Tag: pubmed

PLoS Pathog. 2022 Nov 4;18(11):e1010613. doi: 10.1371/journal.ppat.1010613. Online ahead of print.

ABSTRACT

The lung is an understudied site of HIV persistence. We isolated 898 subgenomic proviral sequences (nef) by single-genome approaches from blood and lung from nine individuals on long-term suppressive antiretroviral therapy (ART), and characterized genetic diversity and compartmentalization using formal tests. Consistent with clonal expansion as a driver of HIV persistence, identical sequences comprised between 8% to 86% of within-host datasets, though their location (blood vs. lung) followed no consistent pattern. The majority (77%) of participants harboured at least one sequence shared across blood and lung, supporting the migration of clonally-expanded cells between sites. The extent of blood proviral diversity on ART was also a strong indicator of diversity in lung (Spearman’s ρ = 0.98, p<0.0001). For three participants, insufficient lung sequences were recovered to reliably investigate genetic compartmentalization. Of the remainder, only two participants showed statistically significant support for compartmentalization when analysis was restricted to distinct proviruses per site, and the extent of compartmentalization was modest in both cases. When all within-host sequences (including duplicates) were considered, the number of compartmentalized datasets increased to four. Thus, while a subset of individuals harbour somewhat distinctive proviral populations in blood and lung, this can simply be due to unequal distributions of clonally-expanded sequences. For two participants, on-ART proviruses were also phylogenetically analyzed in context of plasma HIV RNA populations sampled up to 18 years prior, including pre-ART and during previous treatment interruptions. In both participants, on-ART proviruses represented the most ancestral sequences sampled within-host, confirming that HIV sequences can persist in the body for decades. This analysis also revealed evidence of re-seeding of the reservoir during treatment interruptions. Results highlight the genetic complexity of proviruses persisting in lung and blood during ART, and the uniqueness of each individual’s proviral composition. Personalized HIV remission and cure strategies may be needed to overcome these challenges.

PMID:36331974 | DOI:10.1371/journal.ppat.1010613

World J Crit Care Med. 2022 May 9;11(3):178-191. doi: 10.5492/wjccm.v11.i3.178. eCollection 2022 May 9.

ABSTRACT

BACKGROUND: In patients with respiratory failure, loop diuretics remain the cornerstone of the treatment to maintain fluid balance, but resistance is common.

AIM: To determine the efficacy and safety of common diuretic combinations in critically ill patients with respiratory failure.

METHODS: We searched MEDLINE, Embase, Cochrane Library and PROSPERO for studies reporting the effects of a combination of a loop diuretic with another class of diuretic. A meta-analysis using mean differences (MD) with 95% confidence interval (CI) was performed for the 24-h fluid balance (primary outcome) and the 24-h urine output, while descriptive statistics were used for safety events.

RESULTS: Nine studies totalling 440 patients from a total of 6510 citations were included. When compared to loop diuretics alone, the addition of a second diuretic is associated with an improved negative fluid balance at 24 h [MD: -1.06 L (95%CI: -1.46; -0.65)], driven by the combination of a thiazide plus furosemide [MD: -1.25 L (95%CI: -1.68; -0.82)], while no difference was observed with the combination of a loop-diuretic plus acetazolamide [MD: -0.40 L (95%CI: -0.96; 0.16)] or spironolactone [MD: -0.65 L (95%CI: -1.66; 0.36)]. Heterogeneity was high and the report of clinical and safety endpoints varied across studies.

CONCLUSION: Based on limited evidence, the addition of a second diuretic to a loop diuretic may promote diuresis and negative fluid balance in patients with respiratory failure, but only when using a thiazide. Further larger trials to evaluate the safety and efficacy of such interventions in patients with respiratory failure are required.

PMID:36331969 | PMC:PMC9136719 | DOI:10.5492/wjccm.v11.i3.178

PLoS One. 2022 Nov 4;17(11):e0277240. doi: 10.1371/journal.pone.0277240. eCollection 2022.

