Hyun-Soo , Rim John Hoon , Lee Jung-Yun , Nam Eun Ji , Kim Sang Wun , Kim Sunghoon , Kim Young Tae
Published: January 2020

Background: To analyze the effects of BRCA1/2 mutations on chemotherapy response scores (CRS) and survival in a cohort of patients with advanced-stage ovarian cancer who were treated with neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS).Methods: We retrospectively reviewed the medical records of 169 high-grade serous ovarian cancer patients who underwent a germline BRCA1/2 test and received three cycles of NAC at the Yonsei Cancer Center from 2006 to 2018. Chemotherapy response scores were compared in patients with and without BRCA1/2 mutations. The effects of BRCA1/2 mutations and CRS on survival were evaluated. Results: BRCA1/2 mutations were detected in 47 (28.1%) of the 169 patients. Overall, 16 (34.0%) patients with BRCA1/2 mutations had a CRS 3 to chemotherapy compared to scores of 43 in patients (35.2%) without a mutation. Response scores of 3 in patients with BRCA1/2 mutations were not significantly associated with either improved progression-free survival (PFS) (P = 0.949) or overall survival (OS) (P = 0.168). However, CRS 3 in patients without BRCA mutations was significantly associated with both improved PFS (P = 0.030) and OS (P = 0.039). In patients with CRS1/2, carriers of BRCA1/2 mutations had better PFS (P = 0.0344) and OS (P = 0.043) than wild-type BRCA genotype patients.Conclusion: In ovarian cancer patients treated with NAC, CRS did not predict survival for BRCA 1/2 mutation carriers but did for BRCA wild-type patients.
Molecular methods for tracking residual Plasmodium falciparum transmission in a close-to-elimination setting in Zanzibar
Authors: Grossenbacher Benjamin , Holzschuh Aurel , Hofmann Natalie , Omar Kali Abdullah , Stuck Logan , Fakih Bakar Shariff , Ali Abdullah S. , Yukich Joshua , Hetzel Manuel W , Felger Ingrid
Published: January 2020

Background
Molecular detection of low-density Plasmodium falciparum infections is essential for surveillance studies conducted to inform malaria control strategies in close-to-elimination settings. Molecular monitoring of residual malaria infections usually requires a large study size, therefore sampling and diagnostic processes need to be economical and optimized for high-throughput. A method comparison was undertaken to identify the most efficient diagnostic procedure for processing large collections of community samples with optimal test sensitivity, simplicity, and minimal costs.
Methods
In a reactive case detection study conducted on Zanzibar, parasitaemia of 4590 individuals of all ages was investigated by a highly sensitive quantitative (q) PCR that targets multiple var gene copies per parasite genome. To reduce cost, a first round of positivity screening was performed on pools of dried blood spots from five individuals. Ten cycles of a pre-PCR were performed directly on the filter paper punches, followed by qPCR. In a second round, samples of positive pools were individually analysed by pre-PCR and qPCR.
Results
Prevalence in household members and neighbors of index cases was 1.7% (78/4590) with a geometric mean parasite density of 58 parasites/µl blood. Using qPCR as gold standard, diagnostic sensitivity of rapid diagnostic tests (RDTs) was 37% (29/78). Infections positive by qPCR but negative by RDT had mean densities of 15 parasites/µl blood.
Conclusion
The approach of pre-screening reactive case detection samples in pools of five was ideal for a low prevalence setting such as in Zanzibar. Performing direct PCR on filter paper punches saves substantial time and justifies the higher cost for a polymerase suitable for amplifying DNA directly from whole blood. Molecular monitoring in community samples provided a more accurate picture of infection prevalence, as it identified a potential reservoir of infection that was largely missed by RDT. The developed qPCR-based methodology for screening large sample sets represents primarily a research tool that should inform the design of malaria elimination strategies. It may also prove beneficial for diagnostic tasks in surveillance-response activities.
Analyzing Big Tobacco’s global youth marketing strategies in Nigeria using the theory of triadic influence
Authors: Isip Ukoabasi , Calvert John Robert
Published: January 2020

Background

Major transnational tobacco companies (TTCs) have identified Nigeria, the seventh most populous country in the world, as a market with a major revenue potential given its high youth population and growing gross domestic product (GDP). This research analyses tobacco industry-related strategies and activities targeting youth (aged 15 to 24 years) in Nigeria as existing, but most importantly, future tobacco users. Nigeria is the focus of this study because the tobacco industry has viewed it as a major emerging market since the 1990s. Successful marketing in Nigeria could provide the industry with a template for similar initiatives in other emerging markets in low- and middle-income countries.

