Global Rate Research Articles

Heart Failure with Normal Natriuretic Peptide Levels and Preserved Ejection Fraction: A Prospective Clinical and Cardiac MRI Study.

Purpose To describe the clinical presentation, comprehensive cardiac MRI characteristics, and prognosis of individuals with predisposed heart failure with preserved ejection fraction (HFpEF). Materials and Methods This prospective cohort study (part of MISSION-HFpEF [Multimodality Imaging in the Screening, Diagnosis, and Risk Stratification of HFpEF]; NCT04603404) was conducted from January 1, 2019, to September 30, 2021, and included individuals with suspected HFpEF who underwent cardiac MRI. Participants who had primary cardiomyopathy and primary valvular heart disease were excluded. Participants were split into a predisposed HFpEF group, defined as HFpEF with normal natriuretic peptide levels based on an HFA-PEFF (Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, and Final Etiology) score of 4 from the latest European Society of Cardiology guidelines, and an HFpEF group (HFA-PEFF score of ≥ 5). An asymptomatic control group without heart failure was also included. Clinical and cardiac MRI-based characteristics and outcomes were compared between groups. The primary end points were death, heart failure hospitalization, or stroke. Results A total of 213 participants with HFpEF, 151 participants with predisposed HFpEF, and 100 participants in the control group were analyzed. Compared with the control group, participants with predisposed HFpEF had worse left ventricular remodeling and function and higher systemic inflammation. Compared with participants with HFpEF, those with predisposed HFpEF, whether obese or not, were younger and had higher plasma volume, lower prevalence of atrial fibrillation, lower left atrial volume index, and less impaired left ventricular global longitudinal strain (-12.2% ± 2.8 vs -13.9% ± 3.1; P < .001) and early-diastolic global longitudinal strain rate (eGLSR, 0.52/sec ± 0.20 vs 0.57/sec ± 0.15; P = .03) but similar prognosis. Atrial fibrillation occurrence (hazard ratio [HR] = 3.90; P = .009), hemoglobin level (HR = 0.94; P = .001), and eGLSR (per 0.2-per-second increase, HR = 0.28; P = .002) were independently associated with occurrence of primary end points in participants with predisposed HFpEF. Conclusion Participants with predisposed HFpEF showed relatively unique clinical and cardiac MRI features, warranting greater clinical attention. eGLSR should be considered as a prognostic factor in participants with predisposed HFpEF. Keywords: Heart Failure with Preserved Ejection Fraction, Normal Natriuretic Peptide Levels, Cardiovascular Magnetic Resonance, Myocardial Strain, Prognosis Clinical trial registration no. NCT04603404 Supplemental material is available for this article. © RSNA, 2024.

Responsiveness of the condition-specific OVAMA questionnaire to measure symptoms and appearance in patients with vascular malformations.

Evidence-based guidelines for the treatment of vascular malformations are not readily available, possibly due to the diversity in methods used to evaluate treatment efficacy in clinical research, complicating the aggregation and comparison of study results. The OVAMA (Outcome Measures for VAscular Malformations) questionnaire was developed to uniformly measure symptoms and appearance, i.e., condition-specific core outcome domains, in patients with vascular malformations. However, the OVAMA questionnaire needs to be responsive to changes in these constructs in order to assess whether the disease status has altered since treatment. To assess the responsiveness of the OVAMA questionnaire in patients with vascular malformations. In a prospective longitudinal study, patients completed the OVAMA questionnaire at baseline and eight weeks follow-up since treatment or watchful waiting policy. Additionally, patients completed the Global rating of change (GRC) scales at follow-up. Responsiveness was evaluated following the criterion approach of testing predefined hypotheses about expected relationships between the OVAMA questionnaire and GRC scales, measuring the same constructs. The OVAMA questionnaire was considered responsive if ≥ 75% of the hypotheses were confirmed. Between July 2020 and September 2022, 89 patients were recruited in a vascular anomaly centre in the Netherlands, of which 63 patients completed the questionnaires at baseline and follow-up. In total, fifteen constructs of the OVAMA questionnaire were assessed for five hypotheses. Of these 75 hypotheses, 63 (84%) hypotheses were confirmed and thereby providing evidence that the OVAMA questionnaire is responsive to change. Our study found convincing evidence that the OVAMA questionnaire is responsive to changes in symptoms and appearance in patients with vascular malformations. In addition to determining a baseline of symptoms and appearance, the OVAMA questionnaire can now be used to evaluate the effect of treatment from the patient's perspective. The responsive OVAMA questionnaire allows for uniform evaluation and comparison of the effects of treatment on the condition-specific core outcome domains, tackling heterogeneity in outcome measurement and improving the clinical research of vascular malformations.