ABSTRACT

BACKGROUND: Animal source foods (ASFs) are rich in high-quality proteins, including essential amino acids and highly bioavailable micronutrients vital for child growth and cognitive development. But, the daily consumption of ASFs among 6-23 months old children is very low in Tigray, Northern Ethiopia.

OBJECTIVE: The study aimed to assess the effectiveness of nutrition education intervention to improve the consumption of ASFs among 6-23 months old children from rural communities with strict religious fasting traditions of avoiding intake of ASFs in Northern Ethiopia.

METHODS: A quasi-experimental study was conducted in two food insecure districts namely Samre Seharti (intervention) and Tanqua Abergele (comparison). The mother-child pairs in the intervention group (n = 140) received nutrition education based on the barriers and available resources for optimal consumption of ASFs among children and followed up for nine months. The mother-child pairs in the comparison group (n = 153) received routine nutrition education. The data were collected using a pre-tested structured questionnaire. The baseline and endline data assessment included interviews on socio-demographic and socio-economic status, dietary intake, and child feeding practices. The effectiveness of the intervention was measured using the difference-in-difference (DID) analysis model.

RESULTS: At endline, the consumption of ASFs among children was 19.5 percentage points higher in the intervention group compared with the comparison group (p = 0.008). In addition, there was a significant increase in egg consumption among children in the intervention group (DID of 16.9, p = 0.012) from the comparison group. No child was consuming meat at baseline in both the intervention and comparison arms and it was very low at endline (5.2% vs. 7.9%). Overall, the proportion of children that consumed eggs in the intervention group was higher than in the comparison group in households that owned sheep and goats (4.8% vs. 21.4%, p = 0.050) and chicken (6.3% vs. 43.8%, p = 0.002) after education interventions. However, no statistically significant difference was observed between cow ownership and milk consumption among children (p>0.05).

CONCLUSIONS: Age-appropriate educational interventions for mothers and owning small livestock in the household can improve the consumption of ASFs and eventually the minimum diet diversity of children in communities with strict religious traditions of avoiding ASFs during the fasting seasons.

PMID:36331965 | DOI:10.1371/journal.pone.0277240

PLoS One. 2022 Nov 4;17(11):e0277272. doi: 10.1371/journal.pone.0277272. eCollection 2022.

ABSTRACT

Percutaneous transhepatic biliary drainage (PTBD) has been an effective treatment to access the biliary tree, especially in case of endoscopically inaccessible biliary tree. In general, PTBD techniques are divided into two methods: fluoroscopy-guided PTBD and ultrasound (US)-guided PTBD. This study aimed to evaluate the effectiveness of US-guided PTBD, focusing on radiation exposure according to intrahepatic duct (IHD) dilatation degree, differences between right- and left-sided approaches and differences between benign and malignant biliary stenosis/obstruction. We evaluated technical success, clinical success, procedural data (the number of liver capsule punctures, procedural time, fluoroscopy time and radiation dose), and procedure-related complications. During the study period, a total of 123 patients with biliary stenosis/obstruction or bile leakage were initially eligible. We excluded 76 patients treated with only ERCP or initially treated with ERCP followed underwent PTBD insertion. Finally, a total of 50 procedures were performed in 47 patients. Of the 47 patients, 8 patients had anatomical alteration due to previous surgery, 6 patients refused ERCP, and 3 patients failed ERCP. For the remaining 30 patients, PTBD was performed on weekend or at night, 11 of whom had poor general condition, 10 patients underwent ERCP 3 to 4 days later after PTBD insertion, 6 patients improved after PTBD insertion without ERCP, 1 patient died, and 1 patient was referred to other hospital. Remaining 1 patient underwent surgery due to Mirizzi syndrome. All procedures were performed by two interventional radiologists. Technical success rate was 100%, clinical success was 94%, and the complication rate was 10%. Fluoroscopy time and the reported radiation dose were significantly lower in patients with dilated bile ducts than in those with non-dilated bile ducts, when biliary puncture under US guidance was performed initially. However, even in patients with non-dilated bile ducts undergoing initial trials of biliary puncture under US guidance, the fluoroscopy time and the reported radiation dose were low, based on current studies. No statistical significant differences were observed in terms of technical and dosimetry results according to right-sided and left-sided procedures and benign and malignant biliary stenosis/obstruction. Thus, US-guided PTBD was found to be a safe and effective technique that significantly reduced fluoroscopy time and radiation doses.

