Nevin Manimala

Retina. 2021 Dec 15. doi: 10.1097/IAE.0000000000003378. Online ahead of print.

ABSTRACT

PURPOSE: To compare the choroidal characteristics between the eyes of patients with and without hereditary transthyretin amyloidosis (hTTRA).

METHODS: Case-control observational study with choroidal thickness and vasculature evaluation by Optical Coherence Tomography with Enhanced Depth Imaging protocol (OCT-EDI) of the macula.

RESULTS: The study included 332 eyes: 166 eyes of hTTRA patients and 166 eyes of healthy patients. Mean age was similar between groups (p=0.979). For hTTRA patients, on average, in all sectors analysed (in the full 5mm-width image (G) and also in 1mm-width central (C), nasal (N), and temporal (T) sectors), there was a higher stromal area (SA), a lower choroidal thickness (CT) and a lower choroidal vascularity index (CVI), compared to the control group. The linear mixed models revealed no differences according to the systemic treatment groups.

CONCLUSION: hTTRA patients showed statistically significant differences in choroidal characteristics, compared to eyes without pathology. These age-related and statistically significant changes compared to the healthy eyes may help in the future to better monitor the systemic hTTRA disease and complement other systemic evaluations, including on clinical trials to analyse more objective the results of new therapies.

PMID:34923509 | DOI:10.1097/IAE.0000000000003378

J Pediatr Orthop. 2021 Dec 20. doi: 10.1097/BPO.0000000000002032. Online ahead of print.

ABSTRACT

BACKGROUND: Femoral fractures are the most common cause of fracture-related admissions. Unplanned return to the operating room (UpROR) is a major event and imposes a substantial burden on the family and health care system. The purpose of this study was to determine the incidence of complications and early UpROR during the first 6 months following treatment of femoral fractures and their risk factors.

METHODS: In an institutional review board-approved study, a retrospective review of all patients who were treated for a femoral fracture during a 10-year period at a pediatric tertiary care center was performed. Patients less than 18 years old with a diaphyseal fracture and complete records were included, and nondiaphyseal or pathologic fractures, as well as underlying metabolic or genetic disorders, were excluded. All clinic visits in the first 6 months after treatment were reviewed, and all complications and UpRORs were extracted. Patients were grouped based on their age (below 5, 5 to 11, above 11 y old) at initial treatment, and statistical tests were used to infer differences between groups.

RESULTS: Overall, 841 fractures in 832 patients were included, with a mean age of 5.5±4.8 years fracture, of which 72% were male. A total of 106 complications (12.6%) and 45 UpRORs (5.3%) were encountered during the study period. Patients with and without UpROR had similar demographics and injury and treatment characteristics. Loss of reduction was the most common reason for UpROR (58%), followed by implant-related complications. Flexible nails had the highest risk of UpROR among patients who were initially treated surgically (P=0.03).

CONCLUSIONS: Our findings indicate that children under the age of 5 years have a 5% risk of UpROR in the first 6 months after the fracture, mainly for repeat spica casting due to loss of reduction. Patients aged 5 years or older have an ∼6% risk of UpROR, mainly related to complications of flexible nails. The findings of this study are important when consulting families on different treatments of diaphyseal femoral fractures.

LEVEL OF EVIDENCE: Therapeutic level III-retrospective cohort study.

PMID:34923506 | DOI:10.1097/BPO.0000000000002032

West Afr J Med. 2021 Nov 30;Vol. 38(11):1101-1107.

ABSTRACT

BACKGROUND: Fertility is an important component of population change and has attracted the interest of scholars and policy makers. Nigeria’s population growth rate has been driven by high fertility, which has fallen in the last few decades but not as rapidly as the fall of the crude death rate. Men and their kinsmen are the decision-makers on issues relating to reproductive health such as timing of the next birth, number of children and when to stop childbearing while their women cooperate. We determined the reproductive behaviors of men in Doka community in Kaduna State Nigeria.

