Tag: pubmed

Lancet Glob Health. 2023 Oct;11(10):e1519-e1530. doi: 10.1016/S2214-109X(23)00376-5.

ABSTRACT

BACKGROUND: Differences in mortality exist between sexes because of biological, genetic, and social factors. Sex differentials are well documented in children younger than 5 years but have not been systematically examined for ages 5-24 years. We aimed to estimate the sex ratio of mortality from birth to age 24 years and reconstruct trends in sex-specific mortality between 1990 and 2021 for 200 countries, major regions, and the world.

METHODS: We compiled comprehensive databases on the mortality sex ratio (ratio of male to female mortality rates) for individuals aged 0-4 years, 5-14 years, and 15-24 years. The databases contain mortality rates from death registration systems, full birth and sibling histories from surveys, and reports on household deaths in censuses. We modelled the sex ratio of age-specific mortality as a function of the mortality in both sexes using Bayesian hierarchical time-series models. We report the levels and trends of sex ratios and estimate the expected female mortality and excess female mortality rates (the difference between the estimated female mortality and the expected female mortality) to identify countries with outlying sex ratios.

FINDINGS: Globally, the mortality sex ratio was 1·13 (ie, boys were more likely to die than girls of the same age) for ages 0-4 years (90% uncertainty interval 1·11 to 1·15) in 2021. This ratio increased with age to 1·16 (1·12 to 1·20) for 5-14 years, reaching 1·65 for 15-24 years (1·52 to 1·75). In all age groups, the global sex ratio of mortality increased between 1990 and 2021, driven by faster declines in female mortality. In 2021, the probability of a newborn male reaching age 25 years was 94·1% (93·7 to 94·4), compared with 95·1% for a newborn female (94·7 to 95·3). We found a disadvantage of females versus males (compared with countries with similar total mortality) in 2021 in five countries for ages 0-4 years (Algeria, Bangladesh, Egypt, India, and Iran), one country (Suriname) for ages 5-14 years, and 13 countries for ages 15-24 years (including Bangladesh and India). We found the reverse pattern (disadvantage of males vs females compared with countries of similar total mortality) in one country in ages 0-4 years (Vietnam) and eight countries in ages 15-24 years (including Brazil and Mexico). Globally, the number of excess female deaths from birth to age 24 years was 86 563 (-6059 to 164 000) in 2021, down from 544 636 (453 982 to 633 265) in 1990.

INTERPRETATION: The global sex ratio of mortality for all age groups in the first 25 years of life increased between 1990 and 2021. Targeted interventions should focus on countries with outlying sex ratios of mortality to reduce disparities due to discrimination in health care, nutrition, and violence.

FUNDING: The Bill & Melinda Gates Foundation, US Agency for International Development, and King Abdullah University of Science and Technology.

PMID:37734797 | DOI:10.1016/S2214-109X(23)00376-5

Br J Ophthalmol. 2023 Sep 21:bjo-2023-323181. doi: 10.1136/bjo-2023-323181. Online ahead of print.

ABSTRACT

BACKGROUND: Pigmentation could be a relevant prognostic factor in uveal melanoma (UM) development. Microphthalmia-associated transcription factor (MITF) regulates melanin synthesis by activating tyrosinase-related protein 2 (TYRP2) and silver protein (SILV) that induce the melanogenesis pathway. Although their oncogenic potential has been observed in various malignancies but has not been investigated in UM Asian population. Our aim is to study the ultrastructure of melanosomes and the prognostic significance of pigmentation markers such as TYRP2, MITF and SILV in UM.

METHODS: Transmission electron microscopy was performed to compare the ultrastructure of melanosomes in the normal choroid and UM cases. Immunoexpression of TYRP2, SILV and MITF was analysed in 82 UM samples. The mRNA expression level of all genes was measured in 70 UM cases. A statistical correlation was performed to determine the prognostic significance of all markers.

RESULTS: Premelanosomes and mature melanosomes undergoing dedifferentiation were observed in high-pigmented UM cases as compared with low-pigmented UM cases. Seventy per cent of UM cases showed high SILV expression while TYRP2 and MITF expression was present in 58% and 56% of cases, respectively. At the mRNA level, upregulation of TYRP2, SILV and MITF markers was seen in around 50% of UM cases, which was statistically significant with high pigmentation. Reduced metastatic-free survival was statistically significant with the MITF protein expression.

CONCLUSION: Our results demonstrated that ultrastructural changes in melanosomes and high expression of TYRP2, MITF and SILV could dysregulate the melanogenesis pathway and might be responsible for the aggressive behaviour of UM.