PMID:36331963 | DOI:10.1371/journal.pone.0277272

PLoS One. 2022 Nov 4;17(11):e0277209. doi: 10.1371/journal.pone.0277209. eCollection 2022.

ABSTRACT

BACKGROUND: Healthcare waste management is very important due to its hazardous nature that can cause risk to human health and the environment. In developing countries, healthcare waste has not received much attention and has been disposed of together with municipal waste. The aim of the study was to assess the healthcare waste management practices in Addis Ababa City Administration Public Health Facilities.

METHODS: An institutional-based cross-sectional design was used for the study at Addis Ababa city 15 Public health centres and 3 hospitals. Data were collected using self-administered questionnaires distributed to 636 randomly selected healthcare waste handlers and managers. Observational check list also used. The data were entered into the EPI- INFO version TM 7 and exported to IBM SPSS 20 for analysis. Both descriptive and analytic statistics were employed.

RESULTS: Among the respondents, 358 (90.86%) from health centres and 96.38% (133) from hospitals indicated that their facilities had separate containers for hazardous and non-hazardous waste however, 61 (15.48%) from health centres and 29 (21.01%) from hospitals indicated that healthcare waste containers were not clearly marked or labelled. The study found that the main forms of on-site treatment of healthcare waste for health centres and hospitals before disposal were burning. Manager respondents from the health centres 65 (92.86%), 64 (91.43%) and from hospitals 31 (91.18%), 30 (88.24%) indicated that healthcare waste handlers were used protective clothing when handling waste and were provided with protective clothing when handling healthcare waste respectively.

CONCLUSION: In this study healthcare waste management among healthcare waste handlers and healthcare facility managers were not getting full attention. Collection of healthcare waste were not done regularly, containers were not clearly marked and were not located in appropriate areas where they might be needed. Support healthcare waste handlers by training help to improve their knowledge, attitude and practice.

PMID:36331960 | DOI:10.1371/journal.pone.0277209

PLoS One. 2022 Nov 4;17(11):e0277244. doi: 10.1371/journal.pone.0277244. eCollection 2022.

ABSTRACT

Otoliths (ear-stones) in the inner ears of vertebrates containing visible year zones are used extensively to determine fish age. Analysis of otoliths is a time-consuming and difficult task that requires the education of human experts. Human age estimates are inconsistent, as several readings by the same human expert might result in different ages assigned to the same otolith, in addition to an inherent bias between readers. To improve efficiency and resolve inconsistent results in the age reading from otolith images by human experts, an automated procedure based on convolutional neural networks (CNNs), a class of deep learning models suitable for image processing, is investigated. We applied CNNs that perform image regression to estimate the age of Greenland halibut (Reinhardtius hippoglossoides) with good results for individual ages as well as the overall age distribution, with an average CV of about 10% relative to the read ages by experts. In addition, the density distribution of predicted ages resembles the density distribution of the ground truth. By using k*l-fold cross-validation, we test all available samples, and we show that the results are rather sensitive to the choice of test set. Finally, we apply explanation techniques to analyze the decision process of deep learning models. In particular, we produce heatmaps indicating which input features that are the most important in the computation of predicted age.

PMID:36331956 | DOI:10.1371/journal.pone.0277244

Genet Med. 2022 Nov 3:S1098-3600(22)00950-9. doi: 10.1016/j.gim.2022.09.013. Online ahead of print.

