History Of Infectious Diseases Research Articles

#3095 Pinpointing specific circulating microRNAs as putative biomarkers for chronic kidney disease and cardiovascular outcomes

Abstract Background and Aims Chronic kidney disease (CKD) affects over 10% of the worldwide population and entails a significant risk for cardiovascular disease (CVD), leading to an up to 500-fold increase in cardiovascular mortality in advanced stages. However, the pathophysiological mechanisms underlying kidney-heart intercommunication remain unknown. In recent years, microRNAs (miRNAs) emerged as critical regulators of gene expression and numerous miRNAs that have been implicated in both CKD and CVD pathogenesis. Still, so far, their role in kidney-heart crosstalk has not been addressed. In this study, we evaluated the expression of a panel of miRNAs in plasma from pre-dialysis CKD patients and explored their association with main comorbidities and significant outcomes in a 5-year follow up. Method The expression levels of miR-30c-5p, miR-132-3p, miR-199a-5p, and miR-324-3p was assessed by real time qRT-PCR in plasma samples from two cohorts of pre-dialysis CKD patients followed up at the Nephrology Department of Centro Hospitalar Universitário de São João (CHSJ, Porto, Portugal).The discovery cohort was established between November 2014 and August 2018 and comprises 52 CKD patients while the validation cohort comprises samples from 43 CKD patients who underwent a kidney biopsy for diagnostic purposes from November 2019 to December 2022. Patients with acute kidney injury, neoplasia diagnosis, recent infections (<1 week), or known psychiatric disorders were excluded from the study. Plasma samples from 38 healthy blood donors, recruited at the Immunohemotherapy Department of CHSJ, in which creatinine values were measured and considered normal were used as controls. Participants with a history of cancer, inflammatory, or infectious diseases and who were being treated with anti-inflammatory or anti-depressive drugs, were excluded. MiRs expression in comparison with the controls was validated in both cohorts and its expression in the Discovery cohort was correlated with the patients clinical data in a 5 year follow up. Results Results show that miR-30c-5p and miR-132-3p were downregulated in CKD patients compared with healthy controls, presenting a significant power to discriminate the disease condition. Still, considering the stratification of CKD in early/moderate (1-3) and advanced stages (4-5), only miR-30c-5p presented a decreased expression in the initial stages of the disease, showing a significant diagnostic value as an early biomarker for CKD, independently of eGFR. When analyzing the major disease outcomes in a 5 year time, miR-199a-5p was associated with increased frequency of CVD and mortality while miR-324-3p was downregulated in CKD patients that progressed to worse stages. Conclusion These findings highlight miR-30c-5p as a potential biomarker for the diagnosis of CKD in early stages of the disease and identify, for the first time, the enrollment of miR-199a-5p and miR-324-3p in kidney-heart pathophysiological crosstalk, paving the way for the putative establishment of new biomarkers and therapeutic targets for CKD and its outcomes.

Factors correlating with circulating T-zone-like cells of undetermined significance (TZUS) in dogs resident in Italy

T-zone-like cells of undetermined significance (TZUS) share the same phenotypic pattern (CD45-CD5+) with T-zone lymphoma cells and were first described a few years ago in the peripheral blood (PB) of healthy aged American Golden retrievers (GR). History of bladder and eye disease increased the odd of circulating TZUS in the American GR population. Since differences among dogs may exist according to the geographical region of origin, herein we screened 489 PB samples to assess potential factors predisposing to the presence of circulating TZUS in dogs living in Italy. Overall, TZUS were found in 174 (35.6%) samples. Among 83 clinical variables, significant associations emerged with sex, age, diagnosis of neoplasia, history of neoplasia, history of infectious or parasitic disease, history of osteoarticular disease, presence of traumatic lesions or foreign bodies, and lymphocytes count. Only age and history of neoplasia retained significance at multivariate analysis (p=0.019 and p=0.036, respectively). Thus, older age and history of neoplasia are the main factors associated with circulating TZUS in Italian dogs. Future studies should focus on elucidating the biological role of TZUS and determining reproducible criteria for their identification, distinguishing them from infiltrating TZL.

