Nevin Manimala

Environ Manage. 2021 Aug 3. doi: 10.1007/s00267-021-01514-6. Online ahead of print.

ABSTRACT

Globally, shifting cultivation is known to be an important driver of tropical deforestation. However, in this paper, we argue that it can be sustainably managed if the environmental boundary conditions, laid by the traditional customs and practices, are fully respected. We narrate an empirical study from the Zunheboto district of Nagaland, India, where we deployed a mixed research method to explore the Indigenous and Local Knowledge and Practices (ILKPs) associated with shifting cultivation (aka Jhum), particularly concerning farm-level practices, forest and biodiversity conservation, and disaster risk reduction measures. The research method included analysis of primary data obtained through Focus Group discussions (FGDs), key informant interviews (n = 21), and a questionnaire survey (n = 153) with Jhum farmers from two different age groups, i.e., below 50 years (middle-aged farmers) and above 50 years (older farmers). From the qualitative inquiry, we identified 15 ILKPs, which were then validated from survey responses. We used the Mann-Whitney U test to examine differences in agreement between two groups of framers. Based on this analysis, we conclude that upholding of the ILKPs holds strong potential for the local implementation of several Sustainable Development Goals (SDGs), particularly, SDG-1(No poverty), SDG-2 (Zero hunger), and SDG-15 (Life on land). However, eight of the identified ILKPs showed a statistically significant difference between older and middle-aged farmers, underlining a declining trend. Finally, we suggest suitable policy measures to mainstream ILKPs to balance the trade-offs in food production and biodiversity conservation, and to ensure the future sustainability of Jhum cultivation in the region and beyond.

PMID:34342685 | DOI:10.1007/s00267-021-01514-6

Eur J Pediatr. 2021 Aug 3. doi: 10.1007/s00431-021-04214-9. Online ahead of print.

ABSTRACT

The association of proadrenomedullin and neonatal sepsis has been examined in numerous studies. The object of our meta-analysis is to evaluate differences in proadrenomedullin among neonates with sepsis and health neonates. We systematically searched the following databases: MEDLINE, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and WHO (International Clinical Trials Register Platform) using a structured algorithm. Statistical analysis was conducted using Revman 5.3 and R software. Included studies in the meta-analysis were assessed using the Newcastle-Ottawa scale. Proadrenomedullin levels were found significantly higher in neonates with sepsis than healthy neonates with an SMD equal with 3.07 [95% CI 1.71, 4.42 (p < 10^-5, I² = 98%)]. The optimal cutoff point of pro-ADM was calculated at 17.559 with a sensitivity of 0.879 (0.458; 0.984) and a specificity of 0.994 (0.820; 1.000), and an AUC of 0.905. Subgroup analysis, leave-one-out meta-analysis, and meta-regression were performed in an effort to lower inter-study heterogeneity. Sensitivity analysis was conducted by excluding high risk of bias studies and those contributing to the overall heterogeneity shown by the Baujat plot. Publication bias was assessed using a funnel plot and the trim-and-fill method. Certainty assessment was evaluated using the GRADE score.Conclusion: The findings of our meta-analysis suggest that proadrenomedullin is elevated in neonates with sepsis. However, future prospective cohort studies need to be conducted in order to assess its diagnostic accuracy. What is Known: • Proadrenomedullin has been found increased in adult patients with infectious diseases such as community acquired pneumonia. • Proadrenomedullin plays a major role in the pathophysiology of sepsis in adults. What is New: • Proadrenomedullin is increased in neonates with sepsis. • Future cohort studies need to be conducted in order to elucidate the value of proadrenomedullin in a safer way.

PMID:34342678 | DOI:10.1007/s00431-021-04214-9

Nervenarzt. 2021 Aug 3. doi: 10.1007/s00115-021-01174-1. Online ahead of print.

ABSTRACT

The research domain criteria (RDoC) initiative of the National Institute of Mental Health (NIMH) was presented 12 years ago. The RDoC provides a matrix for the systematic, dimensional and domain-based study of mental disorders that is not based on established disease entities as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD). The primary aim of RDoC is to understand the nature of mental health and illness in terms of different extents of dysfunction in psychological/biological systems with interconnected diagnoses. This selective review article aims to provide a comprehensive overview of RDoC-based studies that have contributed to a better conceptual organization of mental disorders. Numerous promising and methodologically sophisticated studies on RDoC were identified. The number of scientific studies increased over time, indicating that dimensional research is increasingly being pursued in psychiatry. In summary, the RDoC initiative has a considerable potential to more precisely define the complexity of pathomechanisms underlying mental disorders; however, major challenges (e.g. small and heterogeneous study samples, unclear biomarker definitions and lack of replication studies) remain to be overcome in the future. Furthermore, it is plausible that a diagnostic system of the future will integrate categorical and dimensional approaches to arrive at a stratification that can underpin a precision medical approach in psychiatry.