Methods

The research began with a systematic review of secondary literature to determine how the tobacco industry has targeted youth globally. It then used the theory of triadic influence as a heuristic framework to categorize the various industry strategies. Quotations from internal tobacco industry documents were organized into the three streams of the theory of triadic influence: biology/personality, social and cultural/environmental streams. A total of 12 interviews were conducted with 6 policymakers and governmental officials, 2 civil society organization representatives, a high school principal, a journalist and 2 researchers to investigate how the tobacco industry had targeted youth in Nigeria.

Results

The findings indicate that TTCs have actively targeted youth in Nigeria since the 1990s, focusing on changing behaviour through the biology/personality, social and environmental/ cultural streams.

Conclusion

The study recommends that Nigeria implement and vigorously enforce its 2015 National Tobacco Control Bill.
Strategies to reach and motivate migrant communities at high risk for TB to participate in a latent tuberculosis infection screening program: a community-engaged mixed methods study among Eritreans
Authors: Spruijt Ineke , Haile Dawit Tesfay , Erkens Connie , Hof Susan van den , Goosen Simone , Kate Andrea ten , Teshome Hewan , Karels Marja , Koenders Marga , Suurmond Jeanine
Published: January 2020

Background: In the Netherlands, migrant populations with a high tuberculosis (TB) incidence are an important target group for TB prevention. However, there is a lack of insight in effective community-engaged strategies to reach and motivate these migrants to participate in latent TB infection (LTBI) screening and treatment programs.
Methods: In cocreation with Eritrean key figures and TB staff, we designed and executed six strategies to reach and motivate Eritrean communities to participate in LTBI programs, in five regions in the Netherlands. We registered participation in LTBI education and screening, and LTBI treatment uptake and completion. We used semi-structured group and individual interviews with Eritrean participants, key figures, and TB staff to identify facilitators and barriers.
Results: Uptake of LTBI education (13% - 75%) and consequent screening (10% - 124%) varied between strategies. LTBI screening uptake >100% resulted from educated participants motivating others to participate in screening. Two strategies, using face-to-face promotion and targeting smaller groups, were the most successful. The program resulted in high LTBI treatment initiation and completion (both 97%). Reported program barriers included: competing priorities in the target group, perceived good health, poor risk perception, and scepticism towards the program purpose. TB staff perceived the program as useful but demanding in terms of human resources.
Conclusions: Eritrean migrant communities can be successfully reached and motivated for LTBI screening and treatment programs, when sufficient (human) resources are in place and community members, well-connected to and trusted by the community, are engaged in the design and execution of the program.
Essential Newborn Care Utilization and Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis
Authors: Merkeb Yoseph , Adane Fentahun , Yirga Tadesse , Desta Melaku
Published: January 2020