METHODOLOGY: A cross-sectional descriptive community based study of 320 men was conducted.

RESULTS: The mean age±SD of the male respondents was 40 (±14.2) years. The average age at first marriage among men was 23.32 (±4.62 years), the contraceptive use among men was 10(3.2%). Above a third 118 (37.9%) of men were in polygamous union. There was a statistically significant increase in the mean number of living children as the age of men increased (p=0.001). The mean number of children ever fathered was significantly associated with the educational status of men (p=0.03).

CONCLUSION: we found a very low contraceptive use, high number of desired children as well as living children among the men. Government should enlighten married men on the importance of contraceptive use for birth control as well as the social and economic implications of having too many children.

PMID:34922410

West Afr J Med. 2021 Nov 30;Vol. 38(11):1088-1094.

ABSTRACT

BACKGROUND: Blood transfusion therapy remains a mainstay in the care of many tropical diseases. Blood supply in sub-Saharan Africa (SSA) including Nigeria is still a challenge in terms of perennial blood shortages and transfusion transmissible infections (TTI). This study aimed to describe blood donation patterns and compare the rates of TTIs among types of blood donors seen at LUTH.

STUDY METHOD: A 6-year retrospective review of data on donor types and pattern of TTIs at LUTH transfusion service. TTI rates and odd ratios (OR) of TTI positivity amongst VNRD versus FRD were computed at 95% confidence intervals. Proportion of TTI sero-positivity was also compared between the VNRD and FRD groups.

RESULTS: A total of 53,319 blood donors were observed over the study period, with average of 8886.5 donors per year. VNRDs accounted for 12.3% (6533/53,319), while FRDs accounted for 87.7% (46,789/53,319) of all donors. The proportion of VNRDs ranged from 5.1% to 20.8%. The overall prevalence of TTIs over the 6-year period for all donors was 1.34% for HIV, 5.79% for HBV, 2.23% for HCV and 0.88% for syphilis. Sero-positivity rates for HIV, HBV, HCV, and syphilis was statistically significantly lower among VNRD compared to FRDs.

CONCLUSION: There exists a lot of room for improvement in our blood donation practices to improve blood stock and transfusion safety. A more aggressive strategic effort needs to be directed towards achieving a target of 100% voluntary blood donor base through partnerships, advocacy, more financing and resource allocation, and other proven initiatives.

PMID:34922408

J Clin Endocrinol Metab. 2021 Dec 18:dgab911. doi: 10.1210/clinem/dgab911. Online ahead of print.

ABSTRACT

BACKGROUND: Observational studies have demonstrated associations between plasma proteins and obesity, but evidence of causal relationship remains to be studied.

METHODS: To evaluate the causal relationship between plasma proteins and body composition, we conducted a two-sample Mendelian randomization (MR) analysis based on the genome-wide association study (GWAS) summary statistics of 23 body composition traits and 2,656 plasma proteins. We then performed hierarchical cluster analysis to evaluate the structure and pattern of the identified causal associations, and performed gene ontology enrichment analysis to explore the functional relevance of the identified proteins.

RESULTS: We identified 430 putatively causal effects of 96 plasma proteins on 22 body composition traits (except obesity status) with strong MR evidence (P < 2.53 × 10 -6, at a Bonferroni-corrected threshold). The top 3 causal associations are FST (follistatin) on trunk fat-free mass (Beta = -0.63, SE = 0.04, P = 2.00 × 10 -63), IGFBP1 (insulin-like growth factor-binding protein 1) on trunk fat-free mass (Beta = -0.54, SE = 0.03, P = 1.79 × 10 -57) and RSPO3 (r-spondin-3) on WHR (waist circumference/hip circumference) (Beta = 0.01, SE= 4.47 × 10 -4, P = 5.45 × 10 -60), respectively. Further clustering analysis and pathway analysis demonstrated that the pattern of causal effect to fat mass and fat-free mass may be different.

