bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute exacerbation of idiopathic interstitial pneumonias related to chemotherapy for lung cancer: nationwide surveillance in Japan
Authors: Minegishi Yuji , Gemma Akihiko , Homma Sakae , Kishi Kazuma , Azuma Arata , Ogura Takashi , Hamada Naoki , Taniguchi Hiroyuki , Hattori Noboru , Nishioka Yasuhiko , Tanizawa Kiminobu , Johkoh Takeshi , Yokoyama Takuma , Mori Kazutaka , Taguchi Yoshio , Ebina Masahito , Inase Naohiko , Hagiwara Koichi , Ohnishi Hiroshi , Mukae Hiroshi , Inoue Yoshikazu , Kuwano Kazuyoshi , Chiba Hirofumi , Ohta Ken , Tanino Yoshinori , Sakai Fumikazu , Sugiyama Yukihiko
Published: May 2020

Background

Chemotherapy-induced acute exacerbation (AEx) of idiopathic interstitial pneumonias (IIPs) seriously compromises the success of treatment of Japanese lung cancer patients. Here, we conducted a nationwide surveillance to clarify the risk of AEx and compare it with the survival benefit of chemotherapy for this population.

Methods

Advanced nonsmall cell lung cancer (NSCLC) or small cell lung cancer (SCLC) patients with IIPs were retrospectively analysed. For the surveillance of first-line chemotherapy in 2009, we gathered clinical data from 396 patients who received chemotherapy at 19 institutions between January 1990 and July 2009. In a consecutive retrospective study in 2012, we analysed data from 278 patients from 17 institutions who received second-line chemotherapy between April 2002 and March 2012.

Results

Of the 396 patients analysed, 13.1% developed chemotherapy-related AEx. Combination chemotherapies of carboplatin plus paclitaxel (CP) or carboplatin plus etoposide (CE) were frequently used as first-line treatments. The lowest incidence of AEx was 3.7% in CE, followed by 8.6% in CP. In the retrospective study, 16.2% of the 278 patients developed a second-line chemotherapy-related AEx. The overall response rate by second-line chemotherapy was 7.4% in NSCLC and 25.7% in SCLC. The median overall survival from second-line and first-line chemotherapy was 8.0 and 14.3 months in NSCLC, and 8.7 and 16.0 months in SCLC, respectively.

Conclusion

Combination chemotherapies consisting of CP or CE are candidates for standard first-line treatments for patients with advanced lung cancer accompanied by IIP. Second-line chemotherapy should be considered for patients remaining fit enough to receive it.
Repeat assessment of examination signs among children in Malawi with fast-breathing pneumonia
Authors: Lenahan Jennifer L. , Nkwopara Evangelyn , Phiri Melda , Mvalo Tisungane , Couasnon Mari T. , Turner Kali , Ndamala Chifundo , McCollum Eric D. , May Susanne , Ginsburg Amy Sarah
Published: May 2020

Background

As part of a randomised controlled trial of treatment with placeboversus3 days of amoxicillin for nonsevere fast-breathing pneumonia among Malawian children aged 2–59 months, a subset of children was hospitalised for observation. We sought to characterise the progression of fast-breathing pneumonia among children undergoing repeat assessments to better understand which children do and do not deteriorate.

Methods

Vital signs and physical examination findings, including respiratory rate, arterial oxygen saturation measured by pulse oximetry (SpO2), chest indrawing and temperature were assessed every 3 h for the duration of hospitalisation. Children were assessed for treatment failure during study visits on days 1, 2, 3 and 4.

Results

Hospital monitoring data from 436 children were included. While no children hadSpO290–93% at baseline, 7.4% (16 of 215) of children receiving amoxicillin and 9.5% (21 of 221) receiving placebo developedSpO290–93% during monitoring. Similarly, no children had chest indrawing at enrolment, but 6.6% (14 of 215) in the amoxicillin group and 7.2% (16 of 221) in the placebo group went on to develop chest indrawing during hospitalisation.

Conclusion

Repeat monitoring of children with fast-breathing pneumonia identified vital and physical examination signs not present at baseline, includingSpO290–93% and chest indrawing. This information may support providers and policymakers in developing guidance for care of children with nonsevere pneumonia.
Variation of performance, of self-reported alertness and effort as a function of low doses of alcohol and of driving experience
Authors: Berthelon Catherine , Galy Edith
Published: May 2020

Purpose

Alcohol is the most frequent detected substance in the automobile fatal crashes but its precise mode of action on mental state is not always clear, notably when combined with lack of driving experience. The aim of this work is thus to evaluate performance and self-reported alertness and effort as a function of low doses of Blood Alcohol Concentration (BAC) and of drivers’ experience.

Methods

A single blind counterbalanced experiment was conducted on a driving simulator. Fifteen young novice drivers (18 years old, less of 2 months of driving licence) and fifteen young experienced drivers (21 years old, 3 years of driving licence) were tested with 0.0 g/l, 0.2 g/l and 0.5 g/l of alcohol at early afternoon. Driving scenarios was road tracking during 45 min at a constant speed of 110 km/h while maintaining a steady trajectory. Participants responded to the Thayer’s scale before and after each driving session, and to an adaptation of the NASA-TLX after each driving session. Statistical analyses were performed on driving parameters, self-reported alertness and effort as a function of alcohol level and driving experience.

