Category: Nevin Manimala

Contracept Reprod Med. 2023 Mar 3;8(1):22. doi: 10.1186/s40834-023-00217-z.

ABSTRACT

BACKGROUND: The under-five child mortality rate is a widely accepted indicator of the development of a country as well as reflects the country’s health care system and quality of life. Although the child mortality rate is decreasing over time in Bangladesh, the rate is still high among South Asian countries. The target of the Sustainable Development Goal-3.2 is to reduce the under-five mortality rate in all countries of the world to 25 or fewer per 1000 live births by 2030. The purpose of this study is to identify the socio-demographic factors which have an influence on under-five child mortality in Bangladesh as well as to examine whether contraceptive use has any effect on under-five mortality in Bangladesh. Finally, a comparison has been made between the results obtained from the Cox proportional Hazard Model and Weibull model to find out which model is more efficient for the study data.

METHODS: For the study, data was extracted from Bangladesh Demographic Health Surveys 2017-2018 (BDHS 2017-2018). The Kaplan-Meier survival function has been used to demonstrate the survival probabilities of under-five children. While multivariate analyses of the Cox Proportional Hazard model and Weibull model are used to estimate the under-five mortality risks for various predictors.

RESULTS: The study results show consistently higher survival probabilities for children of mothers who used modern contraceptives during survival periods. Other significant predictors for under-five child mortality include mother’s education level (higher education), mother’s age (> 20), wealth index (rich), source of drinking water (tube well), and division (Chittagong, Khulna, Mymensingh). Weibull model has given more efficient results than the Cox Proportional Hazard model except for one covariate (water source).

CONCLUSION: Contraceptives use significantly improves the survival chances of children under-five age. This underscores the importance of contraceptive use in the pursuit of a sustainable reduction in under-five mortality in Bangladesh. It also intensifies the need to address the present level of contraceptive use in the country. This may not be due to the use of contraceptives in itself but may be due to the substantial biological and socioeconomic benefits that are concomitant with contraceptive use which may promote both maternal and child health. So, Extra effort should be given by the policymakers to ensure the use of modern contraceptive methods to improve the under-five survival in Bangladesh.

PMID:36864535 | DOI:10.1186/s40834-023-00217-z

Ultrasound Obstet Gynecol. 2023 Mar 2. doi: 10.1002/uog.26189. Online ahead of print.

ABSTRACT

OBJECTIVE: Ventriculomegaly can be associated with long-term neurodevelopmental impairment. The prenatal diagnosis of ventriculomegaly is most often made at the routine second trimester anomaly scan. The value of first trimester ultrasound has expanded to early diagnosis and screening of fetal abnormalities. The objective of this study was to assess the predictive accuracy of first trimester choroid plexus to head/ventricle ratios for development of ventriculomegaly at a later gestation.

METHODS: This was a case-control study of fetuses with isolated ventriculomegaly diagnosed after 16 weeks’ gestation. The control group included normal fetuses (without ventriculomegaly). The exclusion criteria included aneuploidy, genetic syndromes or other brain abnormalities. Stored 2D first trimester ultrasound images were blindly analyzed offline and fetal biometry measured in axial view of the fetal head. The ratios of choroid plexus to lateral ventricle area (PA/VA), choroid plexus to lateral ventricle length (PL/VL), choroid plexus to lateral ventricle diameter (PD/VD), choroid plexus area to biparietal diameter (PA/BPD) and choroid plexus area to head circumference (PA/HC) were measured at 11-13+6 weeks’ gestation. Intra- and inter-observer variability of these fetal head biometry parameters at 11-13+6 weeks’ gestation were assessed in 20 normal fetuses using intra-class coefficients with 95% confidence intervals. The accuracy of first-trimester biometric measurements for prediction of ventriculomegaly was assessed using the area under the ROC curves (AUC).

