Reduction In Incidence Research Articles

Nitroglycerin combined with NSAIDs for prevention of post-ERCP pancreatitis: A meta-analysis of prospective, randomized, controlled trials.

Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence of approximately 9.7% according to some literature reviews. Recent clinical guidelines propose that glyceryl trinitrate (GTN) can reduce the incidence of post-ERCP pancreatitis (PEP). However, currently, no guidelines provide an exact opinion on GTN and nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent post-ERCP pancreatitis. A meta-analysis was performed of published, full-length, randomized controlled trials (RCTs) evaluating the effects of prophylactic use of GTN, including GTN alone or GTN in combination with NSAIDs, on the prevention of PEP. Literature searches were conducted using PubMed, Embase, Web of Science, and The Cochrane Library. Search terms included "endoscopic retrograde cholangiopancreatography" OR "ERCP," "OR 'PEP' OR 'post-endoscopic retrograde cholangiopancreatography pancreatitis', pancreatitis," "GTN" OR "glyceryl trinitrate" OR "nitroglycerin," "NSAIDs" OR "Nonsteroidal Anti-inflammatory Drugs" and limited to RCT. A total of 10 RCTs comprising 3240 patients undergoing ERCP were included. Meta-analysis revealed that the administration of GTN was associated with a significant reduction in the overall incidence of PEP. Moreover, PEP incidence was significantly lower in the GTN combined with the NSAIDs group than in the GTN alone group. GTN alone or GTN combined with NSAIDs may not reduce the severity of PEP (risk ratio = 0.64; 95% confidence interval: 0.41-0.99; P = .04). The difference in incidence between the 2 groups is 1.01% (6/594) in the GTN with NSAIDs group and 2.36% (14/592) in the placebo group. GTN has a significant benefit in preventing postoperative ERCP pancreatitis (P < .001). And neither GTN nor GTN plus NSAIDs reduces the incidence of non-mild ERCP postoperative pancreatitis. These conclusions need to be confirmed by high-quality randomized controlled studies with multicenter, large samples, and long-term follow-up.

Biostimulant and antagonistic potential of endophytic fungi against fusarium wilt pathogen of tomato Fusarium oxysporum f. sp. lycopersici

Endophytic fungal-based biopesticides are sustainable and ecologically-friendly biocontrol agents of several pests and diseases. However, their potential in managing tomato fusarium wilt disease (FWD) remains unexploited. This study therefore evaluated effectiveness of nine fungal isolates against tomato fusarium wilt pathogen, Fusarium oxysporum f. sp. lycopersici (FOL) in vitro using dual culture and co-culture assays. The efficacy of three potent endophytes that inhibited the pathogen in vitro was assessed against FWD incidence, severity, and ability to enhance growth and yield of tomatoes in planta. The ability of endophytically-colonized tomato (Solanum lycopersicum L.) plants to systemically defend themselves upon exposure to FOL were also assessed through defence genes expression using qPCR. In vitro assays showed that endophytes inhibited and suppressed FOL mycelial growth better than entomopathogenic fungi (EPF). Endophytes Trichoderma asperellum M2RT4, Hypocrea lixii F3ST1, Trichoderma harzianum KF2R41, and Trichoderma atroviride ICIPE 710 had the highest (68.84–99.61%) suppression and FOL radial growth inhibition rates compared to EPF which exhibited lowest (27.05–40.63%) inhibition rates. Endophytes T. asperellum M2RT4, H. lixii F3ST1 and T. harzianum KF2R41 colonized all tomato plant parts. During the in planta experiment, endophytically-colonized and FOL-infected tomato plants showed significant reduction of FWD incidence and severity compared to non-inoculated plants. In addition, these endophytes contributed to improved growth promotion parameters and yield. Moreover, there was significantly higher expression of tomato defence genes in T. asperellum M2RT4 colonized than in un-inoculated tomato plants. These findings demonstrated that H. lixii F3ST1 and T. asperellum M2RT4 are effective biocontrol agents against FWD and could sustainably mitigate tomato yield losses associated with fusarium wilt.

P-734 Low cost antagonist protocol in ivf-icsi cycles using oral ovulation induction agents in developing countries