Risk Factors for Maternal Mortality in Banyumas Regency in 2022

Abstract Introduction: Maternal mortality Rate (MMR) in Banyumas Regency, Indonesia fluctuates. In 2022, it was the highest in Central Java Province with 24 cases spread across 14 Puskesmas. The purpose of this study was to determine the risk factors affecting maternal mortality consisting of maternal education level, anemia status, nutritional status, and history of infectious diseases.Methods: This type of research was a case control study with a sample size of 24 cases and 48 controls. The sampling method was total sampling. Education level, infectious disease, anemia, and nutritional status were investigated. This study was conducted on July to September 2023 in Banyumas Regency, Central Java, Indonesia. Data were collected through interviews using structured questionnaires. Data were analyzed with chi square tests and logistic regression.Results: The results showed that factors that increase the risk of maternal mortality were having a history of infectious diseases (OR = 5.84; 95% CI = 1.46 - 23.33, p = 0.012) and maternal Chronic Energy Deficiency (OR = 3.98; 95% CI = 1.32 - 12.01, p = 0.014).Conclusion: The risk factors for maternal mortality were infectious diseases and maternal Chronic Energy Deficiency. Early detection of risk factors such as history of infectious disease and Chronic Energy Deficiency are needed so prevention efforts can be planned. The improvement of antenatal and postnatal care through increasing the quality of health workers by providing technical and non-technical skills, especially village midwives is very important.

Structured Literature Review to Identify Human Papillomavirus's Natural History Parameters for Dynamic Population Models of Vaccine Impacts.

Human papillomavirus (HPV) is a common sexually transmitted virus that can cause cervical cancer and other diseases. Dynamic transmission models (DTMs) have been developed to evaluate the health and economic impacts of HPV vaccination. These models typically include many parameters, such as natural history of the disease, transmission, demographic, behavioral, and screening. To ensure the accuracy of DTM projections, it is important to parameterize them with the best available evidence. This study aimed to identify and synthesize data needed to parametrize DTMs on the natural history of HPV infection and related diseases. Parameters describing data of interest were grouped by their anatomical location (genital warts, recurrent respiratory papillomatosis, and cervical, anal, vaginal, vulvar, head and neck, and penile cancers), and natural history (progression, regression, death, cure, recurrence, detection), and were identified through a systematic literature review (SLR) and complementary targeted literature reviews (TLRs). The extracted data were then synthesized by pooling parameter values across publications, and summarized using the range of values across studies reporting each parameter and the median value from the most relevant study. Data were extracted and synthesized from 223 studies identified in the SLR and TLRs. Parameters frequently reported pertained to cervical cancer outcomes, while data for other anatomical locations were less available. The synthesis of the data provides a large volume of parameter values to inform HPV DTMs, such as annual progression rates from cervical intraepithelial neoplasia (CIN) 1 to CIN2+ (median of highest quality estimate 0.0836), CIN2 to CIN 3+ (0.0418), carcinoma in situ (CIS) 2 to local cancer+ (0.0396), and regional to distant cancer (0.0474). Our findings suggest that while there is a large body of evidence on cervical cancer, parameter values featured substantial heterogeneity across studies, and further studies are needed to better parametrize the non-cervical components of HPV DTMs.

Prevalence and determinant factors of Chronic Energy Deficiency (CED) in pregnant women

Pregnant women with Chronic Energy Deficiency (CED) are prone to malnutrition due to prolonged imbalances in the intake of essential nutrients. This study aimed to analyze the factors associated with the risk of CED in pregnant women. This study had a quantitative, cross-sectional design and was conducted from June to August 2023 in the working area of the Parung Panjang Health Center, Bogor Regency. The sample size in this study was 140 pregnant women using purposive sampling. The respondents’ characteristics were obtained through questionnaire interviews. MUAC was collected through MUAC tape, dietary intake using a Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ) form, and hemoglobin through a rapid test. Analysis was performed using the chi-square statistical test at 95% CI. The results of this study showed that the prevalence of CED was 20,7%. There was a significant relationship between maternal age, parity, gestational age, history of infectious diseases, knowledge, energy, and protein adequacy and CED in pregnant women (p <0,05). There was no significant relationship between income, anemia status, fat and carbohydrate adequacy, and the occurrence of CED (p> 0,05). In conclusion, the determinants of CED include maternal age, parity, gestational age, history of infection, knowledge, energy, and protein intake.

