Nevin Manimala

Clin Nutr. 2021 Aug 8;40(9):5162-5168. doi: 10.1016/j.clnu.2021.07.032. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Bronchiectasis is a heterogeneous, chronic respiratory condition, in which the role of nutrition remains unclear and nutritional guidance is lacking. Few studies have explored the role of nutrition in disease management, and little is known about nutritional requirements during periods of stability or metabolic stress. The aim of this study was to characterise nutritional status and intakes in a cohort of patients and identify potential associations with body composition and functional capacity.

METHODS: A prospective observational cohort study was undertaken in an adult population (>17 years). Bronchiectasis was confirmed by high-resolution computerised tomography (HRCT). Anthropometric (weight, height, Body Mass Index (BMI), triceps skinfold thickness (TSF), mid upper-arm circumference (MUAC) and mid arm muscle circumference (MAMC)] lung function and nutritional intakes were measured. Results were analysed as a whole and by disease aetiology [primary ciliary dyskinesia (PCD), Idiopathic cause (IC), bronchiectasis in association with asthma and other] and associations tested.

RESULTS: In total, 128 participants (65.5% female) completed the study. Median handgrip strength (HGS) in the total sample was only 66.5% (IQR 60.5-89.8) of reference population norms and was low for those with PCD [58.0% (IQR 43.5-70.0))]. Univariate regression indicated that BMI was a statistically significant predictor of lung function in the whole population with HGS and weight identified as statistically significant predictors of lung function in PCD. The total population and each sub-group failed to meet estimated average requirements for energy but exceeded the Reference nutrient intake (RNI) for protein. Vitamin D was consistently <35% of the RNI.

CONCLUSION: BMI lay within normal to overweight ranges within the whole population and sub-groups, but masked important functional, body composition and nutritional deficits. This was particularly so within a younger sub-group with PCD, who had impaired muscle function, when compared to other causal and associative diseases.

PMID:34461590 | DOI:10.1016/j.clnu.2021.07.032

Clin Nutr. 2021 Jul 27;40(9):5114-5121. doi: 10.1016/j.clnu.2021.07.023. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes.

METHODS: On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (≥18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score ≥2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay.

RESULTS: The prevalence of malnutrition risk in the Latin American nDay study population (N = 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospital-mortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P < 0.001) for patients eating one-quarter of their meal (compared with those who ate the full meal), increasing to 6.6 (95% CI [5.02, 8.7]; P < 0.0001) for patients who ate none of the food offered.

CONCLUSIONS: Based on compilation of nDay surveys throughout Latin America, 2 of every 5 hospitalized patients were at risk for malnutrition. The associated risk for hospital mortality was up to 6-fold higher among patients who ate little or none of their meal on nDay. This high prevalence showed scant improvement over rates two decades ago-a compelling rationale for new focus on nutrition education and training of professionals in acute care settings.

PMID:34461585 | DOI:10.1016/j.clnu.2021.07.023

Sleep Med Rev. 2021 Aug 4;60:101533. doi: 10.1016/j.smrv.2021.101533. Online ahead of print.

ABSTRACT

Driver drowsiness contributes to 10-20% of motor vehicle crashes. To reduce crash risk, ideally drivers would be aware of the drowsy state and cease driving. The extent to which drivers can accurately identify sleepiness remains under much debate. We systematically examined whether individuals are aware of sleepiness while driving, and whether this accurately reflects driving impairment, using meta-analyses and narrative review. Within this scope, there is high variability in measures of subjective sleepiness, driving performance and physiologically-derived drowsiness, and statistical analyses. Thirty-four simulated/naturalistic driving studies were reviewed. To summarise, drivers were aware of sleepiness, and this was associated to physiological drowsiness and driving impairment, such that high levels of sleepiness significantly predicted crash events and lane deviations. Subjective sleepiness was more strongly correlated (i) with physiological drowsiness compared to driving outcomes; (ii) under simulated driving conditions compared to naturalistic drives; and (iii) when examined using the Karolinska sleepiness scale (KSS) compared to other measures. Gaps remain in relation to how age, sex, and varying degrees of sleep loss may influence this association. This review provides evidence that drivers are aware of drowsiness while driving, and stopping driving when feeling ‘sleepy’ may significantly reduce crash risk.

PMID:34461582 | DOI:10.1016/j.smrv.2021.101533

J Reprod Immunol. 2021 Aug 24;147:103368. doi: 10.1016/j.jri.2021.103368. Online ahead of print.