Results

Alcohol deteriorated lateral and longitudinal stability of the trajectories. Notably with BAC 0.5 g/l, effort and speed increased but the increase in speed was particularly high for young experienced drivers. When young novice drivers felt that they were low alert, they also felt that they exerted more effort, their performance decreased, but they reduced their speed.

Conclusions

Alcohol thus degrades driving performance, and especially when the effort is high and alertness is low. The decrease of inhibitory process noted in presence of alcohol seems thus higher for young experienced than for young novice drivers. Results are in line with a drop in the blood alcohol level tolerated while driving.
Effectiveness of a therapeutic multiple-lifestyle intervention taking into account the periconceptional environment in the management of infertile couples: study design of a randomized controlled trial – the PEPCI study
Authors: Dupont Charlotte , Aegerter Philippe , Foucaut Aude-Marie , Reyre Aymeric , Lhuissier François J. , Bourgain Marie , Chabbert-Buffet Nathalie , Cédrin-Durnerin Isabelle , Selleret Lise , Cosson Emmanuel , Lévy Rachel
Published: May 2020

Background

Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It affects approximately one in six couples seeking pregnancy in France or western countries. Many lifestyle factors of the couples’ pre and peri-conceptional environment (weight, diet, alcohol, tobacco, coffee, drugs, physical activity, stress, sleep…) have been identified as risk factors for infertility in both males and females. The high prevalence rates of unhealthy diets and lifestyles in the reproductive population of industrialized countries are worrisome. Nevertheless, adoption of a healthy lifestyle may improve fertility but lifestyle changes are difficult to achieve and to maintain due notably to behavioral factors.

Methods

Consequently, we decided to propose an interventional study aimed at improving the quality of life of infertile couples before the start of assisted reproductive technology treatment. It is a randomized controlled multicentre trial. Both members of the couples are involved in an integrated global care program (PEPCI for “Parcours Environnement PériConceptionnel en Infertilité”) vs. usual care. This global intervention not only considers diet and/or physical activity but follows a holistic approach, including a multidisciplinary assessment to address complete physical, psychological and social well-being. According to patient needs, this includes interventions on weight, exercise, diet, alcohol and drugs, mental and social health.

Discussion

The main objective of trial is to demonstrate that periconceptional multidisciplinary care has a positive impact on reproductive functions. We will also focus on feasibility, acceptance, compliance and conditions of success of a multifaceted lifestyle intervention.

Trial registration

The trial was registered at ClinicalTrials.gov, Identifier: NCT02961907 on November 11, 2016.
Elderly women’s experiences of self-sampling for HPV testing
Authors: Hermansson Ruth S. , Olovsson Matts , Gustavsson Catharina , Lindström Annika Kristina
Published: May 2020

Background

Self-sampling for HPV testing, as an alternative to the conventional speculum based sampling, is highly acceptable to women of screening ages. The aim of this study was to describe older women’s (60 to 75 years) experiences of self-sampling.

Methods

In Sweden a descriptive study with quantitative and qualitative methods was designed to collect data from a survey of women who participated in self-sampling for HPV testing. Individual interviews were done with women who tested positive in the first self-sampling, and were either negative in their second HPV test or were positive in their second HPV test, but without precancerous lesions or cancer.

Results

Of 893 eligible women, 868 (97.2%) answered the survey. Among the surveyed women, 49.2% reported it was very easy to perform self-sampling, 46.8% answered it was easy and 2.0% answered it was not easy. A majority (58.9%) answered that they prefer self-sampling, 16.5% that they prefer sample collection by a healthcare provider, 23.7% did not have any preference and 0.9% did not answer the question. In the interviews, 13 of 16 invited women participated. Most of them reported that they prefer self-sampling because it was easy to perform, less embarrassing and less time consuming than a visit to a clinic. The majority of women reported that they were not worried when informed about having an HPV positive test. Overall, participating women with better knowledge about the significance of an HPV infection were more worried about having a positive HPV test.

Conclusion

Cervical cancer remains a highly preventable disease through screening and early treatment. Our results indicated that vaginal self-sampling for HPV testing was a well-accepted method for cervical cancer prevention in this group of older women.

Trial registration

https://www.researchweb.org/is/en/fouckfuu/project/272587. Registered 24 June 2019-retrospectively registered. www.researchweb.org
Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study
Authors: Ghimire Umesh , Aryal Binod Kumar , Gupta Ankush Kumar , Sapkota Suman
Published: May 2020

Background

Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6 to 59 months in the two districts of Nepal.

Methods

We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centers (OTCC). The nutritional status of children was assessed using mid-upper arm circumference (MUAC) measurement. To determine which variables predict the occurrence of SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value < 0.05 was considered as significant.

Results

Out of 398 children, 5.8% were severely malnourished and the higher percentage of female children were malnourished. Multivariate analysis showed that severe acute malnutrition was significantly associated with family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23–12.71). Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88–10.53) were four times more likely to be severely malnourished. Higher odds of SAM were found among younger age-group (AOR: 12.10; 95% CI: 2.06–71.09) children (0–12 vs. 24–59 months).