CONCLUSION: Our findings may provide evidence for causal relationships from plasma proteins to various body composition traits and provide basis for further targeted functional studies.

PMID:34922401 | DOI:10.1210/clinem/dgab911

Eur J Prev Cardiol. 2021 Dec 18:zwab213. doi: 10.1093/eurjpc/zwab213. Online ahead of print.

ABSTRACT

AIMS: To report the prevalence, deaths, and disability-adjusted life years (DALYs) associated with ischemic heart disease (IHD) and its attributable risk factors in 204 countries and territories from 1990 to 2019, by age, sex, and socio-demographic index (SDI).

METHODS AND RESULTS: Ischemic heart disease was defined as acute myocardial infarction (MI) and chronic IHD (angina; asymptomatic IHD following MI). Cause of death ensemble modelling was used to produce fatality estimates. The prevalence of the non-fatal sequalae of IHD was estimated using DisMod MR 2.1. All estimates were presented as counts and age-standardized rates per 100 000 population. In 2019, IHD accounted for 197.2 million (177.7-219.5) prevalent cases, 9.1 million (8.4-9.7) deaths, and 182.0 million (170.2-193.5) DALYs worldwide. There were decreases in the global age-standardized prevalence rates of IHD [-4.6% (-5.7, -3.6)], deaths [-30.8% (-34.8, -27.2)], and DALYs [-28.6% (-33.3, -24.2)] from 1990 to 2019. In 2019, the global prevalence and death rates of IHD were higher among males across all age groups, while the death rate peaked in the oldest group for both sexes. A negative association was found between the age-standardized DALY rates and SDI. Globally, high systolic blood pressure (54.6%), high low-density lipoprotein cholesterol (46.6%), and smoking (23.9%) were the three largest contributors to the DALYs attributable to IHD.

CONCLUSION: Although the global age-standardized prevalence, death, and DALY rates all decreased. Prevention and control programmes should be implemented to reduce population exposure to risk factors, reduce the risk of IHD in high-risk populations, and provide appropriate care for communities.

PMID:34922374 | DOI:10.1093/eurjpc/zwab213

Mod Rheumatol. 2021 Jan 18:1859675. doi: 10.1080/14397595.2020.1859675. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate efficacy and safety of filgotinib in Japanese RA patients who have failed or were intolerant to one or more biologic disease-modifying antirheumatic drugs (bDMARD) from the global FINCH 2 study (NCT02873936).

METHODS: This subgroup analysis was performed using the predefined statistical analyses. The FINCH 2 study is a randomized, double-blind, placebo-controlled, Phase 3 study in adult RA patients with inadequate response to bDMARDs. The randomized patients were treated with once-daily filgotinib 200 mg, filgotinib 100 mg or placebo on a background of csDMARDs for 24 weeks.

RESULTS: Of 449 patients enrolled in the overall population, 40 patients were enrolled from Japan. In the Japanese population, the American College of Rheumatology 20% response rates at week 12 (primary endpoint) were 83.3% and 53.3% for filgotinib, 200 mg and 100 mg, respectively, vs 30.8% for placebo. Filgotinib was well tolerated, similar to the overall population.

CONCLUSIONS: Both doses of once-daily filgotinib 200 mg and filgotinib 100 mg were effective, and generally well-tolerated in Japanese patients with active refractory RA.

PMID:34922366 | DOI:10.1080/14397595.2020.1859675

Int J Epidemiol. 2021 Dec 18:dyab213. doi: 10.1093/ije/dyab213. Online ahead of print.

NO ABSTRACT

PMID:34922344 | DOI:10.1093/ije/dyab213

Health Policy Plan. 2021 Dec 18:czab151. doi: 10.1093/heapol/czab151. Online ahead of print.

