Low Prevalence Research Articles

Use of renin-angiotensin system blockers and posttraumatic stress disorder risk in the UK Biobank: a retrospective cohort study

BackgroundPrevious research has shown that the use of renin-angiotensin system (RAS) blockers is linked to a lower prevalence of posttraumatic stress disorder (PTSD), but longitudinal studies are scarce. We aimed to estimate the association between the use of RAS blockers and the risk of PTSD among individuals taking antihypertensive medications.MethodsThis longitudinal study included participants aged 40–69 from the UK Biobank. Exposure data were obtained from the initial assessment (2006–10), while outcome data were obtained from the online mental health questionnaire administered 6–11 years later (2016–17). We included participants who were under antihypertensive treatment and did not have a prior diagnosis of PTSD before the initial assessment. Use of RAS blockers was defined as self-reported regular use, at the initial assessment, of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB). Among participants who experienced adverse life experiences, cases of probable PTSD were defined with the six-item PTSD Checklist-Civilian version score ≥ 14. Logistic regression with inverse probability of treatment weighting was used to estimate the odds ratios (ORs) and 95% confidence interval (CI) for the association between RAS blocker use and the risk of probable PTSD.ResultsOf the 15,954 participants (mean age = 59.9 years; 42.6% women) under antihypertensive treatment with no prior history of PTSD at the initial assessment, 64.5% were taking RAS blockers. After a mean follow-up of 7.5 years, 1,249 (7.8%) were newly identified with probable PTSD. RAS blocker users had a lower risk of probable PTSD than RAS blocker non-users (OR = 0.84 [95% CI: 0.75–0.94]), whereas the use of other antihypertensive medications showed no such association (users vs. non-users; calcium channel blockers, OR = 0.99 [95% CI: 0.88–1.11]; beta-blockers, 1.20 [1.08–1.34]; and thiazide-related diuretics, 1.15 [1.03–1.29]). The association between probable PTSD risk and the use of ACEi vs. ARB showed no significant difference (p = 0.96).ConclusionsAmong individuals under antihypertensive treatment, the use of RAS blockers was associated with a decreased risk of probable PTSD. This added benefit of RAS blockers should be considered in the selection of antihypertensive medications.

Contribution of an Artificial Intelligence Tool in the Detection of Incidental Pulmonary Embolism on Oncology Assessment Scans

Introduction: The incidence of venous thromboembolism is estimated to be around 3% of cancer patients. However, a majority of incidental pulmonary embolism (iPE) can be overlooked by radiologists in asymptomatic patients, performing CT scans for disease surveillance, which may significantly impact the patient’s health and management. Routine imaging in oncology is usually reviewed with delayed hours after the acquisition of images. Nevertheless, the advent of AI in radiology could reduce the risk of the diagnostic delay of iPE by an optimal triage immediately at the acquisition console. This study aimed to determine the accuracy rate of an AI algorithm (CINA-iPE) in detecting iPE and the duration until the management of cancer patients in our center, in addition to describing the characteristics of patients with a confirmed pulmonary embolism (PE). Materials and Methods: This is a retrospective analysis of the role of Avicenna’s CE-certified and FDA-cleared CINA-iPE algorithm in oncology patients treated at Gustave Roussy Cancer Campus. The results obtained from the AI algorithm were compared with the attending radiologist’s report and were analyzed by both a radiology resident and a senior radiologist. In case of any discordant results, the reason for this discrepancy was further investigated. The duration between the exact time of the CT scan and analysis was assessed, as well as the duration from the result’s report and the start of active management. Results: Out of 3047 patients, 104 alerts were detected for iPE (prevalence of 1.3%), while 2942 had negative findings. In total, 36 of the 104 patients had confirmed PE, while 68 alerts were false positives. Only one patient reported as negative by the AI tool was deemed to have a PE by the radiologist. The sensitivity and specificity of the AI model were 97.3% and 97.74%, while the PPV and NPV were 34.62% and 99.97%, respectively. Most causes of FP were artifacts (22 cases, 32.3%) and lymph nodes (11 cases, 16.2%). Seven patients experienced delayed diagnosis, requiring them to return to the ER for treatment after being sent home following their scan. The remaining patients received prompt care immediately after their testing, with a mean delay time of 8.13 h. Conclusions: The addition of an AI system for the detection of unsuspected PEs on chest CT scans in routine oncology care demonstrated a promising efficacy in comparison to human performance. Despite a low prevalence, the sensitivity and specificity of the AI tool reached 97.3% and 97.7%, respectively, with detection of all the reported clinical PEs, except one single case. This study describes the potential synergy between AI and radiologists for an optimal diagnosis of iPE in routine clinical cancer care. Clinical relevance statement: In the oncology field, iPEs are common, with an increased risk of morbidity when missed with a delayed diagnosis. With the assistance of a reliable AI tool, the radiologist can focus on the challenging analysis of oncology results while dealing with urgent diagnosis such as PE by sending the patient straight to the ER (Emergency Room) for prompt treatment.