Abstract Study question The study aimed at comparing the cost-effectiveness of a low cost antagonist protocol using oral-ovulation-induction agents with a standard long GnRH-Agonist protocol in IVF-ICSI cycles. Summary answer Low cost antagonist protocol using oral-ovulation-induction agents comparing with a standard long GnRH-Agonist protocol in IVF-ICSI cycles is cost-effectiveness in developing countries. What is known already IVF-ICSI had always been proved to be costly treatment. The additional expenditure is mainly due to use of high dose of gonadotrophins in order to get more number of eggs. To cut down the cost,low dose or mild stimulation protocol have been popularized all over the world in last few years. Use of aromatase inhibitors along with low doses of gonadotrophins have been an effective means of mild stimulation protocols for IVF cycles. Oral ovulogens, reduces the total dose of gonadotrophin required for inducing follicular maturation. We evaluated if incorporation of letrozole could be an effective alternative for low-cost IVF. Study design, size, duration A total of 304 patients under 40 years of age were studied between 2018 to 2022 Subsequently, they were randomly divided into two groups. The agonist group underwent standard long GnRH analogue protocol. The antagonist group received oral ovulation inducing drugs (CC/Letrozole) and 0.25mg antagonist injections upto the day of hCG injection, using a flexible start approach. Participants/materials, setting, methods A total of 304 patients under 40 years of age were studied between 2018 to 2022. All patients received low-dose OCP before starting treatment. Subsequently, they were randomly divided into two groups. The agonist-group underwent standard long GnRH analogue protocol. The antagonist group received oral ovulation inducing drugs (CC/Letrozole) and 0.25mg antagonist injections upto the day of hCG injection, using a flexible start approach. Follicular development was monitored by vaginal ultrasound and serum estradiol levels. Main results and the role of chance There was a significant difference in the gonadotropin usage between the two groups. As a result, the cost of the CC/Letrozole-gonadotropin-antagonist cycle was significantly lower than the long GnRH agonist-gonadotropin protocol. Though the mean number of oocytes retrieved was higher in the long protocol group, yet the clinical pregnancy rate per transfer was the same in both groups. While comparing for the primary outcomes pregnancy rate and miscarriage rate were comparable between two groups. It is of particular importance to note that despite 60%reduction of total dose of rFSH in the Let-rFSH group,which entailed significant reduction of the cost of treatment, the outcomes in all major aspects including pregnancy rate were comparable between the groups. However, numbers of matured follicles, retrieved oocytes and transferable embryos were not statistically different between study and control group in this study. This prospective study, designed to evaluate the efficacy of oral-ovulogens -FSH as a low-cost IVF protocol, involved an average number of patients; however, the results have been encouraging. We have been successful in reaching our objective to modify an expensive conventional down regulated IVF protocol into one in which the cost was reduced to a larger extent, without compromising the rate of success in developing countries. Limitations, reasons for caution Since last Cochrane review, GnRH-antagonist protocol was proved to be a short and simple protocol with good clinical outcome with significant reduction in incidence of severe OHSS and amount of gonadotrophins requirement. Although, we need more RCTs to come to a conclusion on regular use of such combined protocol. Wider implications of the findings Usage of GnRH-antagonist in combination with Oral-Ovulogens offers the advantage of a low-cost economical stimulation in IVF, as compared to an agonist-protocol, with similar pregnancy-rate in developing countries. It not only offers a cost-saving stimulation-protocol but also reduces side effects like OHSS and multiple pregnancies yet maintain a descent success-rate. Trial registration number not applicable

The Clinicoepidemiological Features and Treatment Outcomes in Cervical Carcinoma at Clinical Oncology Department of Ain Shams University Hospital: Retrospective Analysis

Abstract Background Through Increased education, access to care, and the expansion of screening and vaccination programs, reductions in cervical cancer incidence and mortality may be achieved. Aim and Objectives the aim of the study was to determine the clinicoepidemiological features and treatment outcome in cancer cervix at clinical oncology department of Ain Shams University Hospital. Subjects and Methods This retrospective analytical study included consecutive adult female patients ≥ 18 years with pathologically confirmed cervical cancer presented to the Clinical Oncology Department, Ain Shams Faculty of Medicine, Cairo, Egypt from January 2016 to December 2020. Results Most of the patients (71.3%) were under 60years, andthe median age at diagnosis was 53 years. In our cohort, about 54.5 % of patients were postmenopausal, with the median age of menopause around 51.0 years. In most cases, the age of menarche was between 9 and 12 years. 94.1.0 % of the patients were married, and most of them got married after reaching the age of 18 years (74.2%). In our cohort, CCRTH improved both DFS and OS for adjuvant groups as well as PFS and OS for patients who received definitive treatment. Univariate analysis including age, menopausal status, sociodemograhic data, tumor characteristsics, FIGO sataging and treatment received showed that significantrisk factors for reduced PFS and OS of patients who received palliative treatment was Diabetus mellitus as a comorbidity. Conclusion This data emphasizes that patient in rural setting present at later stages which could be improved by creating awareness in rural women, and help accessing adequate screening measures.