Translation, cultural adaptation, and validation of Numerical Pain Rating Scale and Global Rating of Change in Tibetan musculoskeletal trauma patients

Tibetan-speaking patients seeking care in predominantly Mandarin-speaking healthcare settings frequently face communication barriers, leading to potential disparities and difficulties in accessing care. To address this issue, we translated, culturally adapted, and validated the Numerical Pain Rating Scale (NPRS) and the Global Rating of Change (GRoC) into Tibetan (NPRS-Tib and GRoC-Tib), aiming to facilitate cross-linguistic and cross-cultural interactions while examining potential challenges in the adaptation process. Using standard translation-backward translation methods, expert review, pilot testing, and validation through a cross-sectional study with a short-term longitudinal component, we engaged 100 Tibetan patients with musculoskeletal trauma for psychometric validation, including 37 women (aged 22–60 years, mean age 39.1 years). The NPRS-Tib and GRoC-Tib exhibited outstanding psychometric properties, with an Intraclass Correlation Coefficient (ICC) of 0.983 for NPRS-Tib indicating superb test–retest reliability, and expert review confirming good content validity for both instruments. A Spearman's correlation coefficient (Rho) of -0.261 (P = 0.0087) revealed a significant, albeit weak, correlation between changes in NPRS-Tib scores and GRoC-Tib scores. The adaptation process also presented notable challenges, including translation discrepancies from translators' diverse backgrounds and levels of expertise, ambiguity in scale options, and the lack of established tools for criterion validity assessment in Tibetan.

Gene expression programming (GEP) as novel tool for thermal analysis and kinetic modeling of pyrolysis reactions: coal pyrolysis case study

PurposeIn this study, a different approach is introduced to generate the kinetic sub-model for the modeling of solid-state pyrolysis reactions based on the thermogravimetric (TG) experimental data over a specified range of heating rates. Gene Expression Programming (GEP) is used to produce a correlation for the single-step global reaction rate as a function of determining kinetic variables, namely conversion, temperature, and heating rate.Design/methodology/approachFor a case study on the coal pyrolysis, a coefficient of determination (R2) of 0.99 was obtained using the generated model according to the experimental benchmark data. Comparison of the model results with the experimental data proves the applicability, reliability, and convenience of GEP as a powerful tool for modeling purposes in the solid-state pyrolysis reactions.FindingsThe resulting kinetic sub-model takes advantage of particular characteristics, to be highly efficient, simple, accurate, and computationally attractive, which facilitates the CFD simulation of real pyrolizers under isothermal and non-isothermal conditions.Originality/valueIt should be emphasized that the above-mentioned manuscript is not under evaluation in any journals and submitted exclusively for consideration for possible publication in this journal. The generated kinetic model is in the final form of an algebraic correlation which, in comparison to the conventional kinetic models, suggests several advantages: to be relatively simpler, more accurate, and numerically efficient. These characteristics make the proposed model computationally attractive when used as a sub-model in CFD applications to simulate real pyrolizers under complex heating conditions.

Efficacy of heel lifts for mid-portion Achilles tendinopathy (the LIFT trial): study protocol for a randomised controlled trial

BackgroundMid-portion Achilles tendinopathy is a common condition, characterised by localised Achilles tendon load-related pain and dysfunction. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. Heel lifts have also been advocated as a treatment for Achilles tendinopathy, but the efficacy and mechanism of action of this intervention is unclear. This proposal describes a randomised controlled trial comparing the effectiveness of heel lifts versus sham heel lifts for reducing pain associated with mid-portion Achilles tendinopathy, with an embedded biomechanical analysis.MethodsOne hundred and eight men and women aged 18 to 65 years with mid-portion Achilles tendinopathy (who satisfy the inclusion and exclusion criteria) will be recruited. Participants will be randomised, using the website Sealed Envelope, to either a control group (sham heel lifts) or an experimental group (heel lifts). Both groups will be provided with education regarding acceptable pain levels to ensure all participants receive some form of treatment. The participants will be instructed to use their allocated intervention for at least 8 h every day for 12 weeks. The primary outcome measure will be pain intensity (numerical rating scale) at its worst over the previous week. The secondary outcome measures will be additional measures of Achilles tendon pain and disability, participant-perceived global ratings of change, function, level of physical activity and health-related quality of life. Data will be collected at baseline and the primary endpoint (week 12). Data will be analysed using the intention-to-treat principle. In addition, the acute kinetic and kinematic effects of the interventions will be examined at baseline in a subpopulation of the participants (n = 40) while walking and running using three-dimensional motion analysis.DiscussionThe LIFT trial (efficacy of heeL lIfts For mid-portion Achilles Tendinopathy) will be the first randomised trial to compare the efficacy of heel lifts to a sham intervention in reducing pain and disability in people with Achilles tendinopathy. The biomechanical analysis will provide useful insights into the mechanism of action of heel lifts.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12623000627651. Registered 7 June 2023.