Understanding depression, anxiety and stress in young people living with HIV in Ghana

Ghanaians with perinatally acquired human immunodeficiency virus (HIV) infection now live into adulthood. It is known that adolescents and young adults living with HIV have a high risk of mental health comorbidity. Despite increasing global attention on HIV–mental health interactions, the field remains understudied in Ghana, with an attendant lack of national integrated care solutions. This study aimed to measure the burden and explore the context of depression, anxiety and stress symptoms among young people living with HIV receiving care at a tertiary care hospital in Ghana. This was an explanatory sequential mixed-methods study. Depression, anxiety and stress symptoms were measured using the Depression, Anxiety and Stress Scale, and their associations with quality of life (QoL), socioeconomic status, internalised stigma, disease stage and HIV-related risk-taking behaviours were explored. After preliminary quantitative data analysis, semi-structured interviews were conducted for those who screened positive for depression and/or anxiety to explore their experience with this comorbidity. This study found a low prevalence of depression and anxiety symptoms, which were associated with higher stigma scores and lower QoL. We believe this low prevalence to be attributable to the effect of several psychosocial interventional programmes, which were previously piloted with the study cohort that have gradually normalised mental health discussions. Participants also showed marked resilience and knowledge about their condition. The results of this study present an opportunity to advocate and scale up effective locally adapted and strength-based solutions to address the mental illness–HIV syndemic in Ghanaian young people living with HIV.

Prevalence of Bottle‐Feeding Practice and Associated Factors Among Mothers of Children Under Five in the World, 2024: Systematic Review and Meta‐Analysis

ABSTRACTBackgroundChild‐feeding practices, particularly breastfeeding, significantly impact children's health and survival. However, bottle feeding, although historically practiced, presents numerous disadvantages affecting optimal child nutrition and health. Despite World Health Organisation and The United Nations Children's Fund recommendations against bottle feeding, it remains prevalent globally, affecting roughly 59% of infants worldwide and 85% in Australia by 5 months of age.ObjectiveThis study aims to assess the prevalence and determinants of bottle feeding among mothers of children under five globally.MethodsThis systematic review and meta‐analysis adhered to the Preferred Reporting Items for Systematic Review and Meta‐Analysis guidelines. We comprehensively searched electronic databases for English‐language articles published between 2014 and 2024. The quality of studies was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were analysed in STATA version 17, including summary tables, narrative descriptions, forest plots, and statistical heterogeneity and publication bias assessment.ResultsThe pooled prevalence of bottle feeding among mothers was 57%. Subgroup analysis revealed higher prevalence in larger sample sizes (> 2151) and lower prevalence in smaller ones. Factors significantly associated with bottle feeding included mode of delivery (OR = 1.953; 95%, CI: 1.272, 2.635), child hospitalisation (OR = 1.984, CI: 1.593, 2.376), mother's occupation (OR = 1.579; CI: 1.467, 1.690), post‐natal care (OR = 2.965; CI: (1.358, 4.571), age of children (OR = 2.836; CI: 1.895, 3.777), place of residence (OR = 1.423; CI: 0.994, 1.852), and mother's education (OR = 3.366, CI: 1.949, 4.783).ConclusionEfforts to promote optimal child‐feeding practices should address the identified determinants, emphasising the importance of breastfeeding and providing support to mothers, especially those facing challenges such as cesarean delivery, child hospitalisation, and maternal employment.