Conclusions

The findings of this study indicated that household size, household food access, and the child’s age were the major predictors of severe acute malnutrition. Engaging poor families in kitchen gardening to ensure household food access and nutritious diet to the children, along with health education and promotion to the mothers of young children are therefore recommended to reduce child undernutrition.
Risk factors for readmission for phototherapy due to jaundice in healthy newborns: a retrospective, observational study
Authors: Blumovich Amit , Mangel Laurence , Yochpaz Sivan , Mandel Dror , Marom Ronella
Published: May 2020

Background

The guidelines of the American Academy of Pediatrics (AAP) for monitoring neonatal jaundice recommend universal postnatal screening for hyperbilirubinemia within 48 h from discharge. We observed that neonate with low-risk jaundice were more likely to be readmitted to hospital for phototherapy compared to neonate with high-risk jaundice. The aim of this study was to identify additional factors that increase the risk for jaundice-related readmission.

Methods

This observational case-control study was performed on 100 consecutive neonates with jaundice who were readmitted to hospital for phototherapy treatment and were compared to 100 neonates with jaundice during hospitalization who were not readmitted after discharge. The data retrieved from the medical records of all participants included maternal characteristics, delivery type and noteworthy events, gestational age at delivery, birth weight and weight loss, neonate physical findings, Apgar scores, laboratory findings, length of hospital stay, and administration of phototherapy during hospitalization. The length of time since discharge and readmission for jaundice was also recorded.

Results

The risk of readmission decreased by 48% [odds ratio (OR) =0.52; 95% confidence interval (CI) 0.341–0.801] with every day added to the original hospitalization stay, and by 71% (OR = 0.29; 95% CI 0.091–0.891) if phototherapy had been administered during postnatal hospitalization. In contrast, the risk increased by 28% (OR = 1.28; 95% CI 1.164–1.398) with every elevation by 1% in hematocrit, and by 2.78 time (95% CI 1.213–6.345; p = 0.0156) when the delta in infant weight was > 5% (the difference between birth weight and weight at discharge during the postnatal hospitalization).

Conclusions

The risk factors for readmission, such as substantial weight loss (> 5% difference between birth and discharge) and elevated hematocrit should be taken into account in the decision to discharge neonate with low-risk jaundice. The AAP guidelines for decreasing readmission rates of neonatal jaundice by postnatal screening for hyperbilirubinemia alone may be more appropriate for neonate with high-risk jaundice.
Problematic internet use in children and adolescents: associations with psychiatric disorders and impairment
Authors: Restrepo Anita , Scheininger Tohar , Clucas Jon , Alexander Lindsay , Salum Giovanni A. , Georgiades Kathy , Paksarian Diana , Merikangas Kathleen R. , Milham Michael P.
Published: May 2020

Background

Problematic internet use (PIU) is an increasingly worrisome issue, as youth population studies are establishing links with internalizing and externalizing problems. There is a need for a better understanding of psychiatric diagnostic profiles associated with this issue, as well as its unique contributions to impairment. Here, we leveraged the ongoing, large-scale Child Mind Institute Healthy Brain Network, a transdiagnostic self-referred, community sample of children and adolescents (ages 5–21), to examine the associations between PIU and psychopathology, general impairment, physical health and sleep disturbances.

Methods

A total sample of 564 (190 female) participants between the ages of 7–15 (mean = 10.80, SD = 2.16), along with their parents/guardians, completed diagnostic interviews with clinicians, answered a wide range of self-report (SR) and parent-report (PR) questionnaires, including the Internet Addiction Test (IAT) and underwent physical testing as part of the Healthy Brain Network protocol.

Results

PIU was positively associated with depressive disorders (SR: aOR = 2.43, CI: 1.22–4.74, p = .01; PR: aOR = 2.56, CI: 1.31–5.05, p = .01), the combined presentation of ADHD (SR: aOR = 1.91, CI: 1.14–3.22, p = .01; PR: n.s.), Autism Spectrum Disorder (SR: n.s.; PR: aOR = 2.24, CI: 1.34–3.73, p < .001), greater levels of impairment (SR: Standardized Beta = 4.63, CI: 3.06–6.20, p < .001; PR: Standardized Beta = 5.05, CI: 3.67–6.42, p < .001) and increased sleep disturbances (SR: Standardized Beta = 3.15, CI: 0.71–5.59, p = .01; PR: Standardized Beta = 3.55, CI: 1.34–5.75, p < .001), even when accounting for demographic covariates and psychiatric comorbidity.

Conclusions

The association between PIU and psychopathology, as well as its impact on impairment and sleep disturbances, highlight the urgent need to gain an understanding of mechanisms in order to inform public health recommendations on internet use in U.S. youth.
Lonely places or lonely people? Investigating the relationship between loneliness and place of residence
Authors: Victor Christina R. , Pikhartova Jitka
Published: May 2020

Background

Loneliness in later life is largely presented as a problem of the individual focusing upon antecedents such as demographic or health factors. Research examining the role of the broader living environments is much rarer. We examined the relationship between loneliness and three dimensions of the lived environment: geographical region, deprivation, and area classification (urban or rural).