#1236 Translation reprogramming in autosomal dominant polycystic kidney disease

Abstract Background and Aims Global regulation of mRNA translation has emerged as a central mechanism driving cellular adaptation to innate or acquired metabolic challenges. tRNA modifications are emerging as key drivers in the reprogramming of mRNA translation. Metabolic dysregulation is a central feature in the pathophysiology of PKD1-associated autosomal dominant polycystic kidney disease (ADPKD). Here, we aim at investigating the putative role of mRNA translation regulation in the development of cysts in ADPKD. Method The classical murine Inner Medullary Collecting Duct (IMCD) cells knocked out for Pkd1 by CRISPR-Cas9 were used. We combined proteomics and transcriptomics analyses of wild-type versus Pkd1-KO IMCD cells. A series of bioinformatic tools was used to identify pathways and processes dysregulated at the level of mRNA translation. Moreover, global mRNA translation rates were assessed in Pkd1-KO cells by measuring translating ribosomes and nascent protein synthesis by flow cytometry labelling methods. Finally, systematic analyses of tRNA regulation (sequencing and modification) were performed in Pkd1-KO cells. Results The proposed combination of analyses highlighted pathways differentially regulated in Pkd1-KO cells. We focused on pathways and proteins significantly upregulated in Pkd1-KO as compared to controls cells. On top of expected up-regulated pathways, we also uncovered a series of specific cellular and molecular pathways that are specifically and significantly upregulated in Pkd1-KO cells, including intracellular vesicular metabolism and ciliary transport. Interestingly, the pathway “tRNA modification” was significantly enriched in Pkd1-KO cells. Given the role of tRNA modifications in translation reprogramming during cell adaptation, we further validated that several enzymes known to regulate tRNA modification were differentially expressed in Pkd1-KO cells. In order to investigate the changes in tRNA modifications taking place in Pkd1-KO cells, we performed an unbiased analysis of tRNA modifications (LC-MS). This uncovered reproducible differences in the abundance of specific tRNA modifications between control and Pkd1-KO IMCD cells. Conclusion Our data uncovered different patterns of tRNA modifications between Pkd1-KO versus wild-type IMCD cells. This suggests that a specific tRNA-modification-dependent reprogramming of mRNA translation may occur in ADPKD. These data will be further validated using patient derived ADPKD cyst models.

Educational Programme to Implement Skin-to-skin Contact for Preterm Infants in the Intensive Care Units: Qualitative Study Proposal

Introduction Skin-to-skin contact (SSC) has been widely adopted as an efficacious and useful approach to neonatal care. Despite the endorsement of this practice by the World Health Organization (WHO) over a decade ago, healthcare institutions in South Africa, particularly in the North West Province (NWP), have shown limited progress with regard to its implementation. Of particular concern is the fact that South Africa accounts for 60% of the global mortality rate among low birth weight (LBW) preterm infants. Therefore, an educational programme can be beneficial for both parents and nurses in implementing SSC for preterm infants in intensive care units, with the aim of reducing the neonatal mortality rate. Aim The aim of this research is to develop an educational programme to implement SSC for preterm infants in intensive care units of the NWP. Methods This study will be conducted in three phases. Phase 1: An integrative literature review (ILR) will be conducted by following these five steps: formulation of the review question, search strategy, critical appraisal, data analysis, synthesis and conclusion. Phase 2 represents an empirical study using a qualitative exploratory and descriptive design. Purposive sampling will be used to select two populations. Population one will be parents of preterm infants and population two will be registered nurses and midwives. Semi-structured focus group discussions (FGDs) with a minimum of six participants will be used to collect data in both populations until reaching data saturation. Data will then be analyzed using steps proposed by Creswell and Clark. Phase 3 consists of the development of an educational programme to implement SSC for preterm infants in intensive care units, using Kellogg’s Logic Model (KLM). The following three KLM steps will be used for the development of an educational programme: inputs and activities, identifying outputs, outcomes, and outcomes indicators. Conclusion The study furnishes an introduction to the research, the aim and objectives of the research as well as the research methodology that will be adhered to. The results obtained from phases 1 and 2 will be used to form the basis for the development of an education programme in phase 3.