RESULTS: The analysis included 683 singleton pregnancies; of which 102 fetuses were diagnosed with ventriculomegaly. The ventriculomegaly was mild in the majority (n=86; 84.3%) of cases, while it was severe in 16 (15.7%) fetuses. All first trimester fetal choroid plexus to ventricle/head ratios were significantly lower in the ventriculomegaly cases than in controls (p<0.05 all) with good inter- and intra-observer agreement (>0.95 for the majority of the fetal head biometry assessed). After adjusting for crown-rump length, both PL/VL ratio (AUC 0.87, 95% CI 0.73-0.98) and PA/VA ratio (AUC 0.90, 95% CI 0.82-0.98) showed good predictive accuracy for severe ventriculomegaly. PA/BPD ratio (AUC 0.73, 95% CI 0.54-0.90) had modest predictive ability, which was significantly lower than prediction using PA/VA ratio (P=0.003 and P=0.001, respectively). The predictive accuracy of PD/VD ratio was low with an AUC of 0.65 (95% CI 0.46- 0.84). Optimism adjusted AUC values obtained after cross-validation showed that PA/VA ratio offered the highest predictive accuracy with an AUC of 0.90 (95% CI: 0.82-0.98), followed by PL/VL ratio (AUC 0.87, 95% CI 0.73-0.98), PA/BPD ratio (AUC 0.73, 95% CI 0.54-0.90), and PD/VD ratio (AUC 0.65, 95% CI 0.47-0.84). Optimism-adjusted AUC values obtained after cross-validation showed that PA/VA ratio offered the highest predictive accuracy for mild ventriculomegaly with an AUC of 0.83 (95% CI 0.78-0.88), followed by PL/VL ratio (AUC 0.82, 95% CI 0.76-0.88), PA/BPD ratio (AUC 0.75, 95% CI 0.68-0.81), and PD/VD ratio (AUC 0.74, 95% CI 0.67-0.80). Calibration plots show both PA/VA and PL/VL ratios have good calibration CONCLUSION: First-trimester prediction of ventriculomegaly using fetal choroid plexus to ventricle ratios appears promising. Future prospective studies are needed to validate the predictive accuracy of these ultrasound markers as a screening tool for ventriculomegaly. This article is protected by copyright. All rights reserved.

PMID:36864532 | DOI:10.1002/uog.26189

Ultrasound Obstet Gynecol. 2023 Mar 2. doi: 10.1002/uog.26187. Online ahead of print.

ABSTRACT

OBJECTIVE: Having adequate reference ranges of the size of corpus callosum (CC) is necessary to better characterize CC abnormalities and improve parental counseling. The objective of this study was to evaluate the methodology used in developing different references charts for CC biometry.

METHODS: We conducted a systematic review of studies of fetal CC biometry using a set of predefined quality criteria of study design, statistical analysis and reporting methods. We including observational studies whose primary aim was to create ultrasound or MRI charts for size of the CC in normal population of fetuses. Studies were scored against a predefined set of independently agreed methodological criteria and an overall quality score was given to each study.

RESULTS: Twelve studies met the inclusion criteria. Quality scores ranged between 17.4% and 95.6%. The highest potential for bias was noted in the following fields : “sample selection” and “sample size calculation” where only 17% of the studies were population-based study with consecutive or random recruitment of patient and with a justification of the sample size; “number of measurement taken for CC biometrics” where in only 17% of the studies more one measure per fetus and per scan were performed; “description of characteristics of the study population” where only 9% of the studies clearly reported a minimum dataset of demographic characteristics.

CONCLUSION: Our review demonstrates substantial heterogeneity in methods and final biometry values of fetal CC measurement. The use of uniform methodology of the highest quality is essential in order to define a “short” CC and provide appropriate parental counseling. This article is protected by copyright. All rights reserved.

PMID:36864530 | DOI:10.1002/uog.26187

World J Surg Oncol. 2023 Mar 2;21(1):72. doi: 10.1186/s12957-023-02938-6.

ABSTRACT

BACKGROUND: PI3K pathway is the most frequently mutated pathway in head and neck squamous cell carcinoma (HNSC), which plays a crucial role in tumorigenesis and progression. In the present study, we aimed to investigate the role of PI3K pathway mutation in clinical prognosis prediction and the relationship with immune microenvironment and response rate to immunotherapy.