The association between dietary flavonoid intake and frailty risk among middle-aged and elderly US adults: A nationally representative study

Given the global ageing population, exploring potential dietary prevention strategies to reduce the public health burden of frailty is critically important. Dietary flavonoids offer multiple health benefits; however, there is a scarcity of research evidence regarding their association with the risk of frailty in middle-aged and older adults. This study aimed to assess the association between dietary flavonoid intake and frailty risk among middle-aged and older U.S. adults and to analyse the potential roles of different flavonoid subclasses. This study involved 9063 participants aged ≥40 years. Frailty was evaluated using a frailty index, and flavonoid intake was estimated through two 24-h dietary recalls. Analyses were carried out via multivariable logistic regression, restricted cubic spline models, weighted quantile sum regression, and quantile g-computation models. Additionally, subgroup analyses and interaction tests were conducted for age and gender. The results indicated that higher intakes of total flavonoids and subclasses (anthocyanidins, flavan-3-ols, flavanones, flavones, flavonols) were significantly associated with a lower prevalence of frailty, but isoflavone intake was not associated with frailty. A nonlinear, L-shaped dose-response relationship was observed between total flavonoids and frailty risk. Flavonols and flavanones were identified as the main contributors to the overall effect. Age influenced the association between dietary flavonoids and frailty, with middle-aged adults benefiting more than older adults. This study provides new evidence supporting an inverse association between dietary flavonoid intake and frailty risk, especially for foods rich in flavonols and flavanones.

Diversity, geographical distribution and predictive factors of Hepatitis C virus genotypes and subtypes in Rwanda

BackgroundExisting data on the prevalence of hepatitis C virus (HCV) genotypes and subtypes in Rwanda need to be strengthened. The aim of this study was to identify HCV genotypes and subtypes among HCV-infected patients, as well as their geographical distribution in Rwanda, and to identify the social and economic factors that could influence HCV epidemiology which would make it possible to target national preventive and management actions for infected patients. MethodsThis study included 560 patients with confirmed chronic HCV infection. Patients were recruited from various health facilities in the four provinces of Rwanda as well as in the City of Kigali and had never received treatment with direct-acting antiviral (DAAs). HCV viral loads were measured using Cobas® AmpliPrep/Cobas® TaqMan® HCV Quantitative Test, version 2.0. HCV genotyping was performed using an in-house sequencing protocol targeting the NS5B central region. Genotypic HCV prevalence was correlated with patient geographic location, sociodemographic, behavioral, lifestyle, and clinical factors. ResultsHCV genotype 4 was detected in 99.3% of the patients, while genotype 3 was identified in 0.7%. A total of eight (8) HCV subtypes were detected, with 4k being the predominant subtype nationwide (49.5%), followed by subtypes 4r (21.2%), 4q (16.2%), 4v (7.9%), 4b (2.0%), 4l (1.8%), 4c and 3h represent 0.7% each. Our findings reveal subtype distribution variations among provinces. Subtype 4k was prevalent across regions, particularly in Kigali (64.0%) and the Eastern Province (61.6%). Subtype 4q was more common in the northern province (40.7%), 4r in the southern (43.9%) and western provinces (37.1%), and 4v in the eastern province (17.8%). Farmers exhibit a distinct infection profile compared to other occupations, showing a lower prevalence of subtype 4k but a higher prevalence of subtype 4r. ConclusionsOur study revealed that HCV infection is unevenly distributed in Rwanda, dominated by HCV genotype 4, with considerable heterogeneity in the repartition of the different subtypes. We found potential associations between rural/urban lifestyles and HCV subtype profiles. Determined HCV distribution and diversity can serve as basis not only for HCV infection awareness and prevention campaigns, but also success and guidance for personalized treatment.

Association Between Social Determinants of Health and Hearing Loss and Hearing Intervention in Older US Adults.

Estimate the prevalence of hearing loss and hearing assistance device use among older adults in the United States, and assess for associations with select social determinants of health (SDOH). Cross-sectional US population-based study using National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 (pre-pandemic) data. Non-institutionalized civilian adult US population. US adults aged ≥70 years who completed NHANES audiometry exams were included. Sample weights were applied to provide nationally representative prevalence estimates of hearing loss and hearing assistance device use. Logistic regression analyses assessed associations between SDOH and both hearing loss and hearing assistance device use. The overall prevalence of hearing loss was 73.7%. Among those with nonprofound hearing loss, the prevalence of hearing assistance device use was 31.3%. Older individuals (odds ratio [OR], 6.3 [3.668-10.694] comparing ages 80+ versus 70-74 yr) and with lower education (OR, 3.8 [1.455-9.766] comparing <ninth grade versus college graduates or above) experienced a significantly elevated prevalence of hearing loss, whereas females (OR, 0.5 [0.326-0.754] versus males) and Blacks (0.5 [0.295-0.841] versus non-Hispanic Whites) had lower prevalence. Although older individuals with hearing loss had a higher prevalence of hearing assistance device use (OR, 2.1 [1.294-3.553] comparing ages 80+ to 70-74 yr), individuals of Black and other Hispanic races had a significantly lower prevalence of hearing assistance device use than non-Hispanic Whites (OR, 0.4 [0.188-0.671]; OR 0.1 [0.012-0.459], respectively), and those with no health insurance had higher prevalence of use than those who were insured (OR, 4.8 [1.307-17.371]). The prevalence of hearing loss among older adults in the United States remains roughly stable compared with previous population-based estimates, whereas the prevalence of hearing assistance device use is slightly increased. Population-level disparities exist both in the prevalence of hearing loss and hearing assistance device use across SDOH.