ABSTRACT

Recent studies suggest that women with high exposures to dibutyl phthalate (DBP) are at increased risk for preterm birth, a condition associated with aberrant inflammation in the placenta often caused by subclinical infections. Placental inflammation is also a risk factor for neurodevelopmental disorders whose risk may also be enhanced by DBP. It is unclear, however, if DBP enhances placental inflammation. Therefore, we studied the effects of DBP on the production of biomarkers of placental inflammation and neurodevelopment under basal conditions and a setting of mild infection. Placental explant cultures established from women undergoing elective caesarean delivery were treated with DBP with and without co-stimulation by 10⁷ CFU/mL heat-killed E. coli for 24 h at 37 °C. Conditioned medium was harvested and concentrations of IL-1β, TNF-α, IL-10, HO-1 and BDNF, a biomarker for neurodevelopment, were quantified. DBP significantly enhanced IL-6 production in basal cultures but had no significant on the other biomarkers quantified. Both TNF-α and IL-1β production was enhanced by DBP for cultures co-stimulated with E. coli. Although marginal enhancement of IL-6, and IL-10 were observed for bacteria co-treated cultures, results were either non-monotonic or only approached statistical significance. HO-1 production tended to be reduced at the highest concentration of DBP tested and BDNF production was reduced by DBP in a dose-dependent manner for bacteria-stimulated cultures. These results suggest that DBP enhances basal IL-6 production but has little or no effect on other biomarkers studied. However, DBP enhances IL-1β and TNF-α production but reduces BDNF production by bacteria-stimulated cultures.

PMID:34461555 | DOI:10.1016/j.jri.2021.103368

J Pharm Biomed Anal. 2021 Aug 25;205:114333. doi: 10.1016/j.jpba.2021.114333. Online ahead of print.

ABSTRACT

Several metabolomics-derived biomarkers of prostate cancer (PC) have been reported with pre-radical prostatectomy (RP) (knock-in PC) conditions; however, uncontested PC biomarkers panel appraisal and investigation of correlative evidence of these measures is lacking through post-RP (knock-out PC). We sought to explore patients’ filtered serum-based metabolomics derived signature measures in knock-in PC (n = 90) using nuclear magnetic resonance spectroscopy and multiple rigorous statistical analyses, and to develop the correlative evidence of these measures through knock-out PC (n = 90) follow-up on the 15th and 30th days. The glutamate, citrate and glycine were observed as hallmarks of PC. Observed trends revealed; augmented glutamate level in knock-in PC following a sudden drop and subsequently upside of glutamate at 15th and 30th days of knock-out PC, reduction of citrate in knock-in PC subsequently gradual increase of citrate in knock-out PC, and glycine lessening in knock-in PC following augmentation on 30th day of knock-out PC. This study-based evidence clears the doubts regarding the discovery of metabolomics-derived PC biomarkers.

PMID:34461489 | DOI:10.1016/j.jpba.2021.114333

ESMO Open. 2021 Aug 27;6(5):100234. doi: 10.1016/j.esmoop.2021.100234. Online ahead of print.

ABSTRACT

BACKGROUND: The Japan Clinical Oncology Group (JCOG) prognostic index, consisting of performance status, primary tumor resected, number of metastases, and serum alkaline phosphatase, has been one of the robust prognostic indices for patients with advanced gastric cancer on the basis of which clinical trials have stratified prognosis. Only a few studies, however, have utilized the JCOG prognostic index in daily practice.

METHODS: We conducted a retrospective study on patients with advanced gastric cancer who received first-line platinum-containing chemotherapy at a single institute between 2011 and 2017. Prognostic factors were evaluated using a Cox proportional regression model.

RESULTS: A total of 608 patients were enrolled. Multivariate analysis showed that performance status ≥1, presence or absence of primary tumor, serum alkaline phosphatase, neutrophil-to-lymphocyte ratio ≥4, and diffuse-type histology were significantly associated with worse prognosis, whereas the number of metastases was not. Although the original prognostic index could not adequately stratify patients into three risk groups, the modified index (good: 0 and 1, moderate: 2 and 3, poor: 4-6), which was established by incorporating diffuse-type histology and high neutrophil-to-lymphocyte ratio, demonstrated excellent stratification. The median overall survival of the good (n = 315), moderate (n = 243), and poor (n = 54) risk groups was 20.5, 13.5, and 10.2 months, respectively. Hazard ratios (HRs) were 1.69 [95% confidence interval (CI), 1.40-2.04; good versus moderate] and 1.52 (95% CI, 1.11-2.08; moderate versus poor). This novel index also demonstrated a statistically significant stratification of survival after progression following first-line chemotherapy (good versus moderate: HR, 1.41; 95% CI, 1.16-1.70; moderate versus poor: HR, 2.00; 95% CI, 1.45-2.74).