METHODS: We collected 129 samples with immunotherapy information from MSKCC-2019 cohort as well as 501 and 40 samples from TCGA-HNSC and MD-Anderson non-immunotherapy cohorts, respectively. Somatic mutation data was utilized to characterize the mutational status of the PI3K pathway. Subsequently, we further analyzed the differences in prognosis, immunotherapy response, genomic alterations, functional characteristics, and immune microenvironment between the mutation and wild groups.

RESULTS: The Kaplan-Meier survival curves displayed that PI3K pathway mutation predicted observably prolonged overall survival (OS) in the immunotherapy cohort MSKCC-2019 (p = 0.012) but did not reach statistical significance in the non-immunotherapy cohorts TCGA-HNSC (p = 0.68) and MD-Anderson (p = 0.68). After incorporating several clinicopathologic features such as age, gender, and tumor mutation burden (TMB), the results of multivariate Cox regression analysis also demonstrated that the PI3K pathway mutation could indicate better immunotherapy outcomes in HNSC patients with a hazard ratio (HR) of 0.533 (95% CI: 0.313-0.910; p = 0.021) in the immunotherapy cohort MSKCC-2019, compared with 0.888 (95% CI: 0.636-1.241; p = 0.487) and 1.939 (95% CI: 0.483-7.781; p = 0.351) in the non-immunotherapy cohorts TCGA-HNSC and MD-Anderson. In addition, the results of the subclass mapping (SubMap) and the tumor immune dysfunction and exclusion (TIDE) also consistently suggested that patients in the mutation group are more likely to benefit from immunotherapy. And further studies showed that the mutation group owned significantly higher TMB, activated immune-related pathways, richer abundance of immune cells, and higher expression levels of immunomodulators. To improve the prognosis of the wild group, we identified five relatively sensitive potential drugs for the wild group, including “BMS-536924,” “linsitinib,” “NVP-TAE684,” “PLX-4720,” and “clonazepam.”

CONCLUSIONS: The PI3K pathway mutation status could be considered as a potential biomarker to predict better immunotherapeutic efficacy and clinical outcomes after immunotherapy in HNSC patients.

PMID:36864522 | DOI:10.1186/s12957-023-02938-6

BMC Vet Res. 2023 Mar 3;19(1):57. doi: 10.1186/s12917-023-03609-0.

ABSTRACT

BACKGROUND: Epilepsy is the most common chronic neurological disease in dogs. More than two-thirds of these patients suffer from associated behavioural comorbidities. The latter could have their origin in partially overlapping pathomechanisms, with the intestinal microbiome as a potential key link between them. The current arsenal of drugs for epilepsy management remains limited. Most canine patients continue to have seizures despite treatment and the occurrence of comorbidities is not sufficiently addressed, limiting quality of life of affected dogs and owners. Therefore, novel additional epilepsy management options are urgently needed. The microbiome-gut-brain axis may serve as a new target for the development of innovative multimodal therapeutic approaches to overcome current shortcomings in epilepsy management.

METHODS: A six-month prospective, randomised, double-blinded, placebo-controlled, crossover, dietary trial was designed to investigate the potential of the psychobiotic Bifidobacterium longum on behavioural comorbidities in canine epilepsy. Seizure semiology will be evaluated as a secondary outcome measure. Thirty-four privately owned dogs are planned to be included in the ongoing study meeting the following inclusion criteria: Dogs displaying increased anxiety/fear behaviour since the start of the idiopathic epilepsy. Tier II confidence level of the International Veterinary Epilepsy Task Force for the diagnosis of idiopathic epilepsy, with a maximum seizure interval of 3 month and a minimum of three generalised seizures within that period and chronically treated with at least one antiseizure drug without improvement in seizure frequency Each dog will receive the allocated supplement (probiotic vs. placebo) alongside its normal diet for a 3-month period. After a three-week wash out period, the second phase starts by administering the respective other supplement for another 3 months.

