Control Study Research Articles

Usefulness of combined pseudo-continuous arterial spin labelling and spectroscopic analysis in schizophrenic Egyptian population sample

BackgroundSchizophrenia is a prevalent psychiatric disorder that affects 1% of the global population. Schizophrenia frequently begins in late adolescence or early adulthood, causing significant educational, social, and economic costs for people and society. Functional neuroimaging research on schizophrenia physiopathology has been beneficial. Arterial spin labelling (ASL) is one of functional magnetic resonance imaging (fMRI) technologies that assess brain function without radiation. ASL uses magnetic resonance (MR) imaging to quantify tissue-level brain perfusion non-invasively. Arterial spin labelling (ASL) is one of the functional magnetic resonance imaging (fMRI) technologies that assess the brain function without radiation hazards. ASL uses magnetic resonance (MR) imaging to quantify tissue-level brain perfusion non-invasively. Many publications were performed on role of different advanced MRI techniques in schizophrenia, but our study insisted on the added value of combined ASL and MRS over the conventional MRI in schizophrenic Egyptian population sample.Aim of the workThe purpose of this work was to evaluate the added value of combined ASL-perfusion MRI and MRS in schizophrenic patients.MethodsThis prospective case–control study was carried out on two groups: First group was 30 patients who were diagnosed clinically as schizophrenic patients, and second group was 20 healthy volunteers as a control group for comparison in the period from August 2021 till July 2022.ResultsThe majority of newly diagnosed cases had significant higher positive symptoms than chronic cases. According to arterial spin labelling (ASL) data, rCBF was noticed to be reduced in anterior cingulate, frontal lobe, and parietal lobe of both patients’ subgroups but more significant in chronically ill patients. Convergent results of decreased rCBF were also found in the parietal lobe and occipital lobe. Magnetic resonance spectroscopic analysis showed that NAA was decreased in the anterior cingulate cortex, thalami and basal ganglia of the newly diagnosed cases more than chronic cases. The ASL-MRI perfusion accurately detected the hypo-perfusion of different brain regions with sensitivity 100%, specificity 66.67%, positive predictive value 96.43%, negative predictive value 100%, and accuracy 96.67%, while MR spectroscopy showed sensitivity 100%, specificity 33.33%, positive predictive value 93.10%, negative predictive value 100%, and accuracy 93.33% in evaluation of changes of brain metabolites.ConclusionASL is a promising functional MRI technique that can produce together with MRS quantitative information about the metabolites of different brain regions. The ASL-MRI appears as a reliable non-invasive technique to measure cerebral blood flow and identify decreased rCBF without any contrast administration, and it could be repeatable which helps in early diagnosis as well as follow-up of the progression of the disease.

Exploring factors associated with failure of totally implanted vascular access devices in a regional and rural health service: a retrospective case–control study

BackgroundThe assessment and management of totally implanted vascular access devices (TIVAD) prior to the administration of medications/fluids are vital to ensuring the risk of harm is mitigated. While numerous guidelines...

Role of diffusion tensor imaging of extra ocular muscles and orbital fat in Graves’s ophthalmopathy and relation to disease activity