Methods

Our sample consisted of 4663 core members (44% males) aged 50+ (wave 7 mean age 72.8, S.D. = 7.1) present both in waves 3 (2006) and 7 (2014) of the English Longitudinal Study of Ageing (ELSA). Loneliness was measured using two approaches, individual and area-based, and both waves included these questions. Individual-based (self-reported) loneliness was assessed using the three item University of California Los Angeles (UCLA) scale (ranging from 3 = not lonely to 9 = lonely) with a score of 6+ defining loneliness. We also used a novel question which asked participants to evaluate how often they felt lonely in their area of residence (area-based; ranging from 1 = often to 7 = never, using cut off 4+ to define loneliness). The lived environment was classified in three different ways: the Index of Multiple Deprivation (IMD), Government Office Regions (GOR), and area classification (urban or rural). Covariates with established relationship with loneliness including demographic factors, social engagement and health, were included in the analyses.

Results

In wave 7, the prevalence of individual-based loneliness was 18% and area-based was 25%. There was limited congruence between measures: 68% participants reported no individual- or area-based loneliness and 9% reported loneliness for both measures. After adjusting for individual co-variates only one significant relationship was observed between loneliness and area -based characteristics. A significant association was observed between area-based loneliness and deprivation score, with higher levels of loneliness in more deprived areas (OR = 1.4 for highest quintile of deprivation).

Conclusions

Our results indicate that loneliness in older adults is higher in the most deprived areas independent of individual-level factors. In order to develop appropriate interventions further research is required to investigate how area-level factors combine with individual-level loneliness vulnerability measures to generate increased levels of loneliness in deprived areas.
Combined effects of gender affirmation and economic hardship on vulnerability to HIV: a qualitative analysis among U.S. adult transgender women
Authors: Jennings Mayo-Wilson Larissa , Benotsch Eric G. , Grigsby Sheila R. , Wagner Sarah , Timbo Fatmata , Poteat Tonia , Cathers Lauretta , Sawyer Ashlee N. , Smout Shelby A. , Zimmerman Rick S.
Published: May 2020

Background

Transgender women (“trans women”), particularly African-American and Latina trans women, have disproportionately high prevalence of HIV in the United States (U.S.). In order to decrease gender dysphoria and overcome discrimination, trans women affirm their gender through social and medical transition, often in contexts of economic hardship and sexual risk. This study qualitatively examined how gender-affirming behaviors enhance or diminish vulnerability to HIV in light of structural and economic barriers to gender transition.

Methods

We conducted individual interviews with 19 adult trans women in two U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing, or food security. Interviews were recorded, transcribed, and analyzed using thematic content analysis.

Results

The majority (74%) of trans women were racial/ethnic minorities with mean age of 26.3 years. Gender-affirming behaviors varied with 58% of trans women having legally changed their name and gender marker; 79% having initiated hormone therapy; and 11% having not initiated any medical or legal changes. None had undertaken surgical changes. Findings suggested that the process of gender transitioning resulted in both increasing and decreasing HIV risk. The high need for gender affirmation by male sex partners contributed to trans women’s exposure to sexual objectification, sexual risk behaviors, and conflicting interests in HIV prevention messaging. Loss of housing and employment due to transition along with the high costs of transition products and medical visits increased reliance on sex work and created new obstacles in accessing HIV services. Trans women experienced lower HIV risk as they acquired legal and medical transition services, reshaped interactions with sex partners, and received gender-affirming support by others, including health providers, employers, peers, and housing professionals. Sexual abstinence was viewed as a negative consequence of incomplete transition, although characterized as a period of low HIV risk.

Conclusions

Structural and policy initiatives that promote safe gender transition and economic stability in trans women may play a critical role in reducing HIV in this population. Addressing the harmful pressures for U.S. trans women to conform to perceived feminine stereotypes may also serve an important role.
Effectiveness of mobile SMS based counselling intervention in improving the knowledge, attitude, and practices of HIV/AIDS patients enrolled in hospitals/NGOs in Terengganu, Malaysia: a mixed mode study protocol
Authors: Hossain Md Mosharaf , Min Ruhani Binti Mat , Muhammad Zikri , Mani Kulanthayan K. C.
Published: May 2020

Background

HIV/AIDS is one of the most serious problems in many parts of the world, and is a high priority for health managers and decision-makers. The aim of the qualitative part of this study will be to develop a mobile SMS (short messaging services) counselling intervention to prevent HIV/AIDS, while the quantitative part will be to test the effectiveness of a mobile SMS counselling intervention to improve the knowledge, attitude, and practices of patients concerning the prevention of HIV/AIDS.

Method

A mixed methods approach will be used. Qualitative part: Design: focus group discussions (FGDs) will be conducted. Setting: Hospital/NGOs in Terengganu, Malaysia. Participants: Three FGDs will be conducted with male and female HIV/AIDS patients, and one group of local community leaders. One FGD will be conducted for each group. Three in-depth interviews (IDIs) will be conducted with patients who had HIV/AIDS, of which one will be female. Quantitative part: Design: a cluster randomized clinical trial with 384 HIV/AIDS patients in Terengganu, Malaysia. Intervention: Mobile SMS counselling intervention for patients concerning the prevention of HIV/AIDS.

Results

The main outcomes of this study will be the differences in knowledge, attitude, and practices of patients concerning the prevention of HIV/AIDS between the baseline and immediate follow-up after the intervention, and after 3 months.

Conclusions

The mobile based SMS counselling intervention developed will be effective in improving the knowledge, attitude, and practices of patients concerning HIV/AIDS prevention in Terengganu, Malaysia.