ABSTRACT

PURPOSE: Nonerythrocytic αII-spectrin (SPTAN1) variants have been previously associated with intellectual disability and epilepsy. We conducted this study to delineate the phenotypic spectrum of SPTAN1 variants.

METHODS: We carried out SPTAN1 gene enrichment analysis in the rare disease component of the 100,000 Genomes Project and screened 100,000 Genomes Project, DECIPHER database, and GeneMatcher to identify individuals with SPTAN1 variants. Functional studies were performed on fibroblasts from 2 patients.

RESULTS: Statistically significant enrichment of rare (minor allele frequency < 1 × 10^-5) probably damaging SPTAN1 variants was identified in families with hereditary ataxia (HA) or hereditary spastic paraplegia (HSP) (12/1142 cases vs 52/23,847 controls, p = 2.8 × 10^-5). We identified 31 individuals carrying SPTAN1 heterozygous variants or deletions. A total of 10 patients presented with pure or complex HSP/HA. The remaining 21 patients had developmental delay and seizures. Irregular αII-spectrin aggregation was noted in fibroblasts derived from 2 patients with p.(Arg19Trp) and p.(Glu2207del) variants.

CONCLUSION: We found that SPTAN1 is a genetic cause of neurodevelopmental disorder, which we classified into 3 distinct subgroups. The first comprises developmental epileptic encephalopathy. The second group exhibits milder phenotypes of developmental delay with or without seizures. The final group accounts for patients with pure or complex HSP/HA.

PMID:36331550 | DOI:10.1016/j.gim.2022.09.013

JMIR Form Res. 2022 Nov 4;6(11):e38164. doi: 10.2196/38164.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States. High-risk HPV strains are associated with cancer of the cervix, oropharynx, anus, rectum, penis, vagina, and vulva. To combat increasing HPV-related cancers, the 9-valent HPV vaccine Gardasil was developed. Recommendation of the HPV vaccine by a health care provider has been cited as the number one factor affecting vaccine uptake among adolescents and young adults. Physician assistants, nurse practitioners, and pharmacists have been enlisted to bridge the gap.

OBJECTIVE: The specific aim of this research study was to develop a reliable and valid HPV vaccine communication scale that can be used to measure the competency of primary care providers when recommending the need for vaccination to parents and patients.

METHODS: Using a descriptive study, we collected data via a literature review, focus groups, and an expert panel to inform the scale domains and blueprint design. Pretesting (cognitive interviews) was used to inform item revision decisions. An item analysis was also conducted for the responses provided in the cognitive interviews. Item statistics (means and SDs), interitem correlations, and reliability were examined. Data were analyzed using SPSS (IBM Corp) software.

RESULTS: A valid and reliable 42-item HPV vaccine communication competency scale was developed. The scale included 6 domains of interest. Scale items were moderately to strongly correlated with one another, and Cronbach α indicated good internal consistency with each scale. Scale items included were related to provider introduction or rapport (α=.796), patient respect or empathy (α=.737), provider interview or intake (α=.9), patient counseling or education (α=.935), provider communication closure (α=.896), and provider knowledge (α=.824).

CONCLUSIONS: Pharmacists, nurse practitioners, and physician assistants should be trained to be competent in HPV vaccine communication and recommendation due to their expanded roles. Interdisciplinary collaboration is important to account for the trainee’s individual differences and ensure the best health care outcomes for patients. A standardized HPV communication scale can be used to ensure effective and consistent recommendation by health care providers, thus affecting immunization rates.

PMID:36331545 | DOI:10.2196/38164

JMIR Mhealth Uhealth. 2022 Nov 4;10(11):e38951. doi: 10.2196/38951.

ABSTRACT

BACKGROUND: Barriers to accessing in-person care can prevent veterans with posttraumatic stress disorder (PTSD) from receiving trauma-focused treatments such as exposure therapy. Mobile apps may help to address unmet need for services by offering tools for users to self-manage PTSD symptoms. Renew is a mobile mental health app that focuses on exposure therapy and incorporates a social support function designed to promote user engagement.