Low prevalence of spin in conclusions of interventional pediatric orthopedic studies

Interpretation bias as a factor of research reporting quality has not been thoroughly investigated in the conclusions of pediatric orthopedic publications. Our objective was to investigate the prevalence, subtypes, and severity of research reporting bias or spin of the conclusions in full-texts and abstracts of published studies investigating the effects of treatment/intervention in the pediatric orthopedic literature. We systematically searched ten high-ranking orthopedic journals on MEDLINE/PubMed. Inclusion criteria were pediatric orthopedic studies investigating the effects of treatment/intervention. We used descriptive statistics to report the prevalence, subtype, and severity of reporting bias in the studies’ conclusions according to validated classification criteria. We checked the results to ensure that data were neither misreported nor misinterpreted/extrapolated in the conclusions of the full-texts and their abstracts. Out of 93 included studies in the final analysis, 17 (18%) had at least one count of bias. Nine (10%) studies had bias in both full-text and the corresponding abstract conclusions. In four (4%) studies, bias was restricted to conclusions of abstracts only, and in four (4%) studies was restricted to a bias criterion assigned to the classification criteria of conclusions of full-text only and not the abstract. We analyzed 2511 spin/bias items across 93 studies and reported 30 (1%) counts of bias in conclusions of full-text and/or abstracts. The intervention was surgical in (71%) of studies. Interventional pediatric orthopedic studies published in high-ranking journals showed a low prevalence of reporting bias, namely, misleading reporting, misinterpretation, and inadequate extrapolation of conclusions. A comparative analysis with lower-ranking journals as a control group may reveal if our favorable results are an attribute of journal rank/quality. In general, editorial policies should emphasize skilled interpretation and extrapolation of research results.

Tuning the Solvation Structure of a Weakly Solvating Cyclic Ether Electrolyte for Wide‐Temperature Cycling of Lithium‐Sulfurized Polyacrylonitrile Batteries

AbstractSulfurized polyacrylonitrile (SPAN) cathodes in high energy‐density Li‐metal batteries have garnered widespread interest owing to their good cycling stability and moderately high capacities. However, their application is hindered by the low prevalence of advanced electrolytes that can simultaneously mitigate polysulfide generation at the cathode and stabilize the Li‐metal anode. Here, a weakly solvating electrolyte is presented, employing a single solvent tetrahydropyran (THP). The solvation structure is effectively tuned by adjusting the salt concentration to stabilize both the Li‐metal anode and SPAN cathode. This approach enables stable cycling with high SPAN loadings (≈5 mg cm−2) and lean electrolyte contents (≈5 µL mgSPAN−1) across a wide temperature range: 0 °C, room temperature, and 50 °C. A pouch cell with a high SPAN loading and a low electrolyte‐to‐SPAN (E/SPAN) ratio of 3 µL mg−1 shows a stable 79.1% capacity retention after 40 cycles. Additionally, THP can be effectively employed in localized high‐concentration electrolyte (LHCE) systems to reduce the diluent‐to‐solvent ratio for greater LHCE viability. The study demonstrates the potential of weakly solvating solvents in Li‐SPAN batteries, offering a pathway for their practical application.