DISCUSSION: The current study considers modern high-quality standards for epilepsy medication trials. Common biasing effects should be limited to a possible minimum (regression-to-the mean effect, placebo effect, observer effect), ensuring a high validity and accuracy of the acquired results, thus enabling a representative nature of the efficacy of Bifidobacterium longum as add-on supplement for dogs suffering from epilepsy and its comorbidities. This publication should provide a description of the study procedure and data acquisition methods, including prognosed statistical analysis.

PMID:36864510 | DOI:10.1186/s12917-023-03609-0

Cardiooncology. 2023 Mar 2;9(1):12. doi: 10.1186/s40959-023-00162-5.

ABSTRACT

BACKGROUND: This study aimed to evaluate the association between preoperative hs-cTnI and long-term mortality and major adverse cardiovascular events (MACE) in colorectal cancer patients.

METHODS: This single-center retrospective cohort study included 1105 consecutive colorectal cancer patients who received tumor resection surgery between January 2018 and June 2020. Inclusion criteria were an age ≥ 18 years and had been tested for hs-cTnI on admission within 7 days prior to tumor resection surgery. Exclusion criteria were emergent surgery, failure to received tumor resection surgery, hospital death, there was clinical evidence of unstable coronary artery disease or pulmonary embolism occurred before operation according to medical record. The primary endpoint was all-cause death. Secondary endpoint was major adverse cardiovascular events (MACE).

RESULTS: A total of 1105 patients were enrolled: 1032 with normal hs-cTnI and 73 with elevated hs-cTnI. The mean follow-up was 24.4 ± 10.8 months, 176 patients died and 39 patients met MACE. In the elevated troponin group, 50%, 32.1% and 17.9% died from cancer, cardiovascular and other causes, while those in the normal troponin group were 75.7%, 2% and 22.3%, there was statistical difference between 2 groups (P < 0.001). Patients with elevated preoperative hs-cTnI had significantly higher mortality (P < 0.001) and more MACE (P < 0.001) compared with those with normal hs-cTnI. A propensity-matching analysis were performed, resulting in 151 patients with normal hs-cTnI and 60 patients with elevated hs-cTnI. The matched population had the similar results for all-cause death (P = 0.009) and MACE (P = 0.001). The results were consistent after further excluding 147 patients who had received chemoradiotherapy prior to surgery in subgroup analysis. The results of multivariate Cox regression analysis shown that hs-cTnI was one of the best predictors for all-cause death (hazard ratio [HR] 2.278; 95% confidence interval [CI] 1.19-4.361) and MACE (HR, 3.523; 95%CI, 1.477-8.403) in total populations, similar results were found in subgroup analysis.

CONCLUSIONS: Colorectal cancer patients without myocardial ischemia manifestation but with elevated hs-cTnI prior to tumor resection surgery were at increased risk for long-term all-cause death and MACE, irrespective of whether they have received chemoradiotherapy prior to surgery.

PMID:36864502 | DOI:10.1186/s40959-023-00162-5

Trials. 2023 Mar 2;24(1):159. doi: 10.1186/s13063-023-07157-8.

ABSTRACT

BACKGROUND: Recruiting participants for lifestyle programmes is known to be challenging. Insights into recruitment strategies, enrolment rates and costs are valuable but rarely reported. We provide insight into the costs and results of used recruitment strategies, baseline characteristics and feasibility of at-home cardiometabolic measurements as part of the Supreme Nudge trial investigating healthy lifestyle behaviours. This trial was conducted during the COVID-19 pandemic, requiring a largely remote data collection approach. Potential sociodemographic differences were explored between participants recruited through various strategies and for at-home measurement completion rates.

METHODS: Participants were recruited from socially disadvantaged areas around participating study supermarkets (n = 12 supermarkets) across the Netherlands, aged 30-80 years, and regular shoppers of the participating supermarkets. Recruitment strategies, costs and yields were logged, together with completion rates of at-home measurements of cardiometabolic markers. Descriptive statistics are reported on recruitment yield per used method and baseline characteristics. We used linear and logistic multilevel models to assess the potential sociodemographic differences.