OBJECTIVE: We examined the preliminary efficacy of Renew with and without support from a research staff member compared with waitlist among 93 veterans with clinically significant PTSD symptoms. We also examined the impact of study staff support on participant engagement with the app.

METHODS: In a pilot randomized controlled trial, we compared Renew with and without support from a research staff member (active use condition) with waitlist (delayed use condition) over 6 weeks. Participants were recruited through online advertisements. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) was used to measure PTSD symptoms at pre, post, and 6-week follow-up. Usage data were collected to assess engagement with Renew.

RESULTS: Results indicated a small effect size (d=-0.39) favoring those in the active use conditions relative to the delayed use condition, but the between-group difference was not significant (P=.29). There were no differences on indices of app engagement between the 2 active use conditions. Exploratory analyses found that the number of support persons users added to the app, but not the number of support messages received, was positively correlated with app engagement.

CONCLUSIONS: Findings suggest Renew may hold promise as a self-management tool to reduce PTSD symptoms in veterans. Involving friends and family in mobile mental health apps may help bolster engagement with no additional cost to public health systems.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736.

PMID:36331540 | DOI:10.2196/38951

J Med Internet Res. 2022 Nov 4;24(11):e39728. doi: 10.2196/39728.

ABSTRACT

BACKGROUND: Virtual care (VC) visits (telephone or video) and email-based patient communication have been rapidly adopted to facilitate cancer care during the COVID-19 pandemic. Inequities in access and patient experience may arise as these digital health tools become prevalent.

OBJECTIVE: We aimed to characterize inequities in access and patient-reported experience following adoption of digital health tools at a tertiary cancer center during the COVID-19 pandemic.

METHODS: We designed a cross-sectional study of outpatients with visits from September to December 2020. Patient characteristics and responses to an email-based patient-experience survey were collated. Inequities in access were assessed across three pairs of comparison groups: (1) patients with VC and in-person visits, (2) patients with and without documented email addresses, and (3) responders and nonresponders to the survey. Inequities in patient-reported experience were assessed among survey responders. Demographics were mapped to area-level averages from national census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation. Covariate balance between comparison groups was assessed using standardized mean differences (SMDs), with SMD≥0.2 indicating differences between groups. Associations between patient experience satisfaction scores and covariates were assessed using multivariable analyses, with P<.05 indicating statistical significance.

RESULTS: Among the 42,194 patients who had outpatient visits, 62.65% (n=26,435) had at least one VC visit and 31.15% (n=13,144) were emailable. Access to VC and email was similar across demographic and socioeconomic indices (SMD<0.2). Among emailable patients, 21.84% (2870/13,144) responded to the survey. Survey responsiveness was similar across indices, aside from a small difference by age (SMD=0.24). Among responders, 24.4% received VC and were similar to in-person responders across indices (SMD<0.2). VC and in-person responders had similar satisfaction levels with all care domains surveyed (all P>.05). Regardless of visit type, patients had variable satisfaction with care domains across demographic and socioeconomic indices. Patients with higher ethnocultural composition scores were less satisfied with the cultural appropriateness of their care (odds ratio [OR] 0.70, 95% CI 0.57-0.86). Patients with higher situational vulnerability scores were less satisfied with discussion of physical symptoms (OR 0.67, 95% CI 0.48-0.93). Patients with higher residential instability scores were less satisfied with discussion of both physical (OR 0.81, 95% CI 0.68-0.97) and emotional (OR 0.86, 95% CI 0.77-0.96) symptoms, and also with the duration of their visit (OR 0.85, 95% CI 0.74-0.98; P=.02). Male patients were more satisfied with how their health care provider had listened to them (OR 1.64, 95% CI 1.11-2.44; P=.01).

CONCLUSIONS: Adoption of VC and email can equitably maintain access and patient-reported experience in cancer care across demographics and socioeconomic indices. Existing health inequities among structurally marginalized patients must continue to be addressed to improve their care experience.

PMID:36331536 | DOI:10.2196/39728