Vgll3 regulates the timing of puberty in farmed Atlantic salmon, but it does not explain family discordance in male maturation following different smolt production regimes

Atlantic salmon (Salmo salar) farming is moving towards extended periods of land-based production to minimise the time at sea, but this increases the risk of unwanted male sexual maturation. As the timing of puberty is driven by genetics (e.g. vgll3) and the environment, optimising rearing strategies and broodstock management may help alleviate the problem. Subsequently, we used a domesticated strain of vgll3 heterozygous broodstock to produce three all-male half-sibling families using three different production regimes to assess the timing of first puberty. Firstly, “large smolts” were produced in a flow-through system on 13 °C freshwater and constant light from first feeding (day 0) up to 1 kg (day 354). The mean incidence of pubertal males increased from 2% at 30 g, up to 78% at 1 kg. Genetics explained a significant (p < 0.05) amount of the variation, with 93, 71, and 34% of the expected early, intermediate, and late maturing vgll3 genotypes being pubertal on day 354, respectively. In addition, pubertal males in the early vgll3 genotype were found at the first sampling at ≈30 g, while it was not observed in the heterozygous and late genotypes until the fish were ≈90 g and ≈280 g, respectively. Secondly, “post-smolts” were produced by switching half the large smolts to 13 °C seawater at 420 g (day 272) and growing them in tanks to 0.95 kg (day 354). This led to a significant 14% reduction in the total incidence of puberty by day 354 compared to the large smolts. However, the regulation of pubertal timing by vgll3 did not interact with salinity. Thirdly, traditional “under-yearling” smolts were produced using periods of natural or manipulated temperature and photoperiod, followed by transfer to a sea-cage at 150 g in December (day 290) where they stayed for one year until harvest at 4.75 kg (day 648). None of these fish were mature at sea transfer, but 9% were at harvest, with 22, 7, and 2% of the early, intermediate, and late vgll3 genotypes being mature, respectively. When comparing the regimes, family effects outside of vgll3 on the prevalence of sexual maturation were significant for the land-based regimes (family means from 46 to 93% on day 354), but not in sea-cages (family means from 7 to 11% on day 648) and evidence for either vgll3 allele being dominant was mixed. Vgll3 also had minimal effects on body size/growth in any regime/family. In conclusion, i) selecting for the late vgll3 allele is an effective method to delay puberty over a range of production regimes, ii) family effects outside of vgll3 were not consistent across regimes, and iii) using seawater reduced the incidence of precocious puberty during land-based production.

Pachyderm and petrichor: Searching for new ways to mitigate the human-elephant conflict

Geosmin, a taste and odor (T &amp; O) compound that has been hypothesized to occur in higher magnitudes in water bodies due to climate change, is a water quality parameter for human consumption, but an olfactory cue for elephants to migrate towards water holes. It is proposed here to culture bacteria capable of geosmin biodegradation for the development of a unitary, or a consortium of microbes, to lower the geosmin content in human settlement-proximal water holes, to discourage the encroachment of elephants to villages.This novel idea aims to protect both, the elephant population and the human footprint in harm’s way, furnishing a program to conserve elephants while ensuring that human lives are protected. The environmental and social impacts of this proposed nature-based solution will be centered on 1. Elephant conservation 2. Reduction of incidences of the human-elephant conflict, which together provide a natural solution to a dilemma that so far has lacked tangible, sustainable, and long-term, bio-centric remedies.This editorial projects to protect both humans and elephants in a climate-change-impacted dry zone of Sri Lanka, where there are an estimated &gt;5000-6000 elephants, which makes up 10% of the Asian elephant population in 2% of the range, the highest density of Asian elephants in any country. In an increasingly water-impoverished landscape, encroaching on human settlements for water and food flares up the human-elephant conflict that claims hundreds of lives across the human-animal divide, in any given year.There is a quote by arguably the greatest artist that walked on this earth, Pablo Picasso, who coined this wonderful line “God is really only another artist. He invented the giraffe, the elephant and the cat. He has no real style, He just goes on trying other things”. We scientists too need to be like artists – “try other things” to save the opulence of biodiversity – those giraffes, pachyderms and big cats, threatened by habitat expansion and human encroachment, of which the elephant holds the pinnacle rung. This editorial is simply a wake-up call for the scientific community to try other things.

Impact of SGLT2 Inhibitors on Renal Function in Type 2 Diabetic Patients with Coronary Artery Disease Undergoing Percutaneous Intervention: A Systematic Review and Meta-Analysis.

Contrast agents directly cause kidney toxicity in patients undergoing Percutaneous Intervention for cardiovascular disease with Type 2 diabetes. This meta-analysis aims to evaluate the effects of SGLT2-i on renal function in individuals undergoing Percutaneous Intervention. The databases used for the search included PubMed, Scopus, Cochrane Central Registry of Controlled Trials, and Google Scholar. We considered Randomized controlled trials and observational studies published from January 2013 to August 2023. The eligibility to include the studies was assessed independently. The Cochrane modified data extraction form, and Joanna Briggs Institute was used. The Cochrane risk of bias tool and Newcastle-Ottawa quality assessment scale were used to assess the quality of the studies. The certainty of the evidence was assessed using GradePro software. The pooled estimate showed a substantial reduction in serum creatinine levels at 48- and 72-hours post-PCI who received SGLT2i (MD -9.57; 95% CI -18.36, -0.78; p-value 0.03) and (MD -14.40; 95% CI -28.57, -0.22; p-value 0.05). There was a decrease in the incidence of the CI-AKI among SGT2i users (RR: 0.46; 95% CI: 0.32, 0.67; p value< 0.0001). There was no significant difference in the number of patients requiring hemodialysis, but a smaller number of patients required hemodialysis among the SGLT2i users (RR: 0.88; 95% CI: 0.19, 4.07; p-value = 0.87). The use of SGLT2i confers substantial beneficial effects on kidney function and reduction of incidence of Contrast-induced acute kidney injury among patients undergoing PCI procedures for cardiovascular disease with diabetes.