Obstetric vesico-uterine fistula in nine reference hospitals in the Democratic Republic of the Congo: epidemiological, clinical, and therapeutic aspects

IntroductionWith global cesarean section rates rising, there’s concern about increase in obstetric vesico-uterine fistula (OVUF). Very little is known about this anatomoclinical entity of obstetric fistula in Africa in general and in DRC in particular. Our purpose was to describe the epidemiological, clinical, and therapeutic aspects of OVUF in the Democratic Republic of the Congo (DRC).MethodsThis was a descriptive cross-sectional study. Data were collected from patients who presented with OVUF across seven provinces of the DRC (North Kivu, Haut-Uélé, Kasai Central, Kwilu, Maniema, Nord-Ubangi and Sankuru) from January 2017 to December 2022. Study variables were epidemiological, clinical, and therapeutic features.ResultsOf 1,267 patients presenting with obstetric fistulas, 355 (28.0%) had OVUF. The mean age was 32.9 ± 11.6 years, 80.6% of patients (286/355) lived in rural areas, and the majority had a low level of education (40% no formal education, 30.1% primary school, 28.7% secondary school). In total, 64.8% of patients were primiparous (230/355) and in all (100%) cases, OVUF was caused iatrogenically during cesarean delivery. Majority (76.3%) of patients laboured for one day or less (mean duration 1.0 ± 0.5 days) before giving birth, and the fetus died in 58.3% of cases. In 35.8% of cases, the fistula had lasted more than 10 years (mean age 10.1 ± 10.0 years) before repair. A proportion of 88.2% (n = 313) of OVUF was isolated while 11.3% (n = 40) was associated with a uretero-vaginal fistula. In 82.8% (n = 294) of cases the OVUF was single. The average fistula size was 2.4 ± 1.0 cm (range: 0.5 and 5.5 cm) and 274 (77.2%) fistulas measured between 1.5 and 3 cm, with 14.9% (n = 53) of them larger than 3 cm. Fibrosis was present in 65.1% of cases, cervical involvement was absent in 97.7% and post-operative complications were absent in 94.4%. In all cases, the OVUF was surgically repaired abdominally with a success rate of 97.5% (346/355).ConclusionThe proportion of OVUF is relatively high in the DRC. Most affected patients were young, under-educated, primiparous women living in rural areas. Cesarean section was the sole identified cause of OVUF which was isolated, single, without fibrosis, in majority of cases. Abdominal repair of OVUF was very effective, with good results in almost all cases. Teaching young doctors working mainly in remote areas how to perform safe cesarean section is needed to reduce incidence of OVUF in DRC.

Advancing Global Health Through Primary Care Physician Education on Suicide Prevention.

The rising global suicide rate presents a major public health concern, resulting in the loss of over 700,000 lives annually. Discrepancies in the impact of suicide among diverse populations underscore the necessity for targeted prevention strategies. Primary care providers (PCPs) play a crucial role in identifying and managing suicide risk, particularly in underserved areas with limited access to mental health care. Educating PCPs about evidence-based interventions and suicide prevention strategies has demonstrated effectiveness in reducing suicide rates. Landmark initiatives in Australia, Sweden, and Hungary have successfully lowered suicide rates by implementing educational programs for PCPs focused on suicide prevention. Denmark, previously afflicted by some of the highest rates globally in the 1980s, has significantly reduced its figures and now ranks among countries with the lowest rates in high-income nations. Collaborative programs involving PCPs and health workers in low-resource regions have also shown promising outcomes in suicide prevention efforts. Enhancing the expertise of PCPs in suicide prevention can fortify healthcare systems, prioritize mental health, and ultimately save lives, contributing to global health endeavors aimed at addressing the pervasive issue of suicide.