PMID:37734767 | DOI:10.1136/bjo-2023-323181

Open Heart. 2023 Sep;10(2):e002228. doi: 10.1136/openhrt-2022-002228.

ABSTRACT

BACKGROUND: Computer-assisted interpretation of single-lead ECG is the preliminary method for clinicians to flag and further evaluate an arrhythmia of clinical importance for acutely ill patients. Critical scrutiny of novel detection algorithms is lacking, particularly in external real-world data sets. This study’s objective was to evaluate a hybrid machine learning model’s ability to classify eight arrhythmias from a single-lead ECG signal from acutely ill patients.

METHODS: This cross-sectional external retrospective evaluation of a previously trained hybrid machine learning model against an ECG reading team in the setting of home hospital care (acute care delivered at home substituting for traditional hospital care) draws from patients admitted at two hospitals in Boston, Massachusetts, USA between 12 June 2017 and 23 November 2019. We calculated classifier statistics for each arrhythmia, all arrhythmias and strips where the model identified normal sinus rhythm.

RESULTS: The model analysed 2 680 162 min of single-lead ECG data from 423 patients and identified 691 478 arrhythmias. Patients had a mean age of 70 years (SD, 18), 60% were female and 45% were white. For any arrhythmia, the model had a sensitivity of 98%, a specificity of 100%, an accuracy of 98%, a positive predictive value of 100%, a negative predictive value of 93% and an F₁ Score of 99%. Performance was best for pause (F₁ Score, 99%) and worst for paroxysmal supraventricular tachycardia (F₁ Score, 92%). The model’s false positive rate for any arrhythmia was 0.2%, ranging from 0.4% for pause to 7.2% for paroxysmal supraventricular tachycardia. The false negative rate for any arrhythmia was 1.9%.

CONCLUSIONS: A hybrid machine learning model was effective at classifying common cardiac arrhythmias from a single-lead ECG in real-world data.

PMID:37734747 | DOI:10.1136/openhrt-2022-002228

Multisens Res. 2023 Sep 21:1-101. doi: 10.1163/22134808-bja10107. Online ahead of print.

ABSTRACT

This is the first systematic review that focuses on the influence of product-intrinsic and extrinsic sounds on the chemical senses involving both food and aroma stimuli. This review has a particular focus on all methodological details (stimuli, experimental design, dependent variables, and data analysis techniques) of 95 experiments, published in 83 publications from 2012 to 2023. 329 distinct crossmodal auditory-chemosensory associations were uncovered across this analysis. What is more, instead of relying solely on static figures and tables, we created a first-of-its-kind comprehensive Power BI dashboard (interactive data visualization tool by Microsoft) on methodologies and significant findings, incorporating various filters and visualizations allowing readers to explore statistics for specific subsets of experiments. We believe that this review can be helpful for researchers and practitioners working in the food and beverage industry and beyond these scopes (e.g., cosmetics). Theoretical and practical implications discussed in this article point to computational approaches that facilitate decision-making regarding multisensory experimental methodology design.

PMID:37734735 | DOI:10.1163/22134808-bja10107

Child Care Health Dev. 2023 Sep 21. doi: 10.1111/cch.13174. Online ahead of print.

ABSTRACT

BACKGROUND: Although current treatments are effective in dealing with congenital heart disease (CHD), non-cardiac comorbidities such as attention-deficit hyperactivity disorder (ADHD) have received widespread attention. The purpose of this systematic review and meta-analysis is to assess the risk of ADHD associated with CHD.

METHODS: The literature search was carried out systematically through eight different databases by the end of September 2022. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. The heterogeneity of the studies was assessed by the Cochran Q test and the I² statistic. Subgroup and sensitivity analyses were used to explore the potential sources of heterogeneity.

RESULTS: Eleven studies were included in this study, which involved a total of 296 741 participants. Our study showed that the children with CHD were at a significantly increased risk of ADHD compared with the reference group (OR = 2.98, 95% CI: 2.18-4.08). The results were moderately heterogeneous. These factors including study design, geographic region and study quality were identified as the first three of the most relevant heterogeneity moderators by subgroup analyses. Sensitivity analysis yielded consistent results. There was no evidence of publication bias.

CONCLUSIONS: The present study suggests that CHD children have a significantly higher risk of ADHD when compared with those without CHD. Early identification and intervention of ADHD is important to reduce its symptoms and adverse effects; therefore, clinicians should increase screening for ADHD in children with CHD and intervene promptly to reduce its effects whenever possible.