Community members’ perspective on social accountability in the health system: a cross- sectional study from Tanzania

Introduction: Social accountability initiatives are considered a way to address inefficiencies and improve overall health system performance. Tanzania has introduced Health Facility Governing Committees (HFGCs) to improve social accountability of the health system. However, information on how communities perceive these committees is lacking. This study aimed to assess the prevalence and social determinants of the HFGCs accountability from the community perspective in Tanzania. Methods: The research employed a cross-sectional survey design in two Tanzanian districts (Handeni and Mbarali) selected for their contrasting health performance. Data collection took place from July to October 2022, involving 1184 households in 31 villages/mitaa. The study measured social accountability through a set of six questions, focusing on community support, sensitization, feedback, trust, engagement, and overall accountability of HFGCs. Socio-demographic data such as sex, age, education, occupation, type of health facility and district were also collected and analyzed using linear regression to identify factors influencing perceptions of accountability. Results: The findings revealed a low prevalence of social accountability as measured by the variables of community awareness and engagement with the HFGCs. Only a small percentage of respondents felt adequately informed or involved in the activities of these committees. Social determinants such as higher education levels and certain occupations, such as business and retirement and those living in Handeni district, correlated positively with a better perception of social accountability. Conclusion: The study highlights significant challenges in the operational effectiveness of HFGCs in Tanzania, with a notable disconnect between these bodies and the communities they serve. Despite the theoretical framework for social accountability, actual community engagement remains low, impacting the overall efficacy of health governance at the local level. Future research should focus on improving community awareness and participation in these committees to improve their functionality and accountability, thereby aligning with national health objectives and local needs.

Incidence and risk factors of postoperative delirium in lumbar spinal fusion patients: A National Database analysis

Postoperative delirium (POD) is a frequent complication observed in patients following spinal surgeries. The incidence of POD is particularly concerning for major procedures like lumbar spinal fusion, leading to a range of detrimental outcomes. However, existing research on the prevalence and risk factors associated with POD after lumbar spinal fusion is limited, especially when relying on data from large-scale national databases. This study employed a comprehensive analysis of the National Inpatient Sample (NIS) database, encompassing data from 2010 to 2019. The study population included patients who underwent primary lumbar spinal fusion surgery. We compared patients who did not experience POD with those who developed POD postoperatively, analyzing demographic characteristics, pre-existing comorbidities, and perioperative complications. Analysis of the NIS database identified a total of 493,481 patients who underwent lumbar spinal fusion. The overall incidence of POD following the procedure was 1.07%. Patients who experienced delirium postoperatively exhibited significantly longer hospital stays, incurred higher healthcare costs, and faced a heightened risk of in-hospital mortality (p < 0.001). Additionally, POD following lumbar spinal fusion was associated with various medical complications, including acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infections. Several independent predictors were identified as being significantly associated with postoperative delirium, including advanced age (≥65 years old), pre-existing neurological disorders, a history of alcohol or drug abuse, depression, psychotic disorders, fluid and electrolyte imbalances, diabetes, weight loss, deficiency anemia, coagulopathy, congestive heart failure, pulmonary circulation disorders, peripheral vascular disease, chronic renal insufficiency, and receiving treatment at a teaching hospital. Notably, neurological disorders demonstrated the strongest correlation with the development of postoperative delirium. Overall, our analysis revealed a relatively low prevalence of POD following lumbar spinal fusion surgery. Nevertheless, it is critical to investigate and understand the independent predictors of POD to effectively prevent and mitigate its negative impact on patient outcomes.

Prevalence of Hearing Loss and Hearing Aid Use Among Persons Living With Dementia in the US

Dementia and hearing loss are prevalent and represent public health priorities, but little is known about the prevalence of hearing loss among persons living with dementia at a population level. To estimate the prevalence of hearing loss and hearing aid use among a nationally representative sample of persons living with dementia. In this cross-sectional study, we analyzed data from Medicare beneficiaries who participated in round 11 of the National Health and Aging Trends Study (NHATS). The analytic sample included participants who had complete audiometric data and a dementia classification, and survey weights were applied to yield nationally representative estimates. Data were collected from June to November 2021, and analyzed from October 12, 2023, to February 27, 2024. Audiometric measures of hearing loss and self-reported hearing aid use. National prevalence estimates of possible and probable dementia and hearing loss were estimated by applying NHATS survey weights of sex and age to the population aged 71 years or older based on the US Census Bureau's 2020 American Community Survey data. The analytic sample comprised 2613 NHATS participants (74.6% aged 71-79 years and 25.4% aged ≥80 years; 52.9% female). Overall prevalence of hearing loss among participants with dementia was estimated at 79.4% (95% CI, 72.1%-85.3%). The prevalence of hearing loss increased with age, from 61.1% (95% CI, 37.7%-80.2%) among participants aged 71 to 74 years to 94.2% (95% CI, 88.8%-97.0%) among those aged 85 years or older. Among participants with hearing loss, 21.7% (95% CI, 16.2%-28.3%) reported hearing aid use. In this cross-sectional study, the findings suggest that hearing loss is highly prevalent among individuals with dementia, with a low prevalence of hearing aid use. These findings reveal a potential opportunity for intervention.