#2744 Analysis of bacteremia and mortality in patients with tunneled catheter for hemodialysis: a 14-years observational study

Abstract Background and Aims Infections are a leading cause of morbidity and mortality in hemodialysis patients. Tunneled catheters (TC) have been associated with increased risk of infection and death, but mortality rates are not widely reported. Our study aimed to analyse catheter infection-free survival and mortality of patients with this vascular access. Method This is a retrospective study of all TC inserted during the period of 1 January 2005 to 31 December 2019. The TC were inserted by nephrologists, following a preimplantation protocol agreed with the Infectious Diseases Service. Patients were followed up from the tunneled catheter insertion until the study end date (December 31, 2020), TC related bacteremia or died. Results In the 14-year period under study, 406 TC were implanted in 325 patients. A total of 85 tunneled catheter related bacteremia were diagnosed, resulting in an incidence of 0.40 per 1000 catheter days (81.1% after 6 months of implantation). The predominant microorganisms isolated were Gram-positive organisms: Staphylococcus epidermidis (48.4%); Staphylococcus aureus (28.0%). During the study, a total of 145 patients had the TC removed or exchanged due different causes. The main reasons for catheter removal were the adequate development and use of the arteriovenous fistula (48, 33.1%) and discharge from hemodialysis due to recovery of renal function, transfer to peritoneal dialysis or renal transplantation (47, 32.4%). Only in 26 (17.9%) patients, the TC was removed due to bacteremia at a median of 4.8 (1.0-8.0) days from the bacteremia. The median time to catheter removal for non-infection-related reasons was 448 (185-910) days, without significant differences with the TC related bacteremia group [430 (116-695)] (p=0.83). The 30-day mortality rate from the first TC related bacteremia was 8.7%. During the study period, a total of 168 (51.7%) patients died for different causes. Conclusion The incidence of bacteremia in our study was low and did not seem to have a relevant impact on catheter survival. The global mortality rate was similar to that reported in European registries for patients on renal replacement therapy. An implantation and management protocol, strict in prophylactic measures, could reduce the incidence of bacteremia and reduce its morbidity and mortality.

Restoration of normal central pain processing following manual therapy in nonspecific chronic neck pain.

To determine if a 4-week manual therapy treatment restores normal functioning of central pain processing mechanisms in non-specific chronic neck pain (NSCNP), as well as the existence of a possible relationship between changes in pain processing mechanisms and clinical outcome. Cohort study. Sixty-three patients with NSCNP, comprising 79% female, with a mean age of 45.8 years (standard deviation: 14.3), received four treatment sessions (once a week) of manual therapy including articular passive mobilizations, soft tissue mobilization and trigger point treatment. Pressure pain thresholds (PPTs), conditioned pain modulation (CPM) and temporal summation of pain (TSP) were evaluated at baseline and after treatment completion. Therapy outcome was measured using the Global Rating of Change Scale (GROC), the Neck disability Index (NDI), intensity of pain during the last 24 hours, Tampa Scale of Kinesiophobia (TSK) and Pain Catastrophizing Scale (PCS). Two sets of generalized linear mixed models with Gaussian response and the identity link were employed to evaluate the effect of the intervention on clinical, psychological and psychophysical measures and the association between psychophysical and clinical outcomes. Following treatment, an increased CPM response (Coefficient: 0.89; 95% credibility interval = 0.14 to 1.65; P = .99) and attenuated TSP (Coefficient: -0.63; 95% credibility interval = -0.82 to -0.43; P = 1.00) were found, along with amelioration of pain and improved clinical status. PPTs at trapezius muscle on the side of neck pain were increased after therapy (Coefficient: 0.22; 95% credibility interval = 0.03 to 0.42; P = .98), but not those on the contralateral trapezius and tibialis anterior muscles. Only minor associations were found between normalization of TSP/CPM and measures of clinical outcome. Clinical improvement after manual therapy is accompanied by restoration of CPM and TSP responses to normal levels in NSCNP patients. The existence of only minor associations between changes in central pain processing and clinical outcome suggests multiple mechanisms of action of manual therapy in NSCNP.