Background: Globally, newborn death accounted for 46% of under-five deaths and more than 80% of newborn deaths are the result of preventable and treatable conditions. Reports on the prevalence and associated factors of essential newborn care utilization are highly variable and inconsistent across Ethiopia. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of essential newborn care utilization and associated factors in Ethiopia.
Methods : The international databases include: MEDLINE/PubMed, EMBASE, Web of Sciences, Scopus, Google Scholar, Science Direct, Cochrane library and others were scientifically explored. We considered all primary studies reporting the prevalence of essential newborn care utilization and associated factors in Ethiopia. We retrieved all necessary data by using a standardized data extraction format spreadsheet. STATA 14 statistical software was used to analyze the data and Cochrane Q test statistics and I 2 test was used to assess the heterogeneity between the studies.Random effect model was employed.
Results: The pooled estimate of essential newborn care utilization from 11 studies in Ethiopia was 48.768% (95% CI: 27.891, 69.645). Residence [ OR = 2.50 (95% CI: 1.64, 3.88)], Postnatal care [OR=5.53, 95% CI = (3.02, 10.13], counseling during pregnancy and delivery [OR=4.39, 95% CI = (2.99, 6.45], antenatal care follows up (OR=6.84; 95% CI: 1.15, 4.70) and maternal educational status [OR = 1.63 (95% CI: 1.12, 2.37)] were identified as the associated factors of essential newborn care utilization.
Conclusion: Based on the current study essential newborn care utilization in Ethiopia was significantly low as compared to the current global recommendation on essential newborn care utilization. Place of residence, Postnatal care, counseling during pregnancy and delivery, antenatal care follows up and maternal educational status were associated risk factors variables. Therefore, on the basis of the results, it is suggested that special attention should be given to attempts to ensure that education should focus on women during ante and postnatal follow-up, counseling during pregnancy and delivery, as well as rural and illiterate mothers. Finally, appropriate newborn services utilization at health facilities and raising mother’s level of awareness about newborn care practices should be recommended.
“When my mother called to say that the time of cutting had arrived, I escaped to Belgium with my daughter”: Identifying turning points in the change of attitudes towards the practice of Female Genital Mutilation among migrant women in Belgium
Authors: Agboli Afi A. , Richard Fabienne , Aujoulat Isabelle
Published: January 2020

Background Female Genital Mutilation (FGM) remains a public health concern with negative consequences on women’s health. It is a harmful practice and recognized in international discourses on public health as a form of gender-based violence of which women are not only victims, but also perpetrators. Although the practice of FGM remains a social norm which is difficult to change because of its deep roots in tradition and how it is embedded in the patriarchal system, some women have changed their attitudes towards it and speak out against it. This study identifies and describes turning points (TP) defined as significant events in the lives of the women, that create changes towards the practice of FGM.Methods We conducted an inductive qualitative study based on the life story approach where we interviewed 15 women with FGM. During the interviews the turning points that gave them the courage to change were identified together with the research participants. The analysis drew on lifeline reconstructions and thematic analysis.Results Six common turning points relating to a change in attitude towards FGM were identified: TPs related to encounters with health professionals, education, social interactions with other cultures and their own culture, experiences of motherhood, repeated pain during sexual or reproductive activity and to the fact witnessing some harmful consequences of FGM towards loved ones.Conclusion The turning points identified challenged the understanding of what it means to be a ‘member’ of the community in a patriarchal system, a ‘normal woman’ according to the community and what it means to be a good mother. In addition, the TPs found were expressed together with some issues related to emotional responses and coming to terms with conflict of loyalty, which we see as possible mechanisms to explain the change experienced by the women in our sample.
In vitro and Numerical Simulation of Blood Removal from Cerebrospinal Fluid: Comparison of Lumbar Drain to Neurapheresis Therapy
Authors: Khani Mohammadreza , Sass Lucas , Sharp M. Keith , McCabe Aaron , Verbick Laura Zitella , Lad Shivanand , martin bryn
Published: January 2020

Background: Blood removal from cerebrospinal fluid (CSF) in post-subarachnoid hemorrhage patients may reduce the risk of related secondary brain injury. We formulated a computational fluid dynamics (CFD) model to investigate the impact of a dual-lumen catheter-based CSF filtration system, called Neurapheresis TM therapy, on blood removal from CSF compared to lumbar drain. Methods: A subject-specific multiphase CFD model of CSF system-wide solute transport was constructed based on MRI measurements. The Neurapheresis catheter geometry was added to the model within the spinal subarachnoid space. Neurapheresis flow aspiration and return rate was 2.0 and 1.8 (mL/min), versus 0.2 (mL/min) drainage for lumbar drain. Blood was modeled as a bulk fluid phase within CSF with a 10% initial tracer concentration and identical viscosity and density as CSF. Subject-specific oscillatory CSF flow was applied at the model inlet. The dura and spinal cord geometry were considered to be stationary. Spatial-temporal tracer concentration was quantified based on time-average steady-streaming velocities throughout the domain under Neurapheresis therapy and lumbar drain. To help verify CFD results, an optically clear in vitro CSF model was constructed with fluorescein used as a blood surrogate. Quantitative comparison of numerical and in vitro results was performed by linear regression of spatial-temporal tracer concentration over 24-hours. Results: After 24-hours, tracer concentration was reduced to 4.9% under Neurapheresis therapy compared to 6.5% under lumbar drain. Tracer clearance was most rapid between the catheter aspiration and return ports. Neurapheresis therapy was found to have a greater impact on steady-streaming compared to lumbar drain. Steady-streaming in the cranial SAS was ~50X smaller than in the spinal subarachnoid space for both cases. CFD results were strongly correlated with the in vitro spatial-temporal tracer concentration under Neurapheresis therapy (R 2 =0.89 with +2.13% and -1.93% tracer concentration confidence interval). Conclusion: A subject-specific CFD model of CSF system-wide solute transport was used to investigate the impact of Neurapheresis therapy on tracer removal from CSF compared to lumbar drain over a 24-hour period. Neurapheresis therapy was found to substantially increase tracer clearance compared to lumbar drain. The multiphase CFD results were verified by in vitro fluorescein tracer experiments.
Magnitude of virologic failure and associated factors among adult patients on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia, 2018
Authors: Abebaw Addisu , Taddele Mekuanint , Alem Girma , Birlew Tesfa , Berihun sileshi
Published: January 2020