Dietary sodium sulphate supplementation during mid-to-late gestation improves placental angiogenesis, bile acid metabolism, and serum amino acid concentrations of sows

Sulphate plays a vital role in the growth and development of the foetus. Sodium sulphate (Na2SO4) is utilised as a dietary protein nutrient factor and helps replenish sulphur elements in livestock and poultry. Therefore, this study aimed to investigate the effects of Na2SO4 supplementation in mid to late pregnancy on bile acid metabolism, amino acid metabolism, placental vascular development and antioxidant capacity of sows. At day 1 of gestation (G1), a total of twenty-six primiparous sows were carefully chosen and randomised into two groups: (1) control group, (2) Na2SO4 group (1.40 g/kg). Blood samples and placentas from sows were collected to measure biochemistry parameters, antioxidant indexes, placental vascular density, and indicators related to bile acid metabolism and amino acid concentrations, respectively. We found that dietary supplementation with Na2SO4 had a tendency for a reduction of incidence of stillborn at farrowing. Further observation showed that sows supplemented with Na2SO4 had decreased total bile acid level in cord blood, and increased placental gene expression of sulphotransferase and organic anion transport peptide. Na2SO4 supplementation increased catalase and total superoxide dismutase activity in cord blood, decreased placental malondialdehyde content, and enhanced placental protein expression of Sirtuin 1. Moreover, Na2SO4 consumption resulted in increased vascular density of placental stroma and elevated amino acid levels in sows and cord blood. Furthermore, maternal Na2SO4 consumption reduced serum urea concentrations of sows and umbilical cord blood at G114. In addition, dietary supplementation with Na2SO4 activated the protein expression of the placental mechanistic target of rapamycin complex 1. Collectively, these findings indicated that maternal supplementation with Na2SO4 during mid-to-late gestation elevated foetal survival via improving placental angiogenesis, bile acid metabolism and amino acid utilisation.

Distribution and Types of High-Risk Human Papillomavirus Genotypes and Associated Cervical Neoplastic Lesions in Women Living With HIV Infection in Jos Nigeria

PURPOSE The distribution of high-risk human papillomavirus (hrHPV) genotypes in women living with HIV (WLWH) and cervical neoplastic lesion (CNL) are not clearly predictable. We sought to determine prevalence of hrHPV genotypes, distribution, risk of multiple hrHPV and CNL in WLWH in Jos, Nigeria. METHODS Study was carried out from a cohort of study participants in the u54 NIH/NCI funded project titled ‘Epigenomic biomarkers of HIV-Associated Cancers in Nigeria’ (U54CA221205) in Jos, Nigeria. WLWH who were CC-free (n=22), precancer (61) and CC (n=17) gave informed consent and participated in the study between Oct’-2019 &amp; Sept’- 2022. Information on socio-demographic and clinical history were obtained using structured questionnaire. Cervical-vaginal specimens collected, HPV DNA detection and genotyping performed using Anyplex-II HPV28 kit (Seegene, Korea). Prevalence and distributions of hrHPV genotypes determined and logistic regression analysis used to analyze associations between multiple hrHPV and CNL. RESULTS Of the 101 WLWH, median age was 50.00 (IQR 43-57), median duration of HIV infection was 12 years (IQR 9-14), and median age at sexual debut was 18 years (IQR 16-20). History of multiple sexual partners (MSP) was 70.3%. The overall hrHPV prevalence was 57.4%, with single hrHPV in 29.7% and multiple hrHPV in 27.7%. The three commonest hrHPV genotypes were HPV 16 (12.9%), HPV 31 (10.9%), and HPV 45/52/58 (9.9%). HPV genotypes 16/18/other-hrHPVs was 10.9%, and HPV 31/33/45/52/58 without HPV 16 or 18 was 11.9%. HPV 16 was higher for precancer, and CC compared with CC-free (46.1% vs 38.5% vs 15.4%, p=0.113) and HPV 31/other-hrHPVs was higher in precancer and CC (71.4% vs 28.6% vs 0%, p=0.282) and other-hrHPVs without genotype 16 or 18 was higher in precancer compared with CC-free and CC (82.3% vs 5.9% vs 11.8%, p=0.141). History of MSP (aOR=8.18, 95% CI 1.44, 59.04), age at first cervical cancer screening (aOR=7.5, 95% CI 1.29, 63.23), and duration of HIV infection in years (aOR=0.86, 95% CI 0.73, 0.99), were independently associated with multiple hrHPV genotypes. CONCLUSION There is high prevalence of multiple hrHPV genotypes with diverse distribution. Universal HPV vaccination and HPV DNA testing for cervical cancer screening in HIV clinics may lead to reduction in incidence of CNL among the most at risk population.