PMID:34342676 | DOI:10.1007/s00115-021-01174-1

Heart Vessels. 2021 Aug 3. doi: 10.1007/s00380-021-01915-x. Online ahead of print.

ABSTRACT

Left atrial (LA) function can help predict various cardiovascular events. Catheter ablation for atrial fibrillation (AF) modifies baseline LA function through the maintenance of sinus rhythm and myocardial injury. We investigated the impact of post-ablation LA function on recurrence of AF after ablation and identified the predictors of reduced post-ablation LA function. A total of 616 patients who underwent AF ablation (paroxysmal, N = 310; non-paroxysmal, N = 306) were retrospectively examined with cardiac computed tomography at baseline and 3 months after the final ablation procedure. Post-ablation LA emptying fraction (LAEF_post) was calculated. We evaluated the association between LAEF_post and recurrence of AF after the final ablation procedure. Further, we assessed the predictors of reduced LAEF_post. The recurrence rate of AF was 72.7% after the final ablation procedure [median follow-up 48 months (48.0, 48.0), total number of ablation sessions: 1.4 ± 0.7]. Multivariate analysis revealed that LAEF_post was associated with the recurrence of AF (hazard ratio/10% increase: 0.62, 95% confidence interval: 0.51-0.75, P < 0.0001). LAEF_post had a mild predictive power for recurrence of AF (c-statistics: 0.670, optimal cutoff: 26.36%, P < 0.0001). The recurrence-free proportion among patients with reduced LAEF_post (< 26.36%, N = 100) and those with preserved LAEF_post (≥ 26.36%, N = 516) was 40% and 79%, respectively (P < 0.0001). The predictors of reduced LAEF_post were low pre-ablation LAEF, high pre-ablation LA volume, low body mass index (BMI), and female sex. Further, reduced LAEF_post was associated with the total number of ablation sessions and extra-pulmonary vein LA ablation. In conclusion, reduced LAEF_post was associated with recurrence of AF after ablation. Advanced LA remodeling, low BMI, and female sex could predict reduced LAEF_post. Although additional ablation was associated with reduced LAEF_post, it remains unclear whether reduced LAEF_post resulted from the additional ablation. Reduced LAEF_post might help stratify patients with ablation-refractory AF.

PMID:34342674 | DOI:10.1007/s00380-021-01915-x

Sci Rep. 2021 Aug 2;11(1):15672. doi: 10.1038/s41598-021-94946-3.

ABSTRACT

Acute kidney injury (AKI) is a major global public health problem. It is expensive to manage and associated with a high rate of prolonged hospitalization and in-hospital mortality. Little is known about the burden of acute kidney injury in moderate to low-income countries. We aim to assess predictors of in-hospital mortality among AKI patients admitted to the medical ward. We prospectively identified patients meeting kidney disease improving global outcomes (KIDGO) AKI definitions from April to August 2019. Patients with underlying CKD and patients hospitalized for less than 48 h were excluded. The Cox regression model was fitted to identify predictors of mortality and statistical significance was considered at the p-value of less than 0.05. A total of 203 patients were enrolled over 5 months. Out of this, 121(59.6%) were males, 58(28.6%) were aged greater than 60 years, and 141(69.5%) had community-acquired acute kidney injury. The most common causes of AKI were Hypovolemia 99(48.77%), Glomerulonephritis 51(25.11%), and sepsis 32(15.79%). The overall in-hospital mortality rate was 12.8%. Stage 3 AKI (AHR = 9.61, 95% CI 1.17-28.52, p = 0.035), duration of AKI (AHR = 7.04, 95% CI 1.37-36.08, p = 0.019), length of hospital stay (AHR = 0.19, 95% CI 0.05-0.73, p = 0.012), and hyperkalemia (AHR = 3.61, 95% CI 1.12-11.71, p = 0.032) were significantly associated with in-hospital mortality. There is a high rate of acute kidney injury-related in-hospital mortality in adult patients admitted to the medical ward. The severity of AKI, hyperkalemia duration of AKI, and a short length of hospital stay were predictors of 30-days in-hospital mortality. Most of the causes of AKI are preventable and patients may benefit from early identification and treatment of these reversible causes.