PMID:37734724 | DOI:10.1111/cch.13174

J Am Vet Med Assoc. 2023 Sep 21:1-4. doi: 10.2460/javma.23.07.0406. Online ahead of print.

ABSTRACT

OBJECTIVE: Alfaxalone is a commonly used anesthetic agent in small animals. In cats, alfaxalone can be administered as an IM agent to achieve clinically useful sedation or anesthesia, negating the need for IV injection in difficult patients. The molecular structure of alfaxalone is similar to the hormone progesterone (P4). It is hypothesized that alfaxalone would cross-react with the assay measuring progesterone causing a false elevation.

ANIMALS: 8 healthy neutered male, domestic shorthair cats that were privately owned were enrolled in the study.

METHODS: Male neutered cats were administered 3 mg/kg of alfaxalone IM. Blood samples were collected at set time points (baseline, 30 minutes, 60 minutes, 3 hours, 6 hours, and 10 hours after administration), and serum concentrations of progesterone immunoreactivity (IR) were determined using the Siemens Immulite 1000 automated immunoassay system. Statistical analysis was performed with repeated measures ANOVA and a Tukey-Cramer multiple comparisons test. A P value of < .05 was used for significance.

RESULTS: Serum progesterone IR was significantly elevated at 30 minutes, 1 hour, and 3 hours (P < .05) when compared to baseline progesterone immunoreactivity. Progesterone immunoreactivity had returned to baseline by 6 hours.

CLINICAL RELEVANCE: This study suggests that alfaxalone administered IM in cats may interfere with immunoassay measurement of serum progesterone for up to 6 hours. Caution should be used when interpreting serum progesterone immunoreactivity results in cats within 4 hours of alfaxalone.

PMID:37734719 | DOI:10.2460/javma.23.07.0406

J Theor Biol. 2023 Sep 19:111622. doi: 10.1016/j.jtbi.2023.111622. Online ahead of print.

ABSTRACT

The newly emerging pandemic disease often poses unexpected troubles and hazards to the global health system, particularly in low and middle-income countries like Nepal. In this study, we developed mathematical models to estimate the risk of infection and the risk of hospitalization during a pandemic which are critical for allocating resources and planning health policies. We used our models in Nepal’s unique data set to explore national and provincial-level risks of infection and risk of hospitalization during the Delta and Omicron surges. Furthermore, we used our model to identify the effectiveness of non-pharmaceutical interventions (NPIs) to mitigate COVID-19 in various groups of people in Nepal. Our analysis shows no significant difference in reproduction numbers in provinces between the Delta and Omicron surge periods, but noticeable inter-provincial disparities in the risk of infection (for example, during Delta (Omicron) surges, the risk of infection of Bagmati province is: ∼ 98.94 (89.62); Madhesh province: ∼ 12.16 (5.1); Karnali province ∼31.16 (3) per hundred thousands). Our estimates show a significantly low level of hospitalization risk during the Omicron surge compared to the Delta surge (hospitalization risk is: ∼10% in Delta and ∼2.5% in Omicron). We also found significant inter-provincial disparities in the hospitalization rate (for example, ∼ 6% in Madhesh province and ∼ 21% in Sudur Paschim) during the Delta surge. Moreover, our results show that closing only schools, colleges, and workplaces reduces the risk of infection by one-third, while a complete lockdown reduces the infections by two-thirds. Our study provides a framework for the computation of the risk of infection and the risk of hospitalization and offers helpful information for controlling the pandemic.

PMID:37734704 | DOI:10.1016/j.jtbi.2023.111622

Am J Kidney Dis. 2023 Sep 19:S0272-6386(23)00807-7. doi: 10.1053/j.ajkd.2023.07.015. Online ahead of print.

ABSTRACT

RATIONALE & OBJECTIVE: Survivors of acute kidney injury (AKI) are at high risk of adverse outcomes. Monitoring of kidney function, screening for proteinuria, use of statins and renin-angiotensin-aldosterone system inhibitors (RAASi), and nephrology follow-up among survivors have not been fully characterized. We sought to examine these processes of care after discharge in survivors of hospitalized AKI.

DESIGN: Population-based retrospective cohort study.

SETTING AND PARTICIPANTS: Adults in Alberta, Canada admitted to hospital between 2009 and 2017. Study participants were followed from their discharge date until 2019, with a median follow up of 2.7 years.

EXPOSURE: Hospital-acquired AKI diagnostically conforming to Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria for stage 2 or stage 3 disease, or the need for acute dialysis.