The Relationship Between Food Availability, Household Food Security, and the History of Infectious Diseases with the Incidence of Malnutrition in Toddlers

The aim of this study is to investigate and analyze the relationship between food availability, household food security, and history of infectious diseases with the occurrence of malnutrition in toddlers. The method used in this research is an analytical survey with a cross-sectional study design. The population in this study is toddlers aged 12-59 months in the disaster-prone area of Pantoloan, with a sample of toddlers aged 12-59 months. The results of the study show a significant relationship between food availability and the occurrence of malnutrition in toddlers (p = 0.000). This means that toddlers who do not have guaranteed food availability in the last 12 months have a greater risk of experiencing malnutrition. However, no significant relationship was found between a history of infectious diseases and the occurrence of malnutrition (p = 0.566), possibly due to the mild and non-persistent nature of malnutrition, which does not affect the toddlers' immune system. Furthermore, a significant relationship was found between household food security and the occurrence of malnutrition (p = 0.006). Many families still need to prioritize adequate nutrition for their family, thus improving access to food to meet nutritional needs is still necessary. The study implies a deeper understanding of the factors influencing malnutrition in toddlers in disaster-prone areas and provides a basis for the development of appropriate interventions to improve the nutritional status of toddlers. Efforts to improve food availability and household food security are expected to reduce the risk of malnutrition in toddlers in the area.

Prevalence of infectious diseases, immunity to vaccine-preventable diseases and chronic medical conditions among Ukrainian refugees in Germany – A cross sectional study from the German Network University Medicine (NUM)

BackgroundVulnerability to infectious diseases in refugees is dependent on country of origin, flight routes, and conditions. Information on specific medical needs of different groups of refugees is lacking. We assessed the prevalence of infectious diseases, immunity to vaccine-preventable diseases, and chronic medical conditions in children, adolescents, and adult refugees from Ukraine who arrived in Germany in 2022. MethodsUsing different media, we recruited Ukrainian refugees at 13 sites between 9–12/2022. An antigen test for acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, serologies for a range of vaccine-preventable diseases, as well as interferon gamma release assays (IGRAs) for tuberculosis (TB), and SARS-CoV-2 were performed. We assessed personal and family history of chronic medical conditions, infectious diseases, vaccination status, and conditions during migration. ResultsOverall, 1793 refugees (1401 adults and 392 children/adolescents) were included. Most participants were females (n = 1307; 72·3%) and from Eastern or Southern Ukraine. TB IGRA was positive in 13% (n = 184) of the adults and in 2% (n = 7) of the children.Serology-based immunological response was insufficient in approximately 21% (360/1793) of the participants for measles, 32% (572/1793) for diphtheria, and 74% (1289/1793) for hepatitis B. ConclusionsWe show evidence of low serological response to vaccine-preventable infections and increased LTBI prevalence in Ukrainian refugees. These findings should be integrated into guidelines for screening and treatment of infectious diseases in migrants and refugees in Germany and Europe. Furthermore, low immunity for vaccine-preventable diseases in Ukrainians independent of their refugee status, calls for tailor-made communication efforts.

A Prospective Study of Disease Patterns and Assessment of Drug Interactions with Prasugrel in Tertiary Care Hospital Patients

This prospective observational study evaluates the prescribing patterns and drug-drug interactions of Prasugrel in hospitalized patients at a tertiary care hospital (BBH). Conducted over six months, it involved 110 inpatients, gathering data from various sources including patient profiles, medicine charts, and lab tests. The study primarily focused on Prasugrel usage, identifying patient demographics and assessing the interactions of Prasugrel with other medications. It found that 64.02% of the patients on Prasugrel therapy were male and 36.08% female, predominantly aged between 55 to 75 years. These patients often had a history of cardiovascular and infectious diseases. The study revealed that 31.36% of patients experienced interactions with Prasugrel, with a higher incidence in males. The most common interactions were with Pantoprazole, Omeprazole, and Aspirin. These interactions were classified as severe (11.81%), moderate (55.05%), and mild (34.13%). Additionally, 17.91% of interactions were defined, 58.45% probable, and 22.62% possible. Prasugrel was mainly prescribed for heart disease, myocardial infarction, and angina. The study suggests cautious use of Pantoprazole with Prasugrel due to potential significant interactions.