Trial registration

Thai Clinical Trials Registry, TCTR20200212001; 7/02/2020.
Attitude, practice and its associated factors towards Diabetes complications among type 2 diabetic patients at Addis Zemen District hospital, Northwest Ethiopia
Authors: Belsti Yitayeh , Akalu Yonas , Animut Yaregal
Published: May 2020

Background

This study aimed to assess the level of attitude, practices, and its associated factors towards complications of diabetes mellitus among type 2 diabetes patients.

Methods

An institution-based cross-sectional study was done on type 2 diabetes patients coming to the diabetes outpatient department at Addis Zemen District Hospital in Northwest Ethiopia. Interviewer-administered structured questionnaires were used to collect data from 402 patients. Multivariable logistic regression was employed to decide on factors related to practices and attitudes towards diabetes complications. AOR with 95% CI andp-value under 0.05 was considered to select significantly associated variables.

Results

Two-thirds of the study participants (65.2% (95% CI: 60.2, 69.4)) had a good attitude level while less than half of study participants (48.8% (95% CI: 44.0, 53.5)) had a good practice on diabetes complications. Educational status of read and write (AOR = 2.32, 95% CI(1.26, 4.27)), primary school (AOR = 4.31, 95% CI(2.06, 9.02)), high school and above (AOR = 2.79, 95% CI (1.41, 5.50)), and urban residence (AOR = 1.80, 95% CI (1.12 2.91)) were significant factors for good attitude while educational status of read and write (AOR = 1.96, 95% CI (1.06, 3.61)), and high school and above (AOR = 2.57, 95% CI (1.32, 5.02)) were associated with diabetes complication practices.

Conclusions

A greater proportion of diabetes patients had a relatively good attitude but poor practice towards diabetes complication preventions. Residence was a contributing variable for a good attitude while the level of education was significantly associated with both practice and attitude. The current study suggests the need for structured educational programs about diabetes complications regularly to improve patient’s attitudes and practice.
The impact of the nurses’, doctors’ and clinical officer strikes on mortality in four health facilities in Kenya
Authors: Kaguthi Grace Kiringa , Nduba Videlis , Adam Mary Beth
Published: May 2020

Background

Health worker strikes are a significant threat to universal access to care globally and especially in sub Saharan Africa. Kenya’s health sector has seen an increase in such industrial action. Globally there is limited data that has examined mortality related to such strikes in countries where emergency services were preserved. We sought to assess the mortality impact of an 100 day physician strike which was followed by 151 day nurses’ strike and 20 day clinical officer strike in Kenya.

Methods

Monthly mortality data was abstracted from four public hospitals, Kenyatta National Referral Hospital, AIC Kijabe Hospital, Mbagathi Hospital and Siaya Hospital between December 2016 and March 2018. Differences in mortality were assessed using t-tests and multiple linear regression adjusting for facility, numbers of patients utilizing the hospital and department.

Results

There was a significant decline in the numbers of patients seen, comparing the non-strike and strike periods; beta (ß) coefficient − 649 (95% CI -950, − 347)p < 0.0001. The physicians’ strike saw a significant decline in mortality (ß) coefficient − 19.0 (95%CI -29.2, − 8.87)p < 0.0001. Nurses and Clinical Officer strikes’ did not significantly impact mortality. There was no mortality increase in the post-strike period beta (ß) coefficient 7.42 (95%CI -16.7, 1.85)p = 0.12.

Conclusion

Declines in facility-based mortality during strike months was noted when compared to a non-striking facility, where mortality increased. The decline is possibly associated with the reduced patient volumes, and a possible change in quality of care. Public health facilities are congested and over-utilized by the local population majority of whom cannot afford even low cost private care. Health worker strikes in Kenya where the public health system is the only financially accessible option for 80% of the population pose a significant threat to universal access to care. Judicious investment in the health infrastructure and staffing may decrease congestion and improve quality of care with attendant mortality decline.
Effect of kidney transplantation on right ventricular function, assessment by 2- dimensional speckle tracking echocardiography
Authors: Khani Mohammad , Tara Ahmad , Shekarkhar Shadi , Esfahani Morteza Abdar , Bayat Fariba
Published: May 2020

Background

Advanced chronic kidney disease often results in adverse cardiovascular outcomes and is the leading cause of mortality in patients with end stage renal diseases (ESRD). There is much information about the effect of chronic kidney diseases (CKD) on the left ventricle (LV) chamber, but the right ventricle (RV) as a neglected chamber had not been evaluated precisely, in spite of its importance.

Objectives

The aim of this study was to evaluate the impact of successful kidney transplants on the RV systolic and diastolic function using the advanced method of 2D speckle tracking echocardiography and comparison with the conventional methods.

Method

The study included 48 patients with CKD who were eligible for kidney transplantation and underwent successful kidney transplantations. Right ventricular indices were evaluated, while RV function was focused by conventional methods and 2D speckle tracking echocardiography before the successful kidney transplant and 1 week, 1 month, and 3 months after the successful kidney transplant.

Results

The results of the study showed that RV global longitudinal strain and RV free wall longitudinal strain improved over the time (P = 0.024, P < 0.001 respectively). It also represented that kidney transplantation did not have significant effect on the RV mid cavity diameter, tissue velocity, Myocardial performance index, RV longitudinal diameter, and Tricuspid annular plane systolic excursion indices, but for other indices this effect was significant. On the differences between the mean slope of regression line of the GLS variable in hypertensive subjects (1.0 ± 0.2) and non-hypertensive subjects (0.36 ± 0.32), an independent t-test showed that between the two groups in terms of the improvement of RVGLS, there was a significant statistical difference (P = 0.0067).