Designing cancer screening trials for reduction in late-stage cancer incidence

ABSTRACT Before implementing a biomarker test for early cancer detection into routine clinical care, the test must demonstrate clinical utility, that is, the test results should lead to clinical actions that positively affect patient-relevant outcomes. Unlike therapeutical trials for patients diagnosed with cancer, designing a randomized controlled trial (RCT) to demonstrate the clinical utility of an early detection biomarker with mortality and related endpoints poses unique challenges. The hurdles stem from the prolonged natural progression of the disease and the lack of information regarding the time-varying screening effect on the target asymptomatic population. To facilitate the study design of screening trials, we propose using a generic multistate disease history model and derive model-based effect sizes. The model links key performance metrics of the test, such as sensitivity, to primary endpoints like the incidence of late-stage cancer. It also incorporates the practical implementation of the biomarker-testing program in real-world scenarios. Based on the chronological time scale aligned with RCT, our method allows the assessment of study powers based on key features of the new program, including the test sensitivity, the length of follow-up, and the number and frequency of repeated tests. The calculation tool from the proposed method will enable practitioners to perform realistic and quick evaluations when strategizing screening trials for specific diseases. We use numerical examples based on the National Lung Screening Trial to demonstrate the method.

Does Patellar Denervation with Electrocautery Benefits for Total Knee Arthroplasty without Patellar Resurfacing: A Meta-analysis of Randomized Controlled Trails.

To investigate the effects of patellar denervation (PD) and non-patellar denervation (NPD) after primary total knee arthroplasty (TKA) without patellar resurfacing, this study conducted systematic electronic searches in November 2023 using PubMed, Embase, Web of Science, Cochrane, and Scopus, adhering to Cochrane Collaboration recommendations. Only randomized controlled trials (RCTs) were included. Additionally, a manual search was performed to identify potentially eligible studies from the reference lists of review articles. Two researchers independently conducted literature reviews, data extraction, and risk of bias assessments. The outcome analysis encompassed the incidence of anterior knee pain (AKP), visual analogue scale (VAS), range of motion (ROM), American Knee Society Score (KSS), Oxford Knee Score (OKS), patellar score (PS), complications, and reoperations. Meta-analysis was executed using RevMan 5.3 software. To enhance the credibility of the study, TSA v0.9 software was utilized to perform power analysis on the overall efficacy of primary and secondary outcomes. Twelve studies involving 1745 patients (1587 knees) were included, with 852 undergoing PD and 893 undergoing NPD. Results indicated a superior reduction in AKP incidence in the PD group compared to the NPD group. Statistically significant differences were observed between PD and NPD in KSS, OKS, and PS. However, the upper limit of the 95% confidence interval for each outcome fell below the minimal clinically important difference (MCID). No significant differences were found in VAS and ROM between PD and NPD. Additionally, PD was not associated with an increased incidence of complications or reoperations. Within 12 months and beyond, PD was proven to be a beneficial intervention in reducing AKP following TKA without patellar resurfacing, achieved without an increase in complications or reoperations. Regarding KSS, OKS, and PS, the minimal advantage achievable through PD may not be clinically significant.

Evaluation of fungicides to manage rice false smut (Ustilaginoidea virens) in the hills of Nepal

Rice False Smut (RFS) caused by Ustilaginoidea virens is a major emerging disease of rice due to expanded area of hybrid rice cultivars, increasing use of nitrogenous fertilizers and change in climate. Due to the increasing incidences of this disease across the globe, there is a pressing need to develop techniques for false smut management. The application of fungicides with high efficiency, low toxicity, and low residue is currently the best option to control RFS. Therefore, current research was conducted to determine the effectiveness of fungicides to manage RFS. The experiments were conducted in a completely randomized block design with three replications of seven treatments at RFS-prone subtropical hills of Nepal in the main rice growing season, during 2020 and 2021. The fungicides include trifloxystrobin 25 % + tebuconazole 50 %, chlorothalonil 75 %, carbendazim 12 % + mancozeb 63 %, propiconazole 25 %, azoxystrobin 50 %, carbendazim 50 % and untreated control. Fungicides were applied as two foliar sprays, one at booting and the other at flowering. Fungicide spray significantly increased number of tillers per plant (P ≤ 0.01) and reduced the number of false smut-infected tillers per plant (P ≤ 0.05), false smut severity (P ≤ 0.05), and incidence (P ≤ 0.05). False smut incidence percentages were significantly reduced by all the fungicides except mancozeb + carbendazim compared to the non-treated control. The reduction in RFS incidence was 70 % in propiconazole, 71 % in trifloxystrobin + tebuconazole sprayed plots compared to the non-treated control plots. Thus, the application of suitable fungicide at the appropriate stage would give the satisfactory suppression of RFS in a farmers' field in Nepal.