PMID:34341369 | DOI:10.1038/s41598-021-94946-3

Sci Rep. 2021 Aug 2;11(1):15598. doi: 10.1038/s41598-021-93686-8.

ABSTRACT

Although some neurodegenerative diseases can be identified by behavioral characteristics relatively late in disease progression, we currently lack methods to predict who has developed disease before the onset of symptoms, when onset will occur, or the outcome of therapeutics. New biomarkers are needed. Here we describe spectral phenotyping, a new kind of biomarker that makes disease predictions based on chemical rather than biological endpoints in cells. Spectral phenotyping uses Fourier Transform Infrared (FTIR) spectromicroscopy to produce an absorbance signature as a rapid physiological indicator of disease state. FTIR spectromicroscopy has over the past been used in differential diagnoses of manifest disease. Here, we report that the unique FTIR chemical signature accurately predicts disease class in mouse with high probability in the absence of brain pathology. In human cells, the FTIR biomarker accurately predicts neurodegenerative disease class using fibroblasts as surrogate cells.

PMID:34341363 | DOI:10.1038/s41598-021-93686-8

Transl Psychiatry. 2021 Aug 2;11(1):416. doi: 10.1038/s41398-021-01536-y.

ABSTRACT

Depression is currently the leading cause of disability around the world. We conducted an epigenome-wide association study (EWAS) in a sample of 58 depression score-discordant monozygotic twin pairs, aiming to detect specific epigenetic variants potentially related to depression and further integrate with gene expression profile data. Association between the methylation level of each CpG site and depression score was tested by applying a linear mixed effect model. Weighted gene co-expression network analysis (WGCNA) was performed for gene expression data. The association of DNA methylation levels of 66 CpG sites with depression score reached the level of P < 1 × 10^-4. These top CpG sites were located at 34 genes, especially PTPRN2, HES5, GATA2, PRDM7, and KCNIP1. Many ontology enrichments were highlighted, including Notch signaling pathway, Huntington disease, p53 pathway by glucose deprivation, hedgehog signaling pathway, DNA binding, and nucleic acid metabolic process. We detected 19 differentially methylated regions (DMRs), some of which were located at GRIK2, DGKA, and NIPA2. While integrating with gene expression data, HELZ2, PTPRN2, GATA2, and ZNF624 were differentially expressed. In WGCNA, one specific module was positively correlated with depression score (r = 0.62, P = 0.002). Some common genes (including BMP2, PRDM7, KCNIP1, and GRIK2) and enrichment terms (including complement and coagulation cascades pathway, DNA binding, neuron fate specification, glial cell differentiation, and thyroid gland development) were both identified in methylation analysis and WGCNA. Our study identifies specific epigenetic variations which are significantly involved in regions, functional genes, biological function, and pathways that mediate depression disorder.

PMID:34341332 | DOI:10.1038/s41398-021-01536-y

Spine (Phila Pa 1976). 2021 Aug 2. doi: 10.1097/BRS.0000000000004184. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective cohort study with chart review.

OBJECTIVE: To determine if there is a difference in reoperation rates for adjacent segment disease (operative ASD) in posterior cervical fusions (PCF) that stop at -C7 versus -T1/T2.

SUMMARY OF BACKGROUND DATA: There are surgical treatment challenges to the anatomical complexities of the cervicothoracic junction (CTJ). Current posterior cervical spine surgery is based on the belief that adjacent segment disease (ASD) occurs if fusions are stopped at C7 although there is varying evidence to support this assumption.

METHODS: Patients were followed until validated reoperations for ASD, membership termination, death, or 03/31/2020. Descriptive statistics and five-year crude incidence rates and 95% confidence intervals (CI) for operative ASD for PCF ending at -C7 or -T1/T2 were reported. Time-dependent crude and adjusted, multivariable Cox-Proportional Hazards models were used to evaluate operative ASD rates with adjustment for covariates or risk change estimates more than 10%.