Conclusion

Most of the ESRD patients had subtle RV dysfunction which could be better detected by recent echocardiography methods than conventional methods. Moreover, kidney transplantation led to considerable improvements in RV function in this population.
Effectiveness and safety of follitropin alfa (Ovaleap®) for ovarian stimulation using a GnRH antagonist protocol in real-world clinical practice: a multicenter, prospective, open, non-interventional assisted reproductive technology study
Authors: Sydow Peter , Gmeinwieser Norbert , Pribbernow Katrin , Keck Christoph , Wiegratz Inka
Published: May 2020

Background

The use of recombinant human follicle-stimulating hormone (r-hFSH) in ovarian stimulation protocols for infertility treatment in assisted reproductive technology (ART) clinical practice is well established. More recent advancements include the availability of biosimilar r-hFSH products, which expand the choices available to healthcare practitioners and patients. Better understanding of how such a product contributes to routine clinical practice is valuable to help prescribers make informed treatment choices. The objective of this study was to examine the effectiveness and safety of ovarian stimulation (OS) with follitropin alfa (Ovaleap®) for routine IVF or intracytoplasmic sperm injection treatment in gonadotropin-releasing hormone (GnRH) antagonist cycles in real-world ART clinical practice.

Methods

This non-interventional, multicenter, prospective study was initiated in 34 specialized reproductive medicine centers in Germany. Eligible women were 18–40 years old with a body mass index < 30 kg/m2, menstrual cycle 24–35 days and anti-Müllerian hormone ≥1 ng/mL, who were undergoing a first OS cycle exclusively with Ovaleap® during routine ART using a GnRH antagonist protocol. Primary effectiveness outcomes were number of retrieved oocytes after OS and clinical pregnancy rate (CPR). Secondary outcomes included fertilization rate, number of transferred embryos, live birth delivery rate, safety, and user satisfaction with the Ovaleap® pen.

Result(s)

Of 507 women screened, 463 received at least 1 dose of Ovaleap® and 439 had Visit 2 data (per protocol population; PPP). The mean(±SD) number of retrieved oocytes was 11.8 ± 7.2 (PPP). The CPR among women with documented embryo transfer was 41.3% (158/383), resulting in a live birth delivery rate of 31.6% (138/437) among PPP patients with available follow-up information. Overall, 8.6% (40/463) of women reported ≥1 adverse drug reaction. Ovarian hyperstimulation syndrome occurred in 23 (5.0%) patients, rated mild in 14 (3.0%), moderate in 8 (1.7%), and severe in 1 (0.2%). Patients reported high user satisfaction and high convenience with use of the Ovaleap® pen.

Conclusion

The effectiveness and safety of OS with Ovaleap® in a GnRH antagonist protocol were extended to real-world ART clinical practice for the first time.

Trial registration

Registered on 22 June 2016 (retrospectively registered) at ClinicalTrials.gov (NCT02809989).
Trends and determinants of adolescent childbirth in Uganda- analysis of rural and urban women using six demographic and health surveys, 1988–2016
Authors: Amongin Dinah , Benova Lenka , Nakimuli Annettee , Nakafeero Mary , Kaharuza Frank , Atuyambe Lynn , Hanson Claudia
Published: May 2020

Introduction

Uganda has high adolescent pregnancy. The details of adolescent childbirth and urban/rural patterns are scarce. We investigated the levels, time trends and determinants of adolescent childbirth in Uganda separately for urban and rural women.

Methods

We estimated the percentage of women 20–24 years at each of the six Uganda Demographic and Health Surveys (1988/89, 1995, 2000/01, 2006, 2011 and 2016) who reported a live childbirth before age 20 years (“adolescent childbirth”), and examined change over time using t-test. A modified multivariable Poisson regression was used to examine determinants of having adolescent childbirth on the 2016 survey.

Results

Among these women, 67.5, 66.4, 70.1, 62.3, 57.3 and 54.1% reported an adolescent childbirth in 1988/89, 1995, 2000/01, 2006, 2011 and 2016 surveys, respectively. Between 1988/89 to 2000/01, there was no evidence of change (+ 2.6% point (pp), p = 0.170), unlike between the 2000/01 and 2016 surveys when a significant decline occurred (− 16.0 pp., p < 0.001). First childbirth < 18 years of age declined by − 13.5 pp. (p < 0.001) between 2000/01 and 2016. There was no change over time in the percentage of adolescents 18–19.9 years of age having first childbirth. Among rural residents, childbirth < 18 years declined from 43.8% in 1988/89 to 32.7% in 2016 (− 11.1 pp., p < 0.001), in urban it declined from 28.3 to 18.2% (− 10.1 pp., p = 0.006). There was an increase over time in the percentage of women, both rural and urban, who wanted to delay their first pregnancy. Independent determinants of reporting an adolescent childbirth in both urban and rural residents were: no education/incomplete primary and younger age at first sex. Additional determinants for rural women were residence in Eastern region, Muslim religion, and poor household wealth index.