FOSTERING A PROSPEROUS FAMILY, HEALTHY, AND FREE OF STUNTING IN CENTRAL JAVA: EMPIRICAL STUDY IN TINGKIR SALATIGA

Stunting is a condition when a toddler has a minimum height or body length compared to their age. Factors that influence the occurrence of stunting in children under five in rural and urban areas are mother's education, family income, mother's knowledge of nutrition, exclusive breastfeeding, age at which MP-ASI is given, zinc and iron adequacy levels, history of infectious diseases and genetic factors (Kemenkes, 2023). Activity objectives The output targets of this community service activity are increasing awareness of stunting prevention through improving parenting, understanding the role of housewives, increasing knowledge about financial literacy in the family, and understanding the nutritional needs of pregnant women. Community service activities were carried out in the Tingkir Tengah Village meeting room with the target of involving 45 representatives from 10 RW. Participants consisted of Posyandu cadres, PKK cadres, dashat cadres, and Pregnant Women. Community service activities went well according to plan. The event was attended by more than 80% of invited participants consisting of posyandu cadres, dashat cadres, and pregnant women. This activity is expected to increase knowledge so that reduction and prevention of stunting can be implemented.

Pendugaan Koefisien Regresi Logistik Biner Menggunakan Algoritma Least Angle Regression

Binary logistic regression is a statistical analysis method that aims to determine the relationship between variable which has two categories with the predictor variable that have categorical or continuous scale. The method that used to estimate logistic regression parameters is Maximum Likelihood Estimation (MLE) method. In estimating parameters, Least Angle Regression (LAR) algorithm is used to select the significant variables in order to get the best model from the estimation results of binary logistic regression coefficients. This LAR algorithm is applied to the risko of stunting data in two-year-old-babies at Buntu Batu Health Center working area, Enrekang Regency, South Sulawesi in 2019. This results obtained in the estimation of binary logistic regression prediction model using LAR algorithm, the standard error value is 0.018 smaller than the standard error value of binary logistic regression, which is 0.025. This shows that the binary logistic regression model using LAR algorithm is better than the usual binary logistic regression model on the risk of stunting data. Based on the results obtained, the variables that significantly affect the risk of stunting in two-year-old-babies on 2019 are father’s height, body length of birth, exclusive breastfeeding, history of infectious diseases, and history of immunization.

Preventive behaviors against COVID-19 among health care providers in Iran: A cross-sectional study.

During outbreaks of infectious diseases, if healthcare providers do not follow the principles of prevention, the risk of personal infection increases and they become a source of infection spread. This study aimed to determine the factors related to the preventive health behaviors of COVID-19 among Iranian healthcare providers based on protection motivation theory (PMT). This analytical cross-sectional study included 346 healthcare providers. Data was collected by an online researcher-made questionnaire based on PMT. To analyze the data, independent T tests, analysis of variance (ANOVA), Spearman correlation coefficient, multiple linear regression, and SPSS 22 software were used. α was considered as 0.05. 85.3% of the healthcare providers would always wear masks, 80.7% would always refuse to kiss and touch hands with others, and 34.7% sometimes would exercise at home. The preventive behaviors were significantly correlated with protection motivation (r = 0.84), self-efficacy (r = 0.51), response efficiency (r = 0.43), perceived severity (r = 0.41) Fear (r = 0.21), perceived susceptibility (r = 0.11), response cost (r = -0.14), and reward (r = -0.15). PMT constructs were able to predict 77% of the variance of the behaviors and the protection motivation construct was the strongest predictor (β = 0.806). Income above 300 Dolars per month was significantly related to the decrease in the mean score of preventive behaviors against COVID-19. The female sex and the individual or family history of infectious diseases were significantly related to increasing the mean score of COVID-19 preventive behaviors. Based on the study results, it is suggested that some educational interventions be designed and implemented with a focus on this construct and the perceived severity construct and that more attention be given to the education of health care providers with high-income levels, male providers, and the individuals without a history of corona infection in themselves or their family members.