RESULTS: Of 783 recruited, 602 were eligible to participate, and 421 completed informed consent. Most included participants were recruited via letters/flyers at home (75%), but this strategy was very costly per included participant (89 Euros). Of paid strategies, supermarket flyers were the cheapest (12 Euros) and the least time-invasive (< 1 h). Participants who completed baseline measurements (n = 391) were on average 57.6 (SD 11.0) years, 72% were female and 41% had high educational attainment, and they often completed the at-home measurements successfully (lipid profile 88%, HbA1c 94%, waist circumference 99%). Multilevel models suggested that males tended to be recruited more often via word-of-mouth (OR_females 0.51 (95%CI 0.22; 1.21)). Those who failed the first attempt at completing the at-home blood measurement were older (β 3.89 years (95% CI 1.28; 6.49), whilst the non-completers of the HbA1c (β – 8.92 years (95% CI – 13.62; – 4.28)) and LDL (β – 3.19 years (95% CI – 6.53; 0.09)) were younger.

CONCLUSIONS: Supermarket flyers were the most cost-effective paid strategy, whereas mailings to home addresses recruited the most participants but were very costly. At-home cardiometabolic measurements were feasible and may be useful in geographically widespread groups or when face to face contact is not possible.

TRIAL REGISTRATION: Dutch Trial Register ID NL7064, 30 May 2018, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7302.

PMID:36864494 | DOI:10.1186/s13063-023-07157-8

Ultrasound Obstet Gynecol. 2023 Mar 2. doi: 10.1002/uog.26186. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the prenatal characteristics of double aortic arch (DAA), assess the relative size of the arches and their growth during pregnancy, describe associated cardiac, extracardiac and chromosomal/genetic abnormalities and review postnatal presentation and clinical outcome.

METHODS: All fetuses with a confirmed diagnosis of DAA seen in five specialized referral centers between November 2012 and November 2019 were retrospectively identified from the hospitals’ fetal databases. Fetal echocardiographic findings, intracardiac and extracardiac abnormalities, genetic defects, computed tomography (CT) findings and postnatal clinical presentation and outcome were evaluated.

RESULTS: A total of 79 fetal cases of DAA were included. Of the whole cohort, 48.6% had an atretic left aortic arch (LAA) postnatally, with 5.1% being atretic at 1^st fetal scan and diagnosed antenatally as right aortic arch (RAA). Among those who had CT scan, the LAA was atretic in 55.7%. DAA was an isolated abnormality in 91.1% of the cases, 8.9% had intracardiac (ICA) and 2.5% had extracardiac abnormalities (ECA). Among those tested, 11.5% had genetic abnormalities and specifically 22q11 microdeletion was identified in 3.8% of the patients. At a median follow up of 993.5 days, 42.5% of the patients had developed symptoms of tracheo-esophageal compression (5.5% during the first month of life) and 56.2% underwent intervention. Statistical analysis using Chi-square test showed no statistically significant correlation between patency of both aortic arches or not and need for intervention (P-value 0.134), development of vascular ring symptoms (P-value 0.350) or evidence of airway compression on CT (P-value 0.193) CONCLUSIONS: Most DAA cases can be easily diagnosed in mid-gestation as both arches are patent with a dominant RAA. However, posnatally the LAA has become atretic in approximately half of the cases, supporting the theory of differential growth during pregnancy. DAA is usually an isolated abnormality; however, a thorough assessment is required, to exclude ICA and ECA and to discuss invasive prenatal genetic testing. Postnatally, early clinical assessment is needed, and CT scan should be considered, irrespective of the presence of symptoms or not. This article is protected by copyright. All rights reserved.

PMID:36864493 | DOI:10.1002/uog.26186

Microbiome. 2023 Mar 2;11(1):35. doi: 10.1186/s40168-023-01473-6.