RESULTS: We identified 875 patients with PCFs (beginning at C3 or C4 or C5 or C6) stopping at either -C7 (n = 470) or -T1/T2 (n = 405) with average follow-up time of 4.6 (±3.3) years and average time to operative ASD of 2.7 (±2.8) yrs. Crude overall incidence rates for stopping at -C7 (2.12% (1.02%-3.86%)) and -T1/T2 (2.48% (1.25%-4.40%)) were comparable with no statistical difference in risk (adjHR = 1.47, 95% CI = 0.61-3.53, P = 0.39). Additionally, we observed no differences in the probability of operative ASD in competing risk time-dependent models (Grey’s Test P = 0.448).

CONCLUSION: A large cohort of 875 patients with PCFs stopping at -C7 or -T1/T2 with an average follow-up of > 4 years found no statistical difference in reoperation rates for ASD (operative ASD).Level of Evidence: 3.

PMID:34341320 | DOI:10.1097/BRS.0000000000004184

Spine (Phila Pa 1976). 2021 Aug 2. doi: 10.1097/BRS.0000000000004185. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective study of surgical outcomes in patients with degenerative cervical myelopathy (DCM).

OBJECTIVE: To better characterize outcomes following cervical decompression in those with severe, non-ambulatory forms of DCM.

SUMMARY OF BACKGROUND DATA: DCM represents a collection of age-related degenerative processes of the cervical spine that can result in motor, sensory and autonomic dysfunction, leading to significant reductions in quality of life. Individuals with severe, non-ambulatory forms of DCM are often treated with spinal decompression although the extent of neurological improvement for this patient population is unclear.

METHODS: A retrospective analysis of 48 non-consecutive non-ambulatory patients who underwent cervical decompression surgery between January 2007 and December 2018. Paired t-tests and Wilcoxon-signed rank tests were used to compare Nurick grade and mJOA score before and after surgery. Patient demographics, operative details, and post-surgical complications were analyzed using descriptive statistics.

RESULTS: Patients experienced significant improvements in both Nurick grade and mJOA score following cervical decompression surgery. The mean Nurick grade improved from 4.10 ± 0.31 to 2.21 ± 0.82 (p < 0.001, paired t-test; 95% CI -2.08 to -1.71), while the mean mJOA score improved from 10.58 ± 1.51 to 13.60 ± 1.58 (p < 0.001, paired t-test; 95% CI 2.59 to 3.45). The average follow-up duration was 2.50 ± 1.83 years. Following surgery, 44 of the 48 patients in the study gained the ability to ambulate without the aid of a walking frame or someone else’s assistance.

CONCLUSION: This study demonstrated that patients with severe forms of DCM experienced significant improvement in neurological function following cervical decompression surgery. These improvements indicate that cervical decompression surgery is effective in this patient population and has the potential to improve neurological status.Level of Evidence: 3.

PMID:34341319 | DOI:10.1097/BRS.0000000000004185

Afr J Paediatr Surg. 2021 Oct-Dec;18(4):219-223. doi: 10.4103/ajps.AJPS_159_20.

ABSTRACT

BACKGROUND: Congenital heart defects (CHDs) are one of the most common associated anomalies in patients with an orofacial cleft (OFC). However, few studies have shown the association between cleft type and CHDs in our population. This study aimed to assess the prevalence of CHDs in a cohort of OFC patients at a tertiary health facility in Nigeria, as well as assess the risk of CHD by OFC type.

MATERIALS AND METHODS: This was a prospective study design. Patients with an OFC were consecutively enrolled at a single OFC treatment facility. All subjects were assessed by a paediatric cardiologist and had echocardiography done. They were categorised based on the presence of CHDs, as well as the OFC phenotypic type (cleft lip and/or alveolus, cleft lip and palate and cleft palate only). Statistical analysis was done using STATA version 14 (College Station, Texas), and significance was set at P < 0.05.

RESULTS: A total of 150 subjects enrolled in the study over a period of 2 years (2018-2020). The median age of subjects was 6 months (interquartile range: 2-24), and 54.7% were female. The prevalence of CHDs in the subjects reviewed was 30.7%. Based on the severity of CHDs, the majority presented with simple defects (95.6%). Overall, the most common presentation was patent foramen ovale (12.7%), followed by septal defects (8.0%). There was no significant association between cleft type and the odds of a CHD.

CONCLUSION: The study reports a relatively high prevalence of CHDs in patients with OFC; however, there was no association between the risk of CHD by cleft type. Although a majority of CHDs may pose a low operative risk, cardiac evaluation is recommended for all cases of OFC to aid the identification of potentially high-risk cases.

PMID:34341307 | DOI:10.4103/ajps.AJPS_159_20