Cultural and socio-demographic drivers shape seahorse uses in Malaysia: implications for conservation

Abstract Seahorses Hippocampus spp. are commercially and culturally important to many communities. Although seahorses are widely used in traditional medicine, as curios and as aquarium fishes in Southeast Asia, documentation on the current nature and extent of culturally motivated seahorse uses in Malaysia is lacking. To examine how ethnicity and other socio-demographic drivers shape traditional medicinal use and underlying cultural beliefs involving seahorses, we administered a questionnaire-based survey during March 2021–April 2022 to members of the general public and fishers in Malaysia. Approximately one-fifth (21.0%) of respondents reported consuming seahorses (34.4% of these used seahorses for medicinal purposes, 55.2% for other non-medicinal uses and 10.4% for both types). Consumers of seahorses were from all ethnic groups except for Indigenous groups. In the general public group, medicinal use was more common amongst the Chinese respondents, whereas in the fisher group, other uses were more common amongst the Malay respondents. Amongst the threats facing seahorses, which include overfishing, habitat destruction, bycatch and ocean plastic pollution, only bycatch was perceived as a major threat by most of the general public and fisher respondents. The relatively low prevalence of reported seahorse use amongst Malaysians is an encouraging finding from a conservation perspective. However, the high proportion of non-medicinal uses indicates the need to focus on such other uses to ensure the sustainability of seahorse use in Malaysia.

Efficacy and safety of low-dose tetracycline, amoxicillin quadruple therapy in Helicobacter pylori infection: A retrospective single center study.

Helicobacter pylori (H. pylori) eradication rates have declined with the rise of antibiotic-resistant strains in recent years. Although highly effective with a low prevalence of resistance, standard dose tetracycline is associated with frequent adverse events. The efficacy and safety of low-dose tetracycline as part of tetracycline and amoxicillin-containing bismuth quadruple therapy are not well described. To compare the efficacy and safety of low-dose compared to standard dose tetracycline with combined amoxicillin-containing bismuth quadruple therapy in patients with H. pylori infection. Consecutive patients with H. pylori infection receiving tetracycline, amoxicillin, proton pump inhibitor, and bismuth for 14 days at Sir Run Run Shaw Hospital (1/2022-6/2023) were evaluated. The low-dose tetracycline group received tetracycline 500 mg twice daily (bid) while the standard dose group received 750 mg bid or 500 mg three times daily (tid). Primary endpoints were H. pylori eradication rate and treatment-related adverse events. The mean age of the 218 patients was 48.7 ± 14.0 years, 120 (55%) were male, and 118 (54.1%) received treatment as primary therapy. Furthermore, 73 (33%) patients received low-dose tetracycline (500 mg bid) and 145 (67%) received standard dose tetracycline including 500 mg tid in 74 (33%) and 750 mg bid in 71 (33%). On intention-to-treat analysis, H. pylori eradication rates were 89% [95% confidence interval (CI): 82%-96%] in the 500 mg bid group, 82% (95%CI: 74%-91%) in the 500 mg tid group, and 79% (95%CI: 69%-89%) in the 750 mg bid group without a statistically significant difference (P = 0.25). The incidence of adverse events was lower in the low-dose compared to the standard dose group (12.3% vs 31.1% or 23.9%; P = 0.02). Low-dose tetracycline combined with amoxicillin quadruple therapy for 14 days achieved a high eradication rate and fewer adverse events compared to the standard dose tetracycline regimen in patients with H. pylori infection.

Factors associated with obsessive-compulsive symptoms in medical students during the COVID-19 pandemic in Peru: a cross-sectional study.