Faktor Risiko yang Berhubungan dengan Kejadian Stunting pada Anak Balita di Kelurahan Alak Kecamatan Alak Kota Kupang

Stunting is a condition in which a person's height is less than normal based on age and gender. Height is a type of anthropometric examination and shows a person's nutritional status. The presence of stunting indicates a poor nutritional status Malnutrition in the long term (chronic). This study aims to determine the risk factors associated with stunting incidents in children under five years old in alak village, alak sub district, kupang city in 2023. The type of research used is quantitative research using observational analytic methods with a case control research design. The population used for this study was 520 toddlers in Alak Village, Alak District, Kupang City. A sample of 33 cases and 33 controls using simple random sampling technique. Data were taken directly at the research site using a questionnaire and then processed and analyzed using the chi-square test. The results showed that there was a relationship between income level (p=0.001), education level (p=0.004), history of infectious disease (p=0.001), history of exclusive breastfeeding (p=0.044), and birth spacing (p=0.077) with the incidence of stunting in children under five in Alak Village, Alak District, Kupang City. It is hoped that health workers can increase routine monitoring of additional feeding and provide education regarding stunting.

Factors Affecting Nutritional Status (Height for Age) of Children Under Five in Rote Ndao District, Kupang, Nusa Tenggara Timur, Indonesia

Background: Nusa Tenggara Timur (NTT) Province has many problems related to nutritional intake and public health. Pregnant women and children under five are groups of people who are very vulnerable to this problem. Many government programs have been implemented but to date there are still high maternal and infant mortality rates as well as high problems of malnutrition and stunting. This study aimed to determine what factors influence the nutritional status of toddlers in Rote Ndao Regency. Subjects and Method: This was a cross-sectional study conducted in Rote Ndao Regency, Kupang, NTT, Indonesia, from August to November 2023. A total of 43 mothers who had children aged 12-59 months were selected for this study. The dependent variable was nutritional status (height for age/ HAZ). The independent variables were maternal knowledge on nutrition and stunting, history of infectious diseases, and local-food-based supplementary feeding. Supplementary feeding was measured using food frequency questionnaire (FFQ). Nutritional status was measured by height for age. The data were analyzed using a multiple linear regression. Results: Maternal nutritional knowledge (b= 0.37; 95% CI = 0.23 to 0.50; p = 0.001), no history of infection (b= 0.98; 95% CI= 0.72 to 1.24; p= 0.001), and local-food-based supplementary feeding (b= 1.33; 95% CI= 0.71 to 1.96; p= 0.001) positively and significantly increased nutritional status (height for age) in children under five. Conclusion: Maternal nutritional knowledge, no history of infection, and local-food-based suplementary feeding positively and significantly increase nutritional status (height for age) in children under five. Keywords: supplementary feeding, nutritional status, maternal knowledge, stunting Correspondence: Intje Picauly. Study Program of Public Health, Faculty of Public Health, Universitas Nusa Cendana, Kupang 85111, Nusa Tenggara Timur, Indonesia. Email: intjepicauly@staf.undana.ac.id. Mobile: +6282237145517.

Global COVID-19 vaccine acceptance level and its determinants: an umbrella review

BackgroundThe COVID-19 vaccination is essential for reducing disease burden on a worldwide scale. The success of this strategy will largely depend on how well vaccines are received. Previous reviews had produced contradictory results, and there had been no umbrella review. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the COVID-19 vaccination’s global acceptance rate and its contributing factors.MethodsUsing PRISMA guideline, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus and Google Scholar which reported COVID-19 vaccine acceptance and/or its determinants were searched. The quality of the included studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias and sensitivity analysis were also assessed.ResultTwenty-two SRM with 10,433,306 study participants were included. The pooled COVID-19 vaccine acceptance rate globally is found to be 60.23 (95% CI: 58.27, 62.18). In low-income countries, the pooled level of COVID-19 vaccine acceptance was found to be 54.07(50.31, 57.83) while this magnitude is 64.32 (62.24,66.40) among studies across the globe. Higher level of education (AOR =1.96; 95% CI:1.20, 2.73), good level of knowledge (2.20; 95% CI:1.36, 3.03), favourable attitude (AOR =4.50; 95% CI:2.89, 6.12), previous history of COVID-19 infection (AOR =3.41; 95% CI:1.77, 5.06), male sex (AOR =1.62; 95% CI:1.47, 1.77), and chronic disease (AOR =1.54; 95% CI:1.18, 1.90) were predictors of COVID-19 vaccine acceptance.ConclusionThe pooled level of COVID-19 vaccine acceptance highly varied and found to be unacceptably low particularly in low-income countries. Higher level of education, good level of knowledge, favourable attitude, previous history of COVID-19, male sex, and chronic disease were factors of COVID-19 vaccine acceptance rate. A collaborative effort of stakeholders such as policymakers, and vaccine campaign program planners is needed to improve the acceptance rate of COVID-19 vaccine.