Conclusion

In the 30-year period examined, adolescent childbirth in Uganda declined from highs of 7 in 10 to approximately 5 in 10 women, with more wanting to delay the pregnancy. The decline started after the 2000/01 survey and affected predominantly younger adolescent childbirth < 18 years among both rural and urban residence women. Efforts need to be intensified to sustain the decline in adolescent pregnancies. Targeted and specific strategies for urban and rural areas might be required.
The moral and social narratives of sexual and reproductive health in Kenya: a case of adolescents and young people pre- and within the MDG era
Authors: Akwara Elsie , Idele Priscilla
Published: May 2020

Background

The role of global initiatives in catalyzing change within national contexts is complex and less understood. Addressing adolescent sexual and reproductive health in Kenya requires concerted efforts of both state and non-state actors and more importantly, a supportive environment. This paper deconstructs the moral and social narratives of adolescents’ and young people’s sexual and reproductive health (AYSRH) in Kenya as driven by the powerful discourse and ideologies pre- and within the Millennium Development Goal (MDG) era.

Methods

Literature was systematically searched in PubMed and Medline with policy documents obtained from government agencies from the pre-MDG period (2000 and earlier) and within the MDG period (2001–2015). Literature with a substantial focus on SRH were eligible if they captured the different facets of ASRH in Kenya and sub-Saharan Africa (SSA). The results were reviewed and synthesized to disentangle the moral and social narratives of AYSRH in Kenya with an MDG lens.

Results

The evolution of AYSRH policies and programmes in Kenya was gradual and largely shaped by prevailing development threats and moral and social narratives. Pre-MDG period was dominated by issue-based policies of population growth and high fertility rates, with a focus on married population with strong cultural and religious barriers to AYSRH; early to mid-MDG was mainly influenced by the threat of HIV/AIDS, culminating in the first Adolescent Reproductive Health and Development Policy in 2003. However, the policies and subsequent programmes focused on abstinence only and medical narratives, with persistent religious and cultural opposition to AYSRH. Late-MDG saw more progressive policies (these are policies that refer to those that tends towards acceptance of liberal social reforms and which sometimes are contrary to entrenched social norms, beliefs and practices), high government commitment and a refocus on SRH issues due to sustained early childbearing, culminating in the revised Adolescent Sexual and Reproductive Health Policy of 2015.

Conclusion

Debates in the translation of global goals and commitments to policy and practice at country level need to account for national level realities in AYSRH reforms. The findings contribute to critical evidence for strategic policy and programming approaches for AYSRH in Kenya and in SSA and for the realization of their rights within the context of sustainable development goals.
AIDS-associated Talaromyces marneffei central nervous system infection in patients of southwestern China
Authors: Li Yu-Ye , Dong Rong-Jing , Shrestha Samip , Upadhyay Pratishtha , Li Hui-Qin , Kuang Yi-Qun , Yang Xin-Ping , Zhang Yun-Gui
Published: May 2020

Background

The clinical and laboratory characteristics of AIDS-associated Talaromyces marneffei infection, a rare but a fatal mycosis disease of the central nervous system, remain unclear.

Case presentation

Herein, we conducted a retrospective study of ten AIDS patients with cerebrospinal fluid culture-confirmed central nervous system infection caused by Talaromyces marneffei. All 10 patients were promptly treated with antifungal treatment for a prolonged duration and early antiviral therapy (ART). Among them, seven patients were farmers. Nine patients were discharged after full recovery, while one patient died during hospitalization, resulting in a mortality rate of 10%. All patients initially presented symptoms and signs of an increase in intracranial pressure, mainly manifesting as headache, dizziness, vomiting, fever, decreased muscle strength, diplopia or even altered consciousness with seizures in severe patients. Nine patients (90%) showed lateral ventricle dilatation or intracranial infectious lesions on brain CT. Cerebrospinal fluid findings included elevated intracranial pressure, increased leukocyte count, low glucose, low chloride and high cerebrospinal fluid protein. The median CD4+ T count of patients was 104 cells/μL (IQR, 36–224 cells/μL) at the onset of the disease. The CD4+ T cell counts of three patients who eventually died were significantly lower (W = 6.00, p = 0.020) than those of the patients who survived.

Conclusions

The common clinical symptoms of T. marneffei central nervous system infection are associated with high intracranial pressure and intracranial infectious lesions. Earlier recognition and diagnosis and a prolonged course of amphotericin B treatment followed by itraconazole combined with early ART might reduce the mortality rate.
High-trans fatty acid and high-sugar diets can cause mice with non-alcoholic steatohepatitis with liver fibrosis and potential pathogenesis
Authors: Xin Xin , Cai Bei-Yu , Chen Cheng , Tian Hua-Jie , Wang Xin , Hu Yi-Yang , Feng Qin
Published: May 2020

Background and aims

Even Non-alcoholic steatohepatitis (NASH) has been becoming the key role in process of liver fibrosis or cirrhosis, no any NASH involving liver fibrosis mice model which consistent with the mechanisms of fatty acid and glucose metabolism disorder was widely accepted. Here, we established a mouse model of nonalcoholic steatohepatitis (NASH) with liver fibrosis using a high-fat, high-carbohydrate diet (HFHC) and analyzed the potential pathogenesis using a transcriptome microarray.