CONCLUSIONS: The modified JCOG prognostic index showed excellent stratification of overall survival in real-world patients, which could also help determine the need for treatment changes throughout the continuum of chemotherapy.

PMID:34461485 | DOI:10.1016/j.esmoop.2021.100234

Sci Total Environ. 2021 Aug 24;802:149727. doi: 10.1016/j.scitotenv.2021.149727. Online ahead of print.

ABSTRACT

This is the first study to show microplastics contamination in an alluvial sedimentary aquifer that has been capped from the atmosphere. Microplastics are often reported in biotic and abiotic environments, but little is known about their occurrence in groundwater systems. In this study, eight of the most commonly found microplastics in the environment (polyethylene, PE; polystyrene, PS; polypropylene, PP; polyvinyl chloride, PVC; polyethylene terephthalate, PET; polycarbonate, PC; polymethylmethacrylate, PMMA; and polyamide, PA) were analysed in triplicate groundwater samples (n = 21) from five sampling sites across seven capped groundwater monitoring bores from Bacchus Marsh (Victoria, Australia) using Agilent’s novel Laser Direct Infra-Red (LDIR) imaging system. Microplastics were detected in all samples, with PE, PP, PS and PVC detected in all seven bores. The average size of the microplastics identified was 89 ± 55 μm (St.Dev.), ranging from 18 to 491 μm. The average number of microplastics detected across all sites was 38 ± 8 microplastics/L, ranging from 16 to 97 particles/L. PE and PVC in total contributed to 59% of the total sum of microplastics detected. PE was consistently detected in all seven bores (average: 11 particles/L), while PVC was more pronounced in a bore adjacent to a meat processor (52 particles/L) compared to that of its overall average of 12 particles/L. A statistically significant positive correlation was observed between PVC and PS (R = 0.934, p ≤0.001). As this study collected samples from capped groundwater bores, the most probable avenue for microplastics was permeation through soil. Therefore, to further understand the fate and transport of microplastics within a groundwater system, it is necessary to analyse a greater range of groundwater bores not only from Australia but throughout the world.

PMID:34461481 | DOI:10.1016/j.scitotenv.2021.149727

Prev Vet Med. 2021 Aug 19;195:105470. doi: 10.1016/j.prevetmed.2021.105470. Online ahead of print.

ABSTRACT

Small-scale farming of meat chicken flocks using local native breeds contributes to the economy of many rural livelihoods in Vietnam and many other low- and middle-income countries (LMICs). These systems are also the target of high levels of antimicrobial use (AMU); however, little is known about the profitability and sustainability of such systems. Since small-scale farms are commercial enterprises, this knowledge is essential to develop successful strategies to curb excessive AMU. Using longitudinal data from 203 small-scale (100-2,000 heads) native chicken flocks raised in 102 randomly selected farms in Dong Thap province (Mekong Delta, Vietnam), we investigated the financial and economic parameters of such systems and the main constraints to their sustainability. Feed accounted for the largest financial cost (flock median 49.5 % [Inter-quartile range (IQR) 41.5-61.8 %]) of total costs, followed by day-old-chicks (DOCs) (median 30.3 % [IQR 23.2-38.4 %]), non-antimicrobial health-supporting products (median 7.1 % [IQR 4.7-10.5 %]), vaccines (median 3.1 % [IQR 2.2-4.8 %]), equipment (median 1.9 % [IQR 0.0-4.9 %]) and antimicrobials (median 1.9 % [IQR 0.7-3.6 %]). Excluding labor costs, farmers achieved a positive return on investment (ROI) from 120 (59.1 %) flocks, the remainder generating a loss (median ROI 124 % [IQR 36-206 %]). Higher ROI was associated with higher flock size and low mortality. There was no statistical association between use of medicated feed and flock mortality or chicken bodyweight. The median daily income per person dedicated to raising chickens was 202,100 VND, lower than alternative rural labor activities in the Mekong Delta. In a large proportion of farms (33.4 %), farmers decided to stop raising chickens after completing one cycle. Farmers who dropped off chicken production purchased more expensive feed (in 1000 VND per kg): 11.1 [10.6-11.5] vs. 10.8 [10.4-11.3] for farms that continued production (p = 0.039), and experienced higher chicken mortality (28.5 % [12.0-79.0 %] vs. 16 [7.5-33.0 %]; p = 0.004). The rapid turnover of farmers raising chickens in such systems represents a challenge to the uptake of messages on appropriate AMU and chicken health. To ensure sustainability of small-scale commercial systems, advisory services need to be available to farmers as they initiate new flocks, and support them in the early stages to help overcome their limited experience and skills. This targeted approach would support profitability whilst reducing risk of emergence of AMR and infectious disease from these systems.