History of Infectious Diseases in Toddlers and Frequency of Community Health Center Nutrition Services with Stunting Incidents

Toddlers are an important period in the process of growth and development of a child. Malnourished children can experience malnutrition and this can result in stunting. Stunting incidents could have a negative impact on the growth and development period of toddlers. There were several factors that influenced the incidence of stunting, both directly and indirectly. Stunting was still a serious health problem facing Indonesia. This study aims to analyze the relationship between the history of infectious diseases and the frequency of community health centre nutrition services with the incidence of stunting. The research design was cross-sectional with a stratified simple random sampling technique taken from 8 posyandu (Integrated Healthcare Center) with a total sample of 112 toddlers. This research was conducted in the work area of the Saritani Community Health Center, Boalemo Regency, Gorontalo Province, from January to February 2023. The data analysis technique used in this research was the Chi-Square test. The results of the study showed that there was a significant relationship between the history of infectious diseases in toddlers and the incidence of stunting (p value=0.006; p-value ≤ α = 0.05), OR value=2.804 and there was a significant relationship between the frequency of health centre nutrition services and the incidence of stunting ( p value=0.001; p-value ≤ α = 0.05), OR value=2.859 in the working area of the Saritani Health Center, Boalemo Regency. Nurses can carry out health promotion efforts for mothers of toddlers to increase stunting prevention by knowing the factors that cause stunting. Increase efforts to provide nutritional education services related to stunting at community health centres, namely the First 1000 Days of Life, Infant and Child Feeding Practices, and routine exclusive breastfeeding.

Does a prior diagnosis of infectious disease confer an increased risk of latent autoimmune diabetes in adults?

Infections are proposed risk factors for type 1 diabetes in children. We examined whether a diagnosis of infectious disease also confers an increased risk of latent autoimmune diabetes in adults (LADA). We used data from a population-based Swedish case-control study with incident cases of LADA (n=597) and matched controls (n=2386). The history of infectious disease was ascertained through national and regional patient registers. We estimated adjusted odds ratios (OR) with 95% confidence intervals for ≥1 respiratory (any/upper/lower), gastrointestinal, herpetic, other or any infectious disease episode, or separately, for 1 and ≥2 infectious disease episodes, within 0-1, 1-3, 3-5 and 5-10years before LADA diagnosis/matching. Stratified analyses were performed on the basis of HLA risk genotypes and Glutamic acid decarboxylase antibodies (GADA) levels. Individuals who developed LADA did not have a higher prevalence of infectious disease 1-10years before diabetes diagnosis. For example, OR was estimated at 0.87 (0.66, 1.14) for any versus no respiratory infectious disease within 1-3years. Similar results were seen for LADA with high-risk HLA genotypes (OR 0.95 [0.64, 1.42]) or high GADA levels (OR 1.10 [0.79, 1.55]), ≥2 episodes (OR 0.89 [0.56, 1.40]), and in infections treated using antibiotics (OR 1.03 [0.73, 1.45]). The only significant association was observed with lower respiratory disease the year preceding LADA diagnosis (OR 1.67 [1.06, 2.64]). Our findings do not support the idea that exposure to infections increases the risk of LADA. A higher prevalence of respiratory infection in the year before LADA diagnosis could reflect increased susceptibility to infections due to hyperglycemia.

History of infections is associated with smaller hippocampal volume in older women

AbstractBackgroundAccumulating evidence suggests that infections can play a major role in Alzheimer’s disease (AD), however, mechanism is unclear as multiple pathways may be involved. One possibility is that infections might contribute to AD directly by promoting neuronal death and neurodegeneration.MethodWe investigated the relationship between history of infectious diseases (a potential AD risk factor) and brain hippocampal volume, HV (a biomarker of neurodegeneration and AD neuropathology) in a subsample of the UK Biobank participants with respective information. Infectious disease diagnoses were based on ICD‐10 codes. The left/right HV was measured by the MRI. Analysis of variance (ANOVA) and Welch Two Sample t‐test were used to examine the statistical significance.ResultThe HV was significantly lower in older women (age 65+) with prior history of infections, compared to the same age women without such history (p‐value = 0.014 and 0.029, for the left and right HV, respectively). The effect size increased with age, and this increase was faster for the right vs. left HV. The difference in HV between male subjects with and without history of infections was not statistically significant.ConclusionIn this study, prior infections were significantly associated with the lower left/right HV in women aged 65+, which supports the role of infectious diseases in neurodegeneration and preclinical AD pathology in females. The effect size increased with age, in line with the increase in brain vulnerability to stressors due to aging. The faster increase for the right vs. left HV might indicate that females’ verbal memory declines faster with age compared to visual‐spatial memory, following the exposure to infectious disease, which deserves further investigation. The observed sex differences may reflect a higher vulnerability of the female brain to infection‐related factors, which in turn might contribute to the higher risk of AD in women compared to men.