Background : Viral load monitoring is used as an important marker for diagnosing early treatment failure in patients with HIV infection/AIDS. Ethiopia has started targeted viral load monitoring recently. However, factors leading to virological failure are not well understood. The aim of this study is to assess magnitude of virologic failure and associated factors among adult patient on ART at Debre Markos Referral Hospital, North West Ethiopia. Methods : Cross sectional study was conducted on 304 participants who had started first line HAAR. Data were collected from patients’ chart starting from ART commencement and face to face interview using semi structured questionnaire. Viral load from separated plasma were analyzed according to protocols. The collected data were analyzed using SPSS version 20. Binary and multiple logistic regression models were fitted to identify factors associated with virological failure among adult patient on ART and to control confounding effect. The results were presented as odds ratio (OR) with 95% confidence intervals. Independent associations were considered with p<0.05. Results: Magnitude of virological failure was 10.5%. Lower income, (AOR = 3.5, 95% CI = 1.2 - 10.5, P = 0.024), lack of social support (AOR = 2.9, 95% CI = 1.01 – 8.2, P = 0.024), Interruption of ART, (AOR = 3.5, 95% CI = 1.01 – 12.1, P = 0.046), drug adherence (AOR = 3.6, 95% CI = 1.1 – 11.3, P = 0.028), non-working functional status (AOR = 3.5, 95% CI = 1.2 – 9.7, P = 0.018), WHO stage III or IV (AOR = 2.9, 95% CI = 1.01 – 8.0, P = 0.040), CD4 count < 200 cells/ml (AOR = 3.0, 95% CI = 1.1 – 8.0, P = 0.031) and TB co-infection (AOR = 3.7, 95% CI = 1.2 – 11.3, P = 0.018) were significantly associated with virological failure. Conclusions and recommendations : The prevalence of virologic failure was high. Lower income, lack of social support, interruption of ART, drug non-adherence, baseline non-working functional status, WHO stage, CD4 count < 200 cells/ml and TB co-infection Conducting faith healing, TB co infection, WHO stage III and IV, adherence, and income were determinants of virologic failure. Therefore early identification of associated factors and monitoring of virologic failure has to be strengthened to benefit patients to prevent from further complication. Keywords : HIV, virological failure, ART, Ethiopia
Surgical site infection following elective mesh repair of inguinal hernia: an analysis of risk factors
Authors: Zhuo Yeye , Li Xinxin , Chen Juntian , Zhang Qian , Cai De
Published: January 2020