Ending the HIV Epidemic in Metropolitan Atlanta: a mixed-methods study to support the local HIV/AIDS response.

Four counties within the Atlanta, Georgia 20-county eligible metropolitan area (EMA) are currently prioritized by the US "Ending the HIV Epidemic" (EHE) initiative which aims for a 90% reduction in HIV incidence by 2030. Disparities driving Atlanta's HIV epidemic warrant an examination of local service availability, unmet needs and organizational capacity to reach EHE targets. We conducted a mixed-methods evaluation of the Atlanta EMA to examine geographic HIV epidemiology and distribution of services, service needs and organization infrastructure for each pillar of the EHE initiative. We collected 2021 county-level data (during June 2022), from multiple sources including: AIDSVu (HIV prevalence and new diagnoses), the Centers for Disease Control and Prevention web-based tools (HIV testing and pre-exposure prophylaxis [PrEP] locations) and the Georgia Department of Public Health (HIV testing, PrEP screenings, viral suppression and partner service interviews). We additionally distributed an online survey to key local stakeholders working at major HIV care agencies across the EMA to assess the availability of services, unmet needs and organization infrastructure (June-December 2022). The Organizational Readiness for Implementing Change questionnaire assessed the organization climate for services in need of scale-up or implementation. We found racial/ethnic and geographic disparities in HIV disease burden and service availability across the EMA-particularly for HIV testing and PrEP in the EMA's southern counties. Five counties not currently prioritized by EHE (Clayton, Douglas, Henry, Newton and Rockdale) accounted for 16% of the EMA's new diagnoses, but <9% of its 177 testing sites and <7% of its 130 PrEP sites. Survey respondents (N = 48; 42% health agency managers/directors) reported high unmet need for HIV self-testing kits, mobile clinic testing, HIV case management, peer outreach and navigation, integrated care, housing support and transportation services. Respondents highlighted insufficient existing staffing and infrastructure to facilitate the necessary expansion of services, and the need to reduce inequities and address intersectional stigma. Service delivery across all EHE pillars must substantially expand to reach national goals and address HIV disparities in metro Atlanta. High-resolution geographic data on HIV epidemiology and service delivery with community input can provide targeted guidance to support local EHE efforts.

Adenoma detection rate and tolerability of 2 ultra-low-volume bowel preparations in screening: a noninferiority randomized controlled trial

The adenoma detection rate (ADR), recognized as a surrogate marker for colorectal cancer incidence and mortality reduction, is closely linked to the efficacy of bowel cleansing. However, there is a dearth of evidence examining the impact on ADR when employing two distinct very low-dose bowel cleansing products. This study sought to compare ADR in a fecal immunochemical occult blood testing (iFOBT) based organized screening program by utilizing 1L polyethylene glycol plus ascorbate (1L-PEGA) versus magnesium citrate plus picosulphate (SPMC), both administered in a split-dose regimen. We conducted a comparative, parallel, randomized, noninferiority, and low-intervention clinical trial, the study targeted individuals from a population colorectal cancer screening program aged 50-69 with a positive iFOBT result scheduled for a work-up colonoscopy in the morning. Participants were randomized to either 1L-PEGA or SPMC for bowel cleansing. Main outcome was ADR. Secondary outcomes were bowel preparation quality, individuals' safety, tolerability and satisfaction. A total of 1,002 subjects were included, 501 in each group. There were no differences between groups with respect to pooled ADR (SPMC, 56.5% [52.1-60.8]; 1L-PEGA, 53.7% [49.3-58.0]; RR 0.95 [0.85-1.06]); therefore, SPMC demonstrated noninferiority in ADR compared to 1L-PEGA (difference, 2.8%; 2-sided 95% lower confidence limit (LCL), -3.4). In addition, there were no significant differences in mean lesions regardless of size and location between arms. Bowel preparation favored 1L-PEGA (96.2% vs. 89.2%; p<0.001) whereas SPMC exhibited significantly higher safety and tolerability, as evidenced by fewer non-serious treatment-emergent adverse events CONCLUSIONS: SPMC emerged as a noninferior laxative compared to 1L-PEGA concerning ADR. Despite the superior bowel preparation quality associated with 1L-PEGA, the safety, tolerability and overall satisfaction of participants were higher with SPMC. This trial was registered at ClinicalTrials.gov (EudraCT: 2019-003186-18) on March 18, 2019.

Probiotic Supplementation in the Neonatal Age Group and the Risk of Hospitalisation in the First Two Years: A Data Linkage Study from Western Australia.