Quality of life and factors associated among caregivers of adolescent and young adult Ebola survivors in Democratic Republic of the Congo, a cross-sectional study

BackgroundEbola virus disease is a medical condition whose consequent effects on quality of life of patients. In the history of infectious diseases, there have been pathologies that have had significant repercussions for caregivers, healthcare providers and the community.ObjectivesThis study investigate determinants of quality of life among caregivers of adolescent and young adult Ebola survivors in Democratic Republic of the Congo.MethodsThis was a cross sectional study. The study sites were the two health districts of Beni and Katwa, in North-Kivu province in the Eastern part of Democratic Republic of the Congo. The study period was from April to August 2022. Participants of the study were caregivers of adolescents and young adult Ebola virus survivors. Simple random sampling technique was used to select the 68 study participants. A questionnaire was administered. Data was collected using pretested questionnaire of WHO quality of life Bref (WHOQOL-BREF) and CommCare by Dimagi.Inc. lastest Version 2.52.1 and a sum of score of 78 or higher indicated a high level of life quality. To determine the quality of life of caregivers of adolescents and young adult EVD survivors, descriptive analysis was used. The Pearson correlation coefficient was utilized to check whether the predictor variables are multicollinear. The regression analysis produced the crude odds ratio (COR), adjusted odds ratio (aOR), 95% confidence interval (CI), and p-value. Statistical significance was defined as a p-value 0.05. The final multivariate model contained variables that were significant in the bivariate analysis. Prior to data collection, a research permit from National Ethical Committee of Research in Democratic Republic of the Congo was obtained. Written informed consents from literate or illiterate caregivers of adolescent and young adult Ebola survivors were obtained. Throughout the study, participants' privacy and confidentiality were respected.ResultsA total of 68 care givers participated in the study, with a majority 54/68(79.41%) having poor quality of life. Men were 3.17 times more likely to record good quality of life than women (p = 0.02); OR:(95% CI), 3.17: (1.2 – 8.36), With regards to place of residence, caregivers who lived in town were less likely to have good quality of life compared to those in rural (p = 0.01); OR: (95%CI), 0.25: (0.09 – 0.72).ConclusionThe quality of life of caregivers of adolescent and young adult Ebola survivors in Democratic Republic of the Congo is poor. To be woman caregiver and to live in town are determinants associated with poor quality of life among caregivers of adolescent and young adult Ebola survivors.

Applying Artificial Intelligence Machine Learning to Discover Factors That Shorten Duration of Treatment in Patients with Multiple Myeloma Using Real-World Patient-Level Longitudinal Data from Medical Data Vision Database