ABSTRACT

BACKGROUND: Arctic snowpack microbial communities are continually subject to dynamic chemical and microbial input from the atmosphere. As such, the factors that contribute to structuring their microbial communities are complex and have yet to be completely resolved. These snowpack communities can be used to evaluate whether they fit niche-based or neutral assembly theories.

METHODS: We sampled snow from 22 glacier sites on 7 glaciers across Svalbard in April during the maximum snow accumulation period and prior to the melt period to evaluate the factors that drive snowpack metataxonomy. These snowpacks were seasonal, accumulating in early winter on bare ice and firn and completely melting out in autumn. Using a Bayesian fitting strategy to evaluate Hubbell’s Unified Neutral Theory of Biodiversity at multiple sites, we tested for neutrality and defined immigration rates at different taxonomic levels. Bacterial abundance and diversity were measured and the amount of potential ice-nucleating bacteria was calculated. The chemical composition (anions, cations, organic acids) and particulate impurity load (elemental and organic carbon) of the winter and spring snowpack were also characterized. We used these data in addition to geographical information to assess possible niche-based effects on snow microbial communities using multivariate and variable partitioning analysis.

RESULTS: While certain taxonomic signals were found to fit the neutral assembly model, clear evidence of niche-based selection was observed at most sites. Inorganic chemistry was not linked directly to diversity, but helped to identify predominant colonization sources and predict microbial abundance, which was tightly linked to sea spray. Organic acids were the most significant predictors of microbial diversity. At low organic acid concentrations, the snow microbial structure represented the seeding community closely, and evolved away from it at higher organic acid concentrations, with concomitant increases in bacterial numbers.

CONCLUSIONS: These results indicate that environmental selection plays a significant role in structuring snow microbial communities and that future studies should focus on activity and growth. Video Abstract.

PMID:36864462 | DOI:10.1186/s40168-023-01473-6

BMC Public Health. 2023 Mar 2;23(1):419. doi: 10.1186/s12889-023-15331-5.

ABSTRACT

BACKGROUND: Social inequality in smoking remains an important public health issue. Upper secondary schools offering vocational education and training (VET) comprise more students from lower socioeconomic backgrounds and have higher smoking prevalence than general high schools. This study examined the effects of a school-based multi-component intervention on students’ smoking.

METHODS: A cluster randomized controlled trial. Eligible participants were schools offering VET basic courses or preparatory basic education in Denmark, and their students. Schools were stratified by subject area and eight schools were randomly allocated to intervention (1,160 invited students; 844 analyzed) and six schools to control (1,093 invited students; 815 analyzed). The intervention program comprised smoke-free school hours, class-based activities, and access to smoking cessation support. The control group was encouraged to continue with normal practice. Primary outcomes were daily cigarette consumption and daily smoking status at student level. Secondary outcomes were determinants expected to impact smoking behavior. Outcomes were assessed in students at five-month follow-up. Analyses were by intention-to-treat and per protocol (i.e., whether the intervention was delivered as intended), adjusted for covariates measured at baseline. Moreover, subgroup analyses defined by school type, gender, age, and smoking status at baseline were performed. Multilevel regression models were used to account for the cluster design. Missing data were imputed using multiple imputations. Participants and the research team were not blinded to allocation.

RESULTS: Intention-to-treat analyses showed no intervention effect on daily cigarette consumption and daily smoking. Pre-planned subgroup analyses showed statistically significant reduction in daily smoking among girls compared with their counterparts in the control group (OR = 0.39, 95% CI: 0.16, 0.98). Per-protocol analysis suggested that schools with full intervention had higher benefits compared with the control group (daily smoking: OR = 0.44, 95% CI: 0.19, 1.02), while no marked differences were seen among schools with partial intervention.

CONCLUSION: This study was among the first to test whether a complex, multicomponent intervention could reduce smoking in schools with high smoking risk. Results showed no overall effects. There is a great need to develop programs for this target group and it is important that they are fully implemented if an effect is to be achieved.

TRIAL REGISTRATION: https://www.isrctn.com/ISRCTN16455577 , date of registration 14/06/2018.

PMID:36864450 | DOI:10.1186/s12889-023-15331-5