ORAL SEX, ORAL SEX PROTECTIVE BARRIERS, AND ORAL CANCER: A TRIPLE CONCERN

Oral sex refers to sexual activities involving the stimulation of the genitalia by the use of the mouth, tongue, teeth, or throat. Oral sex is practiced by people of all sexual orientations, and it is practiced in various forms: cunnilingus (oral-vaginal contact);fellatio(oral-penile contact); and anilingus (oral-anal contact).Over 35% of the global adult population have engaged in an oral sex activity at least once in their lifetime. Individuals who engage in oral sex are more vulnerable to various sexually transmitted oral infections, including oral gonorrhoea and oral HPV infection. These infections can result in severe health consequences, including oral cancer.Nonetheless, sexually transmitted oral infections could be avoided by using oral sex protective barriers such as cling films (aka saran wraps), dental dams, and tongue condoms. If oral sex protective barriers are used appropriately, the infections can beavoided. Unfortunately, the global use rate of these protective barriers is very negligible. For example, evidence has shown that just less than 10% of adolescents and young adults in the USA used condom at their last oral sex experience. Overall, the issue of oral sex, oral sex protective barriers, and oral cancer is a triple concern of global health significance; this commentary offered recommendations on how to address the triple concern.

Safety and effectiveness of apremilast in Japanese patients with psoriatic disease: Results of a post-marketing surveillance study.

The safety and efficacy of apremilast in psoriatic disease has been demonstrated in clinical trials, including in Japanese patients. This post-marketing surveillance study was conducted after approval of apremalast in Japan in 2016 to evaluate the safety and effectiveness of the drug in Japanese patients with plaque psoriasis (PsO) and psoriatic arthritis (PsA) in routine clinical practice. Patients (enrolled between September 1, 2017, and August 31, 2019), were observed for 12 months after apremilast treatment initiation or until discontinuation or withdrawal. Safety was assessed by evaluating adverse reactions (ARs) and serious ARs. Effectiveness measures in PsO included the proportion of patients who achieved global improvement and Physician's Global Assessment (PGA) scores of 0/1 and the change from baseline in the Dermatology Life Quality Index (DLQI) after 6 and 12 months treatment. The safety analysis set included 1063 patients (PsO, n = 992; PsA, n = 127). ARs and serious ARs were reported in 29.4% and 0.7% of patients, respectively; most occurred <1 month after apremilast initiation. There were no reports of fatal ARs, serious infections, hypersensitivity, or vasculitis. No new safety signals were identified. Among the key survey items, gastrointestinal disorders were the most common ARs (21.3%). In patients with PsO, after 6 and 12 months of treatment, effectiveness rates of achieving highly effective or effective global improvement of were 90.9% and 93.8%; PGA 0/1 was achieved by 42.7% and 58.1% of patients; mean decrease from baseline in total DLQI score was 4.2 (p < 0.0001) and 5.7 (p < 0.0001), respectively. Effectiveness was evaluated in a small number of patients with PsA for some measures; after 6 and 12 months of treatment, improvements were observed in global improvement effectiveness rates, Disease Activity Score in 28 Joints score, Visual Analog Scale score, and DLQI score. We conclude that orally administered apremilast was well tolerated and effective in Japanese patients with PsO and/or PsA enrolled in this post-marketing surveillance study.

Global epidemiology of early-onset upper gastrointestinal cancer: trend from the Global Burden of Disease Study 2019.

In recent years, there has been a growing incidence of gastrointestinal cancer in young individuals. Despite its significant morbidity and mortality, research on upper gastrointestinal (UGI) cancer in young populations has been relatively limited. Therefore, studies on the epidemiological changes of this cancer are needed. Using data from the Global Burden of Disease Study 2019, we examined the incidence, death, and disability-adjusted life years (DALYs) from UGI cancers in the young, namely, early-onset esophageal cancer (EOEC) and early-onset gastric cancer (EOGC). These results were stratified by sex, geographical region, country, and sociodemographic index. There was a total of 185 140 cases, 120 289 deaths, and 5.70 million DALYs attributable to early-onset UGI cancers globally. From 2010 to 2019, the global incidence, death, and DALYs rates of early-onset UGI cancers decreased. In contrast, the incidence rates increased in both EOEC (+1.15%) and EOGC (+0.21%) in the Eastern Mediterranean region. Over the past decade, the burden of UGI cancer in the young has decreased. However, it has increased in the Eastern Mediterranean region. Further research to elucidate the attributable risk factors in this population is warranted.

Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach

The World Health Organization as part of the goal of universal vaccination coverage by 2030 for all individuals. The global under-five mortality rate declined from 59% in 1990 to 38% in 2019, due to high immunization coverage. Despite the significant improvements in immunization coverage, about 20 million children were either unvaccinated or had incomplete immunization, making them more susceptible to mortality and morbidity. This study aimed to identify predictors of incomplete vaccination among children under-5 years in East Africa. An analysis of secondary data from six east African countries using Demographic and Health Survey dataset from 2016 to the recent 2021 was performed. A total weighted sample of 27,806 children aged (12–35) months was included in this study. Data were extracted using STATA version 17 statistical software and imported to a Jupyter notebook for further analysis. A supervised machine learning algorithm was implemented using different classification models. All analysis and calculations were performed using Python 3 programming language in Jupyter Notebook using imblearn, sklearn, XGBoost, and shap packages. XGBoost classifier demonstrated the best performance with accuracy (79.01%), recall (89.88%), F1-score (81.10%), precision (73.89%), and AUC 86%. Predictors of incomplete immunization are identified using XGBoost models with help of Shapely additive eXplanation. This study revealed that the number of living children during birth, antenatal care follow-up, maternal age, place of delivery, birth order, preceding birth interval and mothers’ occupation were the top predicting factors of incomplete immunization. Thus, family planning programs should prioritize the number of living children during birth and the preceding birth interval by enhancing maternal education. In conclusion promoting institutional delivery and increasing the number of antenatal care follow-ups by more than fourfold is encouraged.

Seasonal Variations in Food Insecurity Prevalence of Mother-Child Dyads in Seme Sub-County, Kisumu, Kenya

Food insecurity remains a major impediment to the attainment of adequate health outcomes among the population. This is attributable to the adverse implications that food insecurity poses on the nutritional status of the populations. Globally, in the year 2021, an estimated population of 3.1 billion people (42%) faced unprecedented food crisis evident by inability to afford a healthy meal. Meanwhile, global rates of stunting attributable to food insecurity among children under the age of sixty months was 22.3%. In Kenya, close to 32% of the populations are acutely food insecure and require urgent food insecurity interventions. Kisumu County is a food import county; hence, decline in food supplies in the counties depends on for food supply results in food crisis amongst its populace. Women and children are disproportionately affected by food insecurity due to gender and age-related factors. Rural populations are often worse affected by food insecurity as evident by high rates of stunting experienced in rural areas when compared to overweight rates that are more in urban areas. It is on this basis that we sought to assess the prevalence of food insecurity among mother-child dyads drawn from Seme Sub-County, a rural area in the County of Kisumu, Kenya. We used a longitudinal study design adopting repeated cross-sectional measures to assess food security status of a sample of 201 mother-child pairs during planting and harvesting seasons. Food security status of mothers was assessed quantitatively using Household Food Insecurity Access Scale. Children’s food security status was assessed using Prevalence of Undernourishment as indicated by the anthropometric measurements. Qualitative data were further synthesized using Key Informant Interviews and Focus Group Discussions to complement quantitative data on prevalence of food insecurity among mother-child dyads. Data was analysed descriptively to indicate proportions of mothers and children depicting various food insecurity classifications. The mean HFIAS score for season I; 11.22 (± 5.36 SD) was statistically significantly different (higher) than mean HFIAS score for season II; 9.63 (± 5.18 SD) at α ≤ 0.05 (t-test: p=0.003). During planting season, a majority of the mothers; 134 (70.9%) experienced severe food insecurity prevalence and during harvesting season, a majority of the mothers; 117 (61.9%) experienced severe food insecurity prevalence. In planting season, almost three-quarters of the children; 137 (72.5%) were food secure as they had normal weight-for-age Z score (were not underweight). On the other hand, slightly higher than average; 102 (54.0%) of the children were food secure during harvesting season. These findings demonstrate suboptimal variations in prevalence of food insecurity across the two seasons. Mothers were more likely to experience severe food insecurity prevalence than children. Thus, there is a need to develop adequate interventions aimed at optimizing intra-household food distribution dynamics as means of ensuring adequate food security for both mothers and children in the study area

Underreporting or Failed Notification? Global Botulism Reporting, 2000-2022.

Botulism is a rare, potentially fatal illness caused by botulinum toxins produced by Clostridium bacteria. There are no coordinated worldwide reporting mechanisms for botulism cases and therefore few reliable case frequency estimates. This study aimed to establish an international benchmark for case frequency to determine estimated global rates of underreporting of botulism cases. To this end, a comprehensive, multilingual search of major global and national databases, including gray data and government sources, was performed. Data from case series were pooled, standardized against United Nations midyear population estimates, and analyzed using Kolmogorov-Smirnov tests to identify normally distributed data series. National incidence rates of normally distributed series were compared with that of the United States, which was considered the gold standard due to its extensive data reported for 2004-2018. A total of 6,932 botulism cases from 59 nations were identified in the literature, with a global case fatality rate of 1.37%. The national mean incidence rate ranged from 0.00 to 8.04 cases per million people, with an international mean incidence rate of 0.62 cases per million people. At the continent level, incidence rates tended toward normal distributions, although few countries outside of North America and Europe exhibited normal distributions. Based on comparisons with the US standard, an estimated 88.71% of botulism cases worldwide were unreported in 2016. Better awareness of botulism among healthcare professionals, coordinated global reporting mechanisms, and research on additional contributing factors to underreporting would enable better understanding of global case frequency, thereby potentially reducing the global incidence of botulism and improving outcomes.