Introduction: To maximize the benefit of treatment in multiple myeloma (MM), it is important to continue treatment for appropriate duration . Our recent real-world study using the Medical Data Vision (MDV) claim database showed that median duration of treatment (DoT) of 1 line (L), 2L and 3L treatment was rather short (range: 6.7 to 8.6 months) in Japanese non-transplant patients with MM (Handa H, et al. Plos one. 2023). However, the broad range of treatment patterns in Japan makes it difficult to identify the cause of shortened DoT. Therefore, we assessed the predictive factors that shorten DoT at threshold of <3, <6 and <12 months by applying machine learning (ML) model using real-world clinical data of MM patients from the MDV database. Methods: This retrospective cohort study was conducted on 4848 individual treatments (2,762 patients; 1L for stem cell transplant-not conducted, 2L/3L) in patients (aged ≥18 years) with transplant-ineligible (newly diagnosed or relapsed/refractory) MM between 2003-21. An explainable deep learning model (point-wise linear model, PWL) was developed using 647 feature variables (evaluated before, during, and after treatment; Table) from the MDV database to identify the important predictors associated with DoT. The PWL model generated a custom-made logistic regression model for each sample, which was very familiar to medical researchers and allowed to analyze the importance of the feature variables. Predictive performance of the PWL model was compared with elastic-net regularized logistic regression and XGBoost models and calculated by area under the curve (AUC) and evaluated by 10-fold double cross validation. To stratify the patients with shorter DoT, a clustering analysis of 4848 individual treatment was conducted based on the similarity of coefficients of the custom-made logistic regression models generated from the PWL model. To understand characteristics of samples belonging to each cluster, the relationship between predicted DoT and MM treatment-related comorbidity management was investigated ( Table). Results: The AUC score of the PWL model to predict DoT of <3, <6 and <12 months was 0.61, 0.64 and 0.66, respectively ( Figure). As per clustering analysis, there were 2 clusters (cluster A and B) at DoT of <3 months and 3 clusters (cluster A, B and C) each at DoT of <6 and <12 months, respectively. At <3 months, cluster B showed lower median of prediction probability, and had a significantly (P<0.01) higher previous treatment lines, pre-treatment Charlson Comorbidity Index (CCI) versus cluster A. At <6 months, cluster C showed lower median of prediction probability, and had significantly (P<0.01) higher CCI and comorbidities, and cluster B had significantly (P<0.01) lower estimated glomerular filtration rate, among the clusters. At <12 months, cluster C showed lower median of prediction probability, and had significantly (P<0.01) higher lactate dehydrogenase (LD), previous treatment lines, pre-treatment CCI, degree of care requirement at diagnosis of MM, pre-treatment tube and parenteral nutrition, and comorbidities, among clusters. Additionally, in cluster B (at <3 months), and cluster C (at <6 and <12 months), use of immunomodulatory drugs (IMiDs) in treatment for MM was significantly higher in patients who met predicted DoT at each threshold versus the ones who were not. However, age and history of infectious diseases (antibacterial agents, γ globulin, etc.) was not affected. In addition, IMiDs and aspirin use at <3 and <6 months, and IMiDs use at <12 months had significant differences in events during and after treatment, which are important for considering treatment strategies for MM patients and may lead to the optimization of treatment plans. Study limitation included exclusion of important prognostic factors (cytogenetic profile, R-ISS stage, and presence of all plasmacytomas). Conclusions: TheML technique with PWL model yielded efficient results to understand the trend associated with event in treatment and characteristics of Japanese patients with MM whose DoT were shortened. Patient's condition and management related factors might have associated with shortened DoT, in consistent with clinical findings. These results are critical to continually improving MM management, achieving optimal patients care, and understanding the burden of disease and health services available to Japanese patients with MM in the real-world.

Path analysis model for preventing stunting in dryland area island East Nusa Tenggara Province, Indonesia.

The problem of stunting is still a fundamental problem in Indonesia's human development. East Nusa Tenggara Province is an archipelago dryland area where in 2007-2021 it has contributed to the highest number of stunting children prevalence in Indonesia. This study aims to determine the relationship of variables in individual, household and district level with the prevalence of stunting. This type of research is observational study with a cross sectional design. This study used individual secondary data from the Indonesian Nutritional Status Survey in 2021 consisting of 7,835 toddlers and National Social Economics Survey 2021. This research found that both specific & sensitive intervention programs had an influence in accelerating the decline in stunting prevalence (higher score on Z Score). Results also revealed the positive influence of the food access variable on nutritional intake. The results of the path analysis test showed that sensitive intervention program variables have a positive effect on food access variable and environmental variable (environmental sanitation) such as the habit of open defecation and healthcare. There was significant relationship on disease history, environment and intake to Height for Age (HAZ) score. In conclusion, direct and indirect factors have important roles to prevent stunting. Sensitive and specific intervention program, food access, macro determinants and environment are the indirect indicators which contribute significantly to the stunting. The risk of children under five years old experiencing malnourished nutritional status increases with a history of infectious disease (diarrhea, ARI, worms). The risk of children under five years experiencing malnourished nutritional status decreases with adequate nutritional intake. It is hoped that there will be a special model of stunting control interventions at the individual level and at the family, household and district level that are integrated and of high quality through multisectoral cooperation in the dryland areas of the islands of East Nusa Tenggara Province.