Methods

Fifty mice were stratified by weight and randomly divided into the HFHC model and control (Con) groups. Ten mice were sacrificed at the beginning of the experiments, 10 mice of HFHC and Con group were euthanized at the end of 20 and 30 weeks. The following analyses were performed: biochemical analysis; histological assessment; evaluation of hepatic type I collagen (Col-I), α-smooth muscle actin (α-SMA) and transforming growth factor-β1 (TGF-β1) protein and mRNA expression levels; and transcriptomic gene chip analysis.

Results

Compared with the Con group at each time point, the body weight and liver wet weight of the HFHC model group of mice were significantly higher. At 30th weeks, alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting blood glucose (FBG) and fasting insulin (FINS) levels or activities and the triglyceride (TG) and hydroxyproline (HYP) content in the HFHC model group were significantly elevated. Severe steatosis was present in the liver tissues contributed from the HFHC group of mice. Typically, substantial perisinusoidal fibrosis with a cage-like structure and bridging formations were observed in the mice liver in HFHC group. Col-I, α-SMA and TGF-β1 protein and mRNA expression levels in liver tissues of HFHC mice dramatically increased over time. Compared with the Con group, the HFHC group had 151 differentially expressed genes that were involved in 41 signaling pathways.

Conclusions

After keeping 30 weeks HFHC diet treatment, the mice exhibited substantial liver fibrosis, hepatic steatosis, ballooning degeneration and inflammation. Basing on the transcriptome microarray assays, the experimental NASH involving liver fibrosis potentially related to dramatically changed ECM-receptor interaction, Toll-like receptor signaling and other signaling pathways.
Inhibition of transforming growth factor beta signaling pathway promotes differentiation of human induced pluripotent stem cell-derived brain microvascular endothelial-like cells
Authors: Yamashita Misaki , Aoki Hiromasa , Hashita Tadahiro , Iwao Takahiro , Matsunaga Tamihide
Published: May 2020

Background

The blood–brain barrier (BBB) plays an important role as a biological barrier by regulating molecular transport between circulating blood and the brain parenchyma. In drug development, the accurate evaluation of BBB permeability is essential to predict not only the efficacy but also the safety of drugs. Recently, brain microvascular endothelial-like cells derived from human induced pluripotent stem cells (iPSCs) have attracted much attention. However, the differentiation protocol has not been optimized, and the enhancement of iPSC-derived brain microvascular endothelial-like cells (iBMELCs) function is required to develop highly functional BBB models for pharmaceutical research. Thus, we attempted to improve the functions of differentiated iBMELCs and develop a versatile BBB model by modulating TGF-β signaling pathway without implementing complex techniques such as co-culture systems.

Methods

iPSCs were differentiated into iBMELCs, and TGF-β inhibitor was used in the late stage of differentiation. To investigate the effect of TGF-β on freezing–thawing, iBMELCs were frozen for 60–90 min or 1 month. The barrier integrity of iBMELCs was evaluated by transendothelial electrical resistance (TEER) values and permeability of Lucifer yellow. Characterization of iBMELCs was conducted by RT-qPCR, immunofluorescence analysis, vascular tube formation assay, and acetylated LDL uptake assay. Functions of efflux transporters were defined by intracellular accumulation of the substrates.

Results

When we added a TGF-β inhibitor during iBMELCs differentiation, expression of the vascular endothelial cell marker was increased and blood vessel-like structure formation was enhanced. Furthermore, TEER values were remarkably increased in three iPSC lines. Additionally, it was revealed that TGF-β pathway inhibition suppressed the damage caused by the freezing–thawing of iBMELCs.

Conclusion

We succeeded in significantly enhancing the function and endothelial characteristics of iBMELCs by adding a small molecular compound, a TGF-β inhibitor. Moreover, the iBMELCs could maintain high barrier function even after freezing–thawing. Taken together, these results suggest that TGF-β pathway inhibition may be useful for developing iPSC-derived in vitro BBB models for further pharmaceutical research.
Evolution through segmental duplications and losses: a Super-Reconciliation approach
Authors: Delabre Mattéo , El-Mabrouk Nadia , Huber Katharina T. , Lafond Manuel , Moulton Vincent , Noutahi Emmanuel , Castellanos Miguel Sautie
Published: May 2020

The classical gene and species tree reconciliation, used to infer the history of gene gain and loss explaining the evolution of gene families, assumes an independent evolution for each family. While this assumption is reasonable for genes that are far apart in the genome, it is not appropriate for genes grouped into syntenic blocks, which are more plausibly the result of a concerted evolution. Here, we introduce theSuper-Reconciliationproblem which consists in inferring a history of segmental duplication and loss events (involving a set of neighboring genes) leading to a set of present-day syntenies from a single ancestral one. In other words, we extend the traditional Duplication-Loss reconciliation problem of a single gene tree, to a set of trees, accounting for segmental duplications and losses. Existency of a Super-Reconciliation depends on individual gene tree consistency. In addition, ignoring rearrangements implies that existency also depends on gene order consistency. We first show that the problem of reconstructing a most parsimonious Super-Reconciliation, if any, is NP-hard and give an exact exponential-time algorithm to solve it. Alternatively, we show that accounting for rearrangements in the evolutionary model, but still only minimizing segmental duplication and loss events, leads to an exact polynomial-time algorithm. We finally assess time efficiency of the former exponential time algorithm for the Duplication-Loss model on simulated datasets, and give a proof of concept on the opioid receptor genes.