OUTCOMES: Outcomes following hospital discharge included the proportion of participants who had evaluation of kidney function, were seen by a specialist or general practitioner, and received prescriptions for recommended medications for chronic kidney disease (CKD) post-discharge.

ANALYTICAL APPROACH: Cumulative incidence curves were used to characterize the proportion of participants who received each process of care outcome within the first 90 days and subsequent 1-year follow-up period after hospital discharge. To avoid risks associated with multiple hypothesis testing, differences were not statistically compared across groups.

RESULTS: The cohort (n = 23,921) included 50.2% men (n = 12,015) with a median [IQR] age of 68.1 years [56.9, 78.8]. Within 90 days post-discharge, 21.2% and 8.6% of patients with and without pre-existing CKD, respectively, were seen by a nephrologist. 60.1% of AKI survivors had at least one serum creatinine measured but only 25.5% had an assessment for albuminuria within 90 days after discharge. 52.7% of AKI survivors with pre-existing CKD, and 51.6% with de novo CKD were prescribed a RAASi within 4-15 months after discharge from hospital.

LIMITATIONS: Retrospective data were collected as part of routine clinical care.

CONCLUSION: The proportion of patients receiving optimal care after an episode of AKI in Alberta was low and may represent a target for improving long-term outcomes for this population.

PMID:37734688 | DOI:10.1053/j.ajkd.2023.07.015

Respir Med. 2023 Sep 19:107408. doi: 10.1016/j.rmed.2023.107408. Online ahead of print.

ABSTRACT

OBJECTIVES: Pulse rate variability (PRV) predicts stroke in patients with sleep disordered breathing (SDB). However, the relationship between PRV and cardiovascular disease (CVD) was unknown in SDB.

METHODS: This was a cross-sectional study. Community residents in Guangdong were investigated. Sleep study were conducted with a type Ⅳ sleep monitoring. PRV parameters was assessed from the pulse waveforms derived from the sleep monitoring.

RESULTS: 3747 participants were enrolled. The mean age was 53.9 ± 12.7 years. 1149 (30.7%) were diagnosed as SDB. PRV parameters, except for the averages of pulse-to-pulse intervals (ANN), were higher in participants with SDB than those without. After adjusting for traditional CVD risk factors, deceleration capacity of rate (DC), ANN, and the percentage of pulse-to-pulse interval differences that were more than 50 ms (PNN50) were correlated with CVD risk in participants with SDB (OR were 0.826, 1.002, and 1.285; P were 0.003, 0.009, and 0.010), but not in participants without SDB. There was no interaction effect between DC, ANN, PNN50 and oxygen desaturation index. In hierarchical analysis, DC and ANN were predictors for CVD in SDB patients with age <60 years, male, overweight, diabetes, and normal lipid metabolism. PNN50 was predictor for CVD in the elderly SDB patients without overweight, diabetes or dyslipidemia.

CONCLUSIONS: PRV parameters may be specific predictors for CVD in SDB. PNN50 was a potent biomarker for CVD risk in the elderly with SDB, event without traditional CVD risk factors.

PMID:37734671 | DOI:10.1016/j.rmed.2023.107408

J Am Pharm Assoc (2003). 2023 Sep 19:S1544-3191(23)00302-3. doi: 10.1016/j.japh.2023.09.007. Online ahead of print.

ABSTRACT

BACKGROUND: Adverse Effects of Medical Treatment (AEMT) refer to unintended harm caused by medical care and are a significant public health concern.

OBJECTIVE: This study utilizes the Global Burden of Disease (GBD) database to investigate AEMT mortality trends among older adults in the United States from 1990 to 2019, focusing on crude mortality rates and age-standardized mortality rate trends by age group and sex.

METHODS: The study employs cause-of-death ensemble modeling and statistical analysis to examine crude and age-standardized mortality rates (ASR) for AEMT in older age groups and identify trends in mortality due to AEMTs in those over 65 years of age in the United States. Trends in the ASR of AEMT were analyzed using the Joinpoint regression model.

RESULTS: AEMT mortality rates increased among older adults from 2012 to 2019, with the highest increase observed in the 95 years or older age group. Significant differences were noted in AEMT mortality rates between older men and women, with older men having higher rates and showing an upward trend, while rates among older women decreased from 1990 to 2019.

CONCLUSION: The study highlights an overall increase in ASR related to AEMT among older adults in the US, with men shown to have a greater susceptibility to death from AEMT. Increased attention towards the detrimental impact of AEMT on our aging population, particularly for men, in conjunction with reinforcement of health policies and education, is warranted.

PMID:37734658 | DOI:10.1016/j.japh.2023.09.007