Probiotic supplementation in preterm neonates is standard practice in many centres across the globe. The impact of probiotic supplementation in the neonatal age group on the risk of hospitalisation in infancy has not been reported previously. Infants born < 32 + 6 weeks of gestation in Western Australia were eligible for inclusion. We conducted a retrospective cohort study comparing data from before probiotic supplementation (Epoch 1: 1 December 2008-30 November 2010, n = 1238) versus after (Epoch 2: 1 June 2012-30 May 2014, n = 1422) on the risks of respiratory- and gastrointestinal infection-related hospitalisation. A subgroup analysis of infants born < 28 weeks of gestation was analysed separately for similar outcomes. Compared to Epoch 1, an 8% reduction in incidence of hospitalisation up to 2 years after birth was observed in Epoch 2 (adjusted incidence rate ratio (IRR) of 0.92; 95% confidence interval (CI); 0.87-0.98), adjusted for gestational age, smoking, socioeconomic status, and maternal age. The rate of hospitalisation for infants born < 28 weeks of gestation was comparable in epochs 1 and 2. Infants exposed to probiotic supplementation in the neonatal period experience a reduced risk of hospitalisation in the first two years after discharge from the neonatal unit.

Management Interventions to Reduce Incidence of Diarrhoea in Piglets during Pre Weaning Period

A study was carried out at an organized pig farm in Kalyani, West Bengal, to assess effectiveness of management practices like teat dipping and floor mopping on reduction of bacterial load and diarrhoeal incidence during pre-weaning period in piglets. Twenty lactating sows of Ghoongroo breed along with their newborn piglets (146 nos.) during pre-weaning period were studied. In group 1 (control) floor of each farrowing pen was washed with normal water. In group 2, additionally teats of each sow were treated with 10% povidone iodine dip. In group 3 floor of each farrowing pen was washed with normal water followed by mopping with 0.25% potassium permanganate. In group 4 both sow teat dipping and sty floor mopping with disinfectant was done. It was observed that the average bacterial load during the total pre-weaning period of 8 weeks was 48.4x103± 5.3 x103 cfu/cm2 in control group, whereas the average bacterial load was 34.0 x103±1.2X103 and 7.18 x102±0.10 x102 cfu/cm2 before and after teat dip application in group 2, and 32.5 x103±1.3 x103 cfu/cm2 and 6.98 x102±0.11 x102 cfu/cm2 in group 4, respectively, indicating positive impact of teat dipping as well as disinfectant floor mopping in reducing the bacterial loads of sow teats. Regular teat dipping and sty floor mopping can improve the body growth of piglets, by reducing the occurrence of piglet diarrhoea. Thus, the chances of economic losses in pig production unit can be reduced.

Modified One Anastomosis Gastric Bypass Following Sleeve Gastrectomy for Severe Reflux and Delayed Gastric Emptying: A Prospective Trial with Clinical and Physiological Outcome Measures.

Gastro-esophageal reflux (GORD) following sleeve gastrectomy (SG) is a central challenge, and precise indications for revisional surgery or the physiology have not been precisely defined. We aimed to determine whether OAGB performed for reflux post-SG (1) accelerates gastric emptying half-time, (2) reduces the frequency and severity of reflux events, and (3) improves reflux symptoms. We undertook a prospective trial (ACTRN12616001089426). There were 22 participants who underwent measurement before and after revisional surgery with 29 optimal SG (patients with optimal outcome from their primary surgery) as controls. All participants underwent a protocolized nuclear scintigraphy, 24-h pH monitoring, and gastroscopy and completed objective questionnaires. Trial patients were 90.9% female, age 44.4years. Conversion from SG to OAGB was at a median of 45.2 ± 19.6months. Scintigraphy showed an increased rate of gastric emptying post-OAGB 34 (IQR 14) vs 24 (IQR 10.3) min, p-value 0.008, with decreased number of reflux events post-prandially (39 (IQR 13) vs 26 (IQR 7), p-value 0.001). This data correlated with the pH analysis; total acid events substantially reduced post-OAGB 58.5 (IQR 88) vs 12 (IQR 9.4) events, p-value 0.017. Endoscopic findings indicated a reduction in incidence of bile stasis 72.7% vs 40.9% post-OAGB, p-value < 0.00010. Post-OAGB, patients experienced less frequent regurgitation (12 ± 4.1 vs. 5.5 ± 3, p-value 0.012) and reflux (37.1 ± 15.7 vs. 16.8 ± 12.6, p-value 0.003). We found OAGB is an effective treatment for reflux associated with delayed gastric emptying post-SG. The likely mechanisms is by, an increase in the rate of gastric clearance and reduced reflux events and overall esophageal acid exposure. This suggests that some forms of post-SG reflux are driven by slower emptying of the residual stomach and are amenable to treatment with drainage above the incisura.