PMID:34461467 | DOI:10.1016/j.prevetmed.2021.105470

J Contam Hydrol. 2021 Aug 12;243:103867. doi: 10.1016/j.jconhyd.2021.103867. Online ahead of print.

ABSTRACT

The earth texture with complex morphological geometry and compositions such as shale and carbonate rocks, is typically characterized with sparse field samples because of an expensive and time-consuming characterization process. Accordingly, generating arbitrary large size of the geological texture with similar topological structures at a low computation cost has become one of the key tasks for realistic geomaterial reconstruction and subsequent hydro-mechanical evaluation for science and engineering applications. Recently, generative adversarial neural networks (GANs) have demonstrated a potential of synthesizing input textural images and creating equiprobable geomaterial images for stochastic analysis of hydrogeological properties, for example, the feasibility of CO₂ storage sites and exploration of unconventional resources. However, the texture synthesis with the GANs framework is often limited by the computational cost and scalability of the output texture size. In this study, we proposed a spatially assembled GANs (SAGANs) that can generate output images of an arbitrary large size regardless of the size of training images with computational efficiency. The performance of the SAGANs was evaluated with two and three dimensional (2D and 3D) rock image samples widely used in geostatistical reconstruction of the earth texture and Lattice-Boltzmann (LB) simulations were performed to compare pore-scale flow patterns and upscaled permeabilities of training and generated geomaterial images. We demonstrate SAGANs can generate the arbitrary large size of statistical realizations with connectivity and structural properties and flow characteristics similar to training images, and also can generate a variety of realizations even on a single training image. In addition, the computational time was significantly improved compared to standard GANs frameworks.

PMID:34461459 | DOI:10.1016/j.jconhyd.2021.103867

Public Health. 2021 Aug 3;198:164-170. doi: 10.1016/j.puhe.2021.07.030. Online ahead of print.

ABSTRACT

OBJECTIVES: COVID-19 pandemic affected majority of students worldwide because school closures were one of the first and frequently taken measures in tackling epidemic. This study analyzed trends in COVID-19 morbidity and mortality from the beginning of pandemic in Croatia, in relation to schools opening and closing.

STUDY DESIGN: Retrospective data review.

METHODS: Data on COVID-19 positive patients in Croatia from week 9 of 2020 to week 10 of 2021 in Croatia were analyzed using joinpoint regression. Analysis also included hospitalizations and mortality trends for age groups 26 to 65 and 66+ from week 30 of 2020.

RESULTS: Schools opened in fall after the summer holidays in week 37. Joinpoint regression analysis revealed a statistically significant increase in cumulative incidence rates of COVID-19 in all age groups until 50th week, except in the 19-25 age group which saw an increase until 49th week. During the period of increase, there were periods of moderate increases and rapid increases in incidence that were present between 39/41 week and 43/44 week in all age groups except in those 0-6 years [from 40th till 43rd week in age groups 7-14 and 15-18, average percentage change (APC) = 87.41, P = 0.035, and APC = 83.47, P = 0.013; from 39th till 43rd in 19-25, APC = 91.90, P = 0.002; from 40th till 44th in 26-65, APC = 74.79, P < 0.001; from 41st till 44th in 66+, APC = 81.95, P = 0.004]. Steeper increase in hospitalizations was seen in 40th week for age groups 26 to 65 (40th to 45th week APC = 34.67, P < 0.001) and 66+ (40th to 45th week APC = 38.76, P < 0.001). Steeper increase in mortality started in 41st week for both age groups 26 to 65 and 66+ (41st to 46th week APC = 59.59, P < 0.001 and 41st to 45th week APC = 70.28, P < 0.001). Schools were closed for winter holidays in week 51. A steep decrease occurred in week 50 for cases and in week 51 for mortality and hospitalizations. There was no significant increase in hospitalizations and mortality after schools were re-opened in week 03 of 2021 (primary schools) and week 07 (secondary schools).

CONCLUSION: COVID-19 morbidity and mortality trends in Croatia observed in fall 2020 in Croatia perhaps cannot completely exclude potential association of school opening in all age groups. However, in winter 2021 effect was completely lacking and numbers were independent of schools’ dynamics. The observed inconsistent pattern indicates that there were no association of school openings and COVID-19 morbidity and mortality trends in Croatia and that other factors were leading to increasing and decreasing numbers. This emphasizes the need to consider the introduction of other effective and less harmful measures by stakeholders, or at least to use school closures as a last resort.

PMID:34461449 | DOI:10.1016/j.puhe.2021.07.030