Motivation for the study. The COVID-19 pandemic contributed to the development of mental disorders among medical students, including obsessive-compulsive symptoms. However, evidence on this problem in this population is still limited. Main findings. One in 10 medical students presented clinically significant obsessive-compulsive symptoms. Implications. The health crisis has had a negative impact on the mental health of medical students. Therefore, it is crucial to implement future interventions to promote the preservation of their psychological well-being. To determine the prevalence of obsessive-compulsive symptoms among medical students in Peru during the COVID-19 pandemic and its associated factors. Cross-sectional study in 270 medical students from a Peruvian public university. Participants were recruited through non-probability sampling. Obsessive-compulsive symptoms were assessed with the Yale-Brown Obsessive Compulsive Disorder Scale (Y-BOCS). After the descriptive analysis, Poisson regression with robust variance was used to determine the factors associated with probable obsessive compulsive disorder (probable OCD). The crude (PRc) and adjusted (PRa) prevalence ratios were calculated, along with their respective 95% confidence intervals (95% CI). The prevalence of obsessive-compulsive symptoms was 13.3% in medical students. During bivariate analysis, students with probable OCD were younger (p=0.044) and had a lower level of knowledge about COVID-19 (p=0.045). The crude model showed a lower prevalence of probable OCD among those with an adequate level of knowledge compared to those with an inadequate level (PR: 0.52, 95% CI: 0.28 to 0.98). However, after adjusting for other variables, none of the described variables were statistically significant. One in ten medical students presented clinically significant obsessive-compulsive symptoms. Implementing future interventions is crucial to preserve the mental well-being of this vulnerable population.

Prognostic Significance of Combining Cytokeratin-19, E-Cadherin and Ki-67 Analysis in Triple-Negative Breast Cancer with Basal-Like and Non-Basal-Like Phenotype

Triple-negative breast cancer (TNBC) is known to have the worst outcome compared to the other forms of breast cancer. Moreover, molecular markers identified basal-like breast cancer (BLBC) phenotypes to be also related to a worse prognosis. In this study, we evaluated by immunohistochemistry (IHC) the prognostic significance of combining Cytokeratin-19 (CK19), E-cadherin, and Ki-67 tissue expression in triple-negative breast cancer (TNBC) cases presenting a basal-like (BLBC) or a non-basal-like (n-BLBC) phenotype to improve the selection and the monitoring of BC patients with a more aggressive outcome. Herein, when compared to n-BLBC, patients with BLBC showed a positive correlation with lymph node metastasis occurrence and lower survival rates. Immunohistochemistry analysis revealed significantly lower E-cadherin prevalence and higher prevalence of both CK19 and Ki-67 in BLBC when compared to n-BLBC. Spearman correlation showed that E-cadherin is negatively and significantly correlated to CK19 and Ki-67 expressions. Moreover, in BLBC, expressing both CK19 and Ki-67 combined with E-cadherin loss was associated with the worst relapse-free and overall survival. In conclusion, TNBC/BLBC phenotypes simultaneously losing E-cadherin and overexpressing CK19 and Ki-67 markers are the most aggressive forms. This combined analysis could be a predictive marker of poor prognosis.

Influence of scleral thickness on photodynamic therapy outcomes in central serous chorioretinopathy.

To test the prognostic role of anterior scleral substantia propria (ASSP) thickness in predicting the 3-month response after half-dose photodynamic therapy (PDT) in central serous chorioretinopathy (CSCR) and to assess its clinical relevance of ASSP in different CSCR phenotypes. A prospective, exploratory, multi-centre cohort study conducted at IRCCS San Martino Hospital (Genoa, Italy) and Jules-Gonin Eye Hospital (Lausanne, Switzerland). Demographic and clinical data, and optical coherence tomography (OCT) were collected at baseline and 3 months after PDT. Based on OCT images, we categorized CSCR phenotypes and collected clinically relevant imaging metrics. ASSP thickness was obtained from four different measurements using anterior segment (AS) OCT. Multivariable regression models were performed to evaluate the distribution of ASSP thicknesses among different CSCR phenotypes and to test the prognostic role of ASSP thickness in discriminating between PDT responders (complete subretinal fluid reabsorption) and partial responders. The study cohort comprised 109 Caucasian patients (82 males, 75.2%) with a total of 142 eyes: 84 eyes simple (59.1%) versus 58 eyes complex (40.9%) CSCR. A linear normal model confirmed a positive association between complex CSCR and higher ASSP thickness (β = 26.1, 95% CL = 12.1/40.1, p < 0.001), with a low prevalence of ciliochoroidal effusion loculations in AS-OCT (1/142 eyes, 0.7%). ASSP thickening was positively linked to the presence of posterior cystoid retinal degeneration (PCRD; p = 0.002), indicating a potential role in the pathogenesis of severe CSCR phenotypes. In the subgroup of treated patients (61 eyes), 63.9% had a complete response after PDT. In these patients a logistic binary model highlighted a significantly higher risk of PDT non-responsiveness (OR = 9.62, 95% CL = 2.44/37.9, p = 0.001) associated with a 60-unit increase in ASSP thickness levels. By contrast, other anatomical parameters (i.e., body surface area, age, gender, axial length) showed no remarkable prognostic roles. This research highlighted the association of ASSP thickening with complex CSCR phenotype in Caucasian patients and its role in predicting PDT efficacy. These findings enhance our comprehension of the anatomical risk factors in patients affected with CSCR and potentially guide a better understanding of non-responsive cases to PDT treatment.