A 3D printed esophageal atresia–tracheoesophageal fistula thorascopy simulator for young surgeons

We developed a 3D-printed thoracoscopic surgery simulator for esophageal atresia with tracheoesophageal fistula (EA-TEF) and assessed its effectiveness in educating young pediatric surgeons. Prototype production and modifications were repeated five times before producing the 3-D printed final product based on a patient’s preoperative chest computed tomography. A 24-item survey was used to rate the simulator, adapted from a previous report, with 16 young surgeons with an average of 6.2 years of experience in pediatric surgery for validation. Reusable parts of the thoracic cage were printed to combine with replaceable parts. Each structure was fabricated using diverse printing materials, and subsequently affixed to a frame. In evaluating the simulator, the scores for each factor were 4.33, 4.33, 4.27, 4.31, 4.63, and 4.75 out of 5, respectively, with the highest ratings in value and relevance. The global rating was 3.38 out of 4, with ten stating that it could be used with slight improvements. The most common comment from participants was that the esophageal anastomosis was close to the actual EA-TEF surgery. The 3D-printed thoracoscopic EA-TEF surgery simulator was developed and reflected the actual surgical environment. It could become an effective method of training young pediatric surgeons.

Effective Approaches to Addressing Challenges in Exclusive Breastfeeding

Exclusive breastfeeding (EBF) is crucial for infant health and development, endorsed by organizations like the American Academy of Paediatrics and the World Health Organization. Despite its benefits, global EBF rates fall short of targets. Globally, 48% of infants under six months are exclusively breastfed, with significant regional disparities. In India, rates vary across states. In Telangana only 68% of infants under six months are exclusively breastfed. Barriers include insufficient support, perceived milk insufficiency, lack of knowledge, latch and positioning issues, maternal and infant health concerns, work constraints, societal norms, formula marketing, and institutional practices. Strategies to overcome these barriers involve family, healthcare providers, employers, communities, education, counselling, supportive environments, peer support, addressing health concerns, workplace support, cultural sensitivity, regulation, and policy changes.

Type 2 diabetes attributable to ambient particulate matter pollution: a global burden study from 1990 to 2019

BackgroundThis study assesses the changes over time and geographical locations in the disease burden of type 2 diabetes (T2D) attributed to ambient particulate matter pollution (APMP) from 1990 to 2019 in 204 countries and regions with different socio-demographic indexes (SDI).MethodsThe Global Burden of Diseases Study 2019 (GBD2019) database was used to analyze the global burden of T2D attributed to APMP. This study evaluated both the age-standardized death rate (ASDR) and disability-adjusted life years (DALYs) related to T2D, comparing data from 1990 to 2019. Estimated Annual Percentage Changes (EAPCs) were also utilized to investigate the trends over the 30-year study period.ResultsThe global age-standardized DALY rate and ASDR exhibited an increasing trend, with an EAPC of 2.21 (95% CI: 2.15 to 2.27) and 1.50 (95% CI: 1.43 to 1.58), respectively. This rise was most notable among older adult populations, men, regions in Africa and Asia, as well as low-middle SDI regions. In 2019, the ASDR for T2D caused by APMP was recorded at 2.47 per 100,000 population, while the DALY rate stood at 108.98 per 100,000 population. Males and countries with middle SDI levels displayed significantly high age-standardized death and DALY rates, particularly noticeable in Southern Sub-Saharan Africa. Conversely, regions with high SDI levels like High-income North America demonstrated decreasing trends.ConclusionThis study reveals a significant increase in T2D worldwide as a result of APMP from 1990 to 2019, with a particular emphasis on its impact on men, the older adult, and regions with low to middle SDI levels. These results underscore the urgent necessity for implementing policies aimed at addressing air pollution in order to reduce the prevalence of T2D, especially in the areas most heavily affected.