Background: Surgical site infection (SSI) is a complication of mesh repair of inguinal hernia (IH) with an increase in length of stay and costs. We investigated both controllable and non-controllable risk factors for SSI following elective mesh repair of IH. Methods: A retrospective analysis was conducted of 1177 adult patients who underwent elective mesh repair of IH (not receiving antibiotic prophylaxis) from January 2010 to September 2019. Demographics, surgical variables and laboratory data were extracted from the electronic medical records. Receiver operating characteristic (ROC) analysis was performed to determine the optimal threshold of continuous variables. Independent risk factors for SSI were identified by univariate and multivariate analyses. Results: In total, 647 open and 530 laparoscopic IH repairs were included. The overall SSI rate within 30 days after surgery was 3.2% (39/1342 hernias) in the absence of antibiotic prophylaxis. Both the preoperative neutrophil‐lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were negatively correlated with the postoperative period of SSI (r = -0.368, P = 0.021; r = -0.334, P = 0.038, respectively). On multivariate analyses, body mass index (BMI) > 24.6 kg/m 2 (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.041-1.275), current smoker (OR, 4.226; 95% CI, 1.222-14.611), preoperative NLR > 1.97 (OR, 3.670; 95% CI, 1.675-8.041), and open approach (OR, 4.866; 95% CI, 1.877-12.618) were significantly related to postoperative SSI. Conclusion: The controllable risk factors (elevated BMI, current smoker) found out here may help to identify patients at high-risk of SSI, allowing targeted preventive measures. Preoperative NLR > 1.97 is a previous unrecorded predictor for SSI following elective mesh repair of IH. Further study is needed to ascertain the magnitude of their effect.
A novel genotyping technique for discriminating LVAS-associated hotspot mutations in SLC26A4 gene
Authors: Zhou Chen , Zou Xiangman , Peng Cuiying , Gao Guoqiang , Guo Zifen
Published: January 2020

An increasing number of biological and epidemiological evidence suggests that IVS7-2A>G and 2168A>G mutations of solute carrier family 26, member 4 ( SLC26A4 ) gene plays a critical role in the development of large vestibular aqueduct syndrome (LVAS). In this study, we developed a rapid genotyping method for discriminating LVAS-associated hotspot mutations in SLC26A4 gene. The genotyping technique consists of 3’ terminal exonuclease-resistant phosphorothioate-modified allele specific primer extension mediated by exo + polymerase. In PCR amplification by Pfu polymerase, allelic specific primers perfectly matching wild type allele were extended while no specific products were yielded from primers targeting mutant type allele. Similarly, allelic specific primers perfectly matching mutant type allele were extended and no specific products were observed from primers targeting wild type allele . The clinical application of 3’ terminal phosphorothioate-modified allele specific primers extension mediated by Pfu polymerase identified both homozygous for SLC26A4 gene IVS7-2A>G mutation in two LVAS patients diagnosed as by temporal bone CT scan. The genetic results from this method is consistent with that of DNA sequencing. The data suggest that exo + polymerase-mediated 3’ terminal phosphorothioate-modified primer extension is reliable in the identification of SLC26A4 gene hotspot mutation prior to high resolution CT scan. The method is extremely suitable for quickly molecular etiologic screening and early diagnosis and aggressive prevention therapy of LVAS.
Comparison of statistical methods for analysis of small sample sizes for detecting the differences in efficacy between treatments for knee osteoarthritis
Authors: Shih Chia-Lung , Hung Te-Yu
Published: January 2020

Background A small sample size (n < 30 for each treatment group) is usually enrolled to investigate the differences in efficacy between treatments for knee osteoarthritis (OA). The objective of this study was to use simulation for comparing the power of four statistical methods for analysis of small sample size for detecting the differences in efficacy between two treatments for knee OA. Methods A total of 10,000 replicates of 5 sample sizes (n=10, 15, 20, 25, and 30 for each group) were generated based on the previous reported measures of treatment efficacy. Four statistical methods were used to compare the differences in efficacy between treatments, including the two-sample t-test (t-test), the Mann-Whitney U-test (M-W test), the Kolmogorov-Smirnov test (K-S test), and the permutation test (perm-test). Results The bias of simulated parameter means showed a decreased trend with sample size but the CV% of simulated parameter means varied with sample sizes for all parameters. For the largest sample size (n=30), the CV% could achieve a small level (<20%) for almost all parameters but the bias could not. Among the non-parametric tests for analysis of small sample size, the perm-test had the highest statistical power, and its false positive rate was not affected by sample size. However, the power of the perm-test could not achieve a high value (80%) even using the largest sample size (n=30). Conclusion The perm-test is suggested for analysis of small sample size to compare the differences in efficacy between two treatments for knee OA.