ABSTRACT

Community health workers (CHWs) effectively improve maternal, newborn, and child health (MNCH) outcomes in low-to-middle-income countries. However, CHW retention remains a challenge. This retrospective registry analysis evaluated medium-term retention of volunteer CHWs in two rural Ugandan districts, trained during a district-wide MNCH initiative. From 2012-14, the Healthy Child Uganda partnership facilitated district-led CHW program scale-up. CHW retention was tracked prospectively from the start of the intervention up to two years. Additional follow up occurred at five years to confirm retention status. Database analysis assessed CHW demographic characteristics, retention rates, and exit reasons five-years post-intervention. A multivariable logistic regression model examined five-year retention-associated characteristics. Of the original cohort of 2,317 CHWs, 70% were female. The mean age was 38.8 years (SD: 10.0). Sixty-months (five years) after the start of the intervention, 84% of CHWs remained active. Of those exiting (n=377), 63% reported a ‘logistical’ reason, such as relocation (n=96), new job (n=51), or death (n=30). Sex (male, female; OR=1.53; 95% CI: 1·20-1·96) and age group (<25years, 30-59; OR=0.40; 95% CI: 0.25-0.62) were significantly associated with five-year retention in multivariable modeling. Education completion (secondary school, primary) was not significantly associated with retention in adjusted analyses. CHWs in this relatively large cohort, trained and supervised within a national CHW program and district-wide MNCH initiative, were retained over the medium-term. Importantly, high five-year retention in this intervention counters findings from other studies suggesting high retention in government-led and volunteer CHW programs. Encouragingly, findings from our study suggest retention was low, not significantly associated with timing of external partner support, and largely not attributed to the CHW role i.e. workload, program factors. Our study showcases the potential for sustainable volunteer CHW programming at scale and can inform planners and policymakers considering program design, including selection and replacement planning for CHW networks.

PMID:34922343 | DOI:10.1093/heapol/czab151

Epilepsy Behav. 2021 Dec 15;126:108480. doi: 10.1016/j.yebeh.2021.108480. Online ahead of print.

ABSTRACT

AIM: We aimed to evaluate the knowledge levels and attitudes of the students of the Department of Health Management about epilepsy.

METHOD: This descriptive and cross-sectional study was conducted with the voluntary participation of 238 health management department students in their first and third years of study who were registered at the Faculty of Health Sciences summer school exam. We collected the data through a research questionnaire form and the Epilepsy Knowledge and Attitude Scales.

RESULTS: Girls accounted for 66.6% (n = 157) all participants, 53.4% of them were 1st year (n = 127), whereas 46.6% (n = 111) were third-year students. Their mean age was 19.97 ± 1.46 years. Among these participants, 52.9% grew in the province (n = 126), 20.6% were smoking, 5% had epilepsy, and 36.6% had relatives with epilepsy. The mean epilepsy knowledge scale score was 5.64 ± 4.41 and the mean epilepsy attitude scale score was 52.55 ± 9.98. The third-year students’ epilepsy knowledge score was significantly higher than their first-year counter parts (p < 0.001). We found no statistically significant difference between the first and third-year participants in attitude scores (p = 0.907). A moderate positive correlation was found between the students’ knowledge level scores about epilepsy and their total attitude scores (r = 0.405, p < 0.001). The female students had a more positive attitude toward epilepsy and higher scores on the epilepsy knowledge scale than their male counterparts (p = 0.001, p = 0.005, respectively). Students who knew someone with epilepsy had higher epilepsy knowledge and attitude scale scores than those who did not (p = 0.001, p = 0.005 respectively).

CONCLUSION: The epilepsy knowledge levels and attitude scale scores of health management students were found to be low. Third-year students were found to have higher knowledge levels than first-year students but there was no statistically significant difference between their attitude scores. More education opportunities should be provided for students of the Department of Health Management about this common chronic disease.

PMID:34922330 | DOI:10.1016/j.yebeh.2021.108480