Assessing the Impact of Tuberculosis on Economic Growth in ASEAN Countries: A Conceptual Framework and Panel Data Analysis

Tuberculosis (TB) remains a major global health issue, particularly in Southeast Asia, where its impact extends beyond public health to affect economic performance. This study evaluates the economic implications of TB incidence on gross domestic product (GDP) growth across eight ASEAN countries from 2000 to 2020. We employed a panel data regression approach, utilizing Common Effect Model (CEM), Fixed Effects Model (FEM), and Random Effects Model (REM) to analyze the relationship between TB incidence and economic growth. The dataset included annual GDP figures, TB incidence rates, foreign direct investment (FDI), labor force size, and trade openness, sourced from international databases. The most appropriate model was selected based on Chow and Hausman tests, with FEM being the preferred model for its ability to account for country-specific effects. The FEM analysis revealed a significant negative impact of TB incidence on GDP, with a reduction of approximately 6.69% in GDP growth for each unit increase in TB incidence. Simulations showed that countries with high TB prevalence, such as the Philippines and Cambodia, experienced substantial economic losses, while reductions in TB incidence could lead to notable economic gains, particularly in Indonesia and Thailand. The study highlights the considerable economic burden of TB on ASEAN countries and emphasizes the importance of integrating TB control measures into economic development strategies. Effective TB prevention and treatment could substantially mitigate economic losses and promote sustainable growth. Policymakers are encouraged to invest in TB healthcare infrastructure and consider the economic benefits of reducing TB incidence in their health policies.

Effectiveness and safety of primary prophylaxis with G-CSF during chemotherapy for invasive breast cancer: a systematic review and meta-analysis from Clinical Practice Guidelines for the Use of G-CSF 2022.

Chemotherapy for breast cancer can cause neutropenia, increasing the risk of febrile neutropenia (FN) and serious infections. The use of granulocyte colony-stimulating factors (G-CSF) as primary prophylaxis has been explored to mitigate these risks. To evaluate the efficacy and safety of primary G-CSF prophylaxis in patients with invasive breast cancer undergoing chemotherapy. A systematic literature review was conducted according to the "Minds Handbook for Clinical Practice Guideline Development" using PubMed, Ichushi-Web, and the Cochrane Library databases. Randomized controlled trials (RCTs) and cohort studies assessing using G-CSF as primary prophylaxis in invasive breast cancer were included. The primary outcomes were overall survival (OS) and FN incidence. Meta-analyses were performed for outcomes with sufficient data. Eight RCTs were included in the qualitative analysis, and five RCTs were meta-analyzed for FN incidence. The meta-analysis showed a significant reduction in FN incidence with primary G-CSF prophylaxis (risk difference [RD] = 0.22, 95% CI: 0.01-0.43, p = 0.04). Evidence for improvement in OS with G-CSF was inconclusive. Four RCTs suggested a tendency for increased pain with G-CSF, but statistical significance was not reported. Primary prophylactic use of G-CSF is strongly recommended for breast cancer patients undergoing chemotherapy, as it has been shown to reduce the incidence of FN. While the impact on OS is unclear, the benefits of reducing FN are considered to outweigh the potential harm of increased pain.

Epidemiology and Outcomes of Neonatal Sepsis: Experience from a Tertiary Australian NICU

Introduction: Neonatal sepsis is associated with significant mortality and morbidity. Low-middle-income countries are disproportionately affected, but late-onset sepsis (LOS) still occurs in up to 20% of infants <28 weeks in high-income countries. Understanding site-specific data is vital to guide management. Methods: A retrospective cohort study was conducted at King Edward Memorial Hospital (KEMH), Perth. Infants admitted between January 2012 and June 2022 were included. Data were extracted from routine electronic databases. Incidence and aetiology of sepsis were determined and the association of sepsis with neonatal outcomes analysed. Results: During the study period, 23,395 newborns were admitted with a median gestation of 37 weeks and birth weight of 2,800 g. There were 370 sepsis episodes in 350 infants; 102 were early-onset sepsis (EOS) (1.6 per 1,000 live births), predominantly Streptococcus agalactiae (35, 34.3%) and Escherichia coli (27, 26.5%); 268 were LOS (0.9 per 1,000 inpatient days), predominantly coagulase-negative staphylococci (CONS) (156, 57.6%) and E. coli (30, 11.1%). The incidence of LOS declined from 2012 to 2022 (p = 0.002). Infants with EOS had increased brain injury (25.7% vs. 4.1%; p = 0.002) and mortality (18.8% vs. 1.6%; p < 0.001). Those with LOS had increased hospital stay (median 95 vs. 15 days; p < 0.001), mortality (15.3% vs. 1.6%; p = 0.018), necrotising enterocolitis (NEC) (7.4% vs. 0.5%; p < 0.001), and chronic lung disease (CLD) (58.1% vs. 5.9%; p = 0.005). Infants <28 weeks with sepsis were at increased risk of neurodevelopmental impairment compared to those without infection (43.2% vs. 30.9%, p = 0.027). Conclusions: While we observed a reduction in LOS incidence, sepsis remains associated with higher mortality, and in survivors with longer hospital stay and increased risk of brain injury, NEC, CLD, and neurodevelopmental impairment.