Predicting the long-term effects of electronic cigarette use on population health: a systematic review of modelling studies

ObjectiveTo systematically review and synthesise the findings of modelling studies on the population impacts of e-cigarette use and to identify potential gaps requiring future investigation.Data source and study selectionFour databases...

Optimizing the survey design for assessing schistosomiasis at the sub-district for treatment decision making

BackgroundSchistosomiasis control programs typically launch with district-level, school-based preventive chemotherapy (PC). Recent World Health Organization recommendations are to shift to community-wide treatment where schistosomiasis prevalence is >10%. Simultaneously there is a push to move to sub-district PC to prioritize communities in need of treatment and alleviate the pressure on global praziquantel need, but few countries have sub-district prevalence data and no guidelines on how to collect this information. Methods/Principal findingsData collected from 57,161 school-aged children (SAC) across six countries (Burkina Faso, Ghana, Mali, Senegal, Sierra Leone, and Togo) to generate spatially realistic gold standard datasets that were used to evaluate different numbers of schools per sub-district (1-10) and district (5–30), number of SAC sampled per school (10–50), on accuracy of prevalence estimates. Sampling fewer children in more schools maximized accuracy of prevalence at the sub-district and district level. Surveying three schools per sub-district or 15 schools per district gave precise prevalence estimates. Increasing the number of SAC beyond 30 per school led to negligible improvements in reliably detecting schistosomiasis. Failure to detect schistosomiasis occurred more frequently in low (1–10%) prevalence and larger districts/sub-districts. ConclusionThis study provides guidelines for evaluating sub-district schistosomiasis in a range of transmission settings. Among two-stage cluster surveys for schistosomiasis, our simulations show surveying three schools per sub-district and 20-30 SAC per school optimized cost-efficiency and minimized risk of mistreatment. Population size and endemicity influenced survey estimates, with the probability of misclassification being greater as populations increased or prevalence decreased.

Rubella epidemiology in Lesotho after vaccine introduction: a five-year review, 2018–2022

BackgroundThe rubella virus is a major contributor to birth defects globally and is preventable by vaccination. In 2020, the world was supposed to be free of both rubella and Congenital Rubella Syndrome (CRS) however this goal has yet to be realized with only 93 out of 194 WHO member states confirmed rubella-free in 2020.MethodsA retrospective measles and rubella case-based surveillance data record review was conducted from 2018 to 2022 to document rubella epidemiology after the introduction of rubella vaccination in Lesotho and progress toward elimination. All samples submitted for surveillance purposes and tested for rubella were considered but only filtered according to inclusion and exclusion criteria. Descriptive statistics were used to analyse the data.ResultsOf the 1041 samples that were tested for rubella between 2018 and 2022, 10 (1%) were confirmed measles positive and were excluded from further analysis. The median age of the respondents was 6.0 (IQR 4.0–8.0.) years. About 643 (62.4%) of respondents were in the age category of 5 - <13 years. Rubella prevalence was 1% (95% CI; 0.5 -1.8%). The non-measles, non-rubella rash illness rate of 2 per 100 000 population was obtained at the national level each year of the study period but by only 2 of the country’s 10 districts in 2021.ConclusionsThe study showed low rubella prevalence. Rubella infection was predominant in those aged 5 - < 13 years. Failure to meet surveillance targets at certain time points during the study period may have led to an underestimation of rubella cases. There is a need to improve the quality of measles and rubella surveillance in Lesotho. Supplementary immunization activities would also be useful in closing immunity gaps, limiting outbreaks, and advancing rubella and CRS elimination in Lesotho.