BackgroundGraves’ ophthalmopathy (GO) is one of the most common autoimmune inflammatory disorders affecting the orbit that characterized by swelling of extra ocular muscles (EOMs) and expansion of the orbital fat. Diffusion tensor imaging (DTI) could assess the microstructural integrity of tissue. We aimed at this study to assess the role of DTI in the evaluation of EOMs and orbital fat in GO and identify the relationship with disease activity.ResultsCase–control study included 40 patients diagnosed as Graves’ disease (20 active and 20 inactive) and 10 health control subjects underwent DTI. Low fraction anisotropy (FA) and high mean diffusivity (MD) of inferior rectus (IR), medial rectus (MR) and orbital fat in GO versus healthy control (HC), while high FA and high MD in active group versus inactive group. In order to differentiate between GO and HC; FA cutoff point of IR, MR& orbital fat were 0.46, 0.45 and 0.26 with sensitivity 98.8%,98.8% and 93.8% and specificity 95.0%, 95.0% and 85%, respectively. MD cutoff point for IR, MR and orbital fat 1.24, 1.27 and 1.275 with sensitivity 97.5%, 98.8% and 98.8% and specificity 95.0%, 95% and 95%, respectively. To differentiate between active and inactive GO; FA cutoff point of IR, MR and orbital fat were 0.35, 0.36 and 0.22 respectively with sensitivity 80.0%, 82.5% and 72.5% and specificity 95.0%, 85.0% and 65.0%, respectively. MD cutoff point for IR, MR and orbital fat were 1.58, 1.63 and 1.54 respectively with sensitivity 90.0%, 97.5% and 85.0%, and specificity 90.0%, 80.0% and 62.5%, respectively.ConclusionsDTI parameters (FA and MD) of EOMs and orbital fat are considered as crucial radiological biomarkers for diagnosis of GO and could quantitatively differentiate active form inactive disease.

Surgical advantage of modified labial salivary gland biopsy using chalazion forceps: a prospective randomized controlled study

Labial salivary gland biopsy (LSGB) is one of the specific diagnostic criteria for primary Sjögren's syndrome (pSS). In traditional LSGB, there is no lower lip fixation device, the field of view is unclear due to intraoperative bleeding, and the incision is large, which is unfavourable for healing. The use of auxiliary devices to improve the shortcomings of traditional LSGB technique would be meaningful. Therefore, this case–control study aimed to assess the value of modified LSGB using chalazion forceps as compared with traditional LSGB. After obtaining written informed consent from all participating parents and patients, we randomly assigned 217 eligible participants to undergo LSGB using chalazion forceps (n = 125) or traditional LSGB (n = 92). The outcome variables were surgical time, incision length, intraoperative bleeding, pain score at 24 h after surgery, incision healing status at 7 days after surgery, gland collection, and pathological results. The final diagnostic results of the two surgical methods were compared, and the match rates between the pathological results and the final clinical diagnoses were compared between the two groups. The data were analysed using parametric and nonparametric tests. Compared with the traditional group, the modified group had a smaller incision, shorter operative time, less blood loss, lower 24 h pain score, and better Grade A incision healing at 7 days after surgery (p < 0.01). There was no statistically significant difference between the patients in the two surgical-method groups in terms of the positive biopsy results and the final diagnosis based on expert opinions (p > 0.05). By multivariable regression analysis, only a focus score (FS) of ≥ 1 (p < 0.01), dry eye disease (p < 0.05) and anti-nuclear antibodies (ANA) titre ≥ 1:320 (p < 0.05) were correlated with the diagnosis of pSS. The positive biopsy results of patients in the different surgical-method groups had a biopsy accuracy of > 80.0% for the diagnosis of pSS. The positive biopsy results in the different surgical-method groups were consistent with the expert opinions and the 2016 ACR-EULAR primary SS classification criteria. The modified LSGB using an auxiliary chalazion forceps offers a good safety with a small incision, shorter operative time, less bleeding, reduced pain and a low incidence of postoperative complications.The match rate of LSGB pathological results of the proposed surgical procedure with the final diagnosis of pSS is high.

Supporting Infants’ Motor Development through Water Activities: A Preliminary Case–Control Study

The first twelve months of an infant’s life are the most dynamic time in the development of motor activities. Water activities can positively stimulate the motor skills, visual perception, and cognitive abilities of infants. The purpose of this study was to evaluate the motor development of infants aged 3–12 months participating in water activities. Participants in the study included 43 infants aged 3–12 months who attended water activities classes at Warsaw City swimming pools (n = 21) and infants not attending any classes (n = 22). Two methods of assessing motor development were used in the study: the Alberta Infant Motor Scale (AIMS) and the Early Motor Development Questionnaire (EMQ). The raw scores of the AIMS test and the EMQ questionnaire were statistically significantly different (p &lt; 0.05) in both groups between the first and second examinations. In contrast, there was a statistically significant improvement in motor development measured by AIMS and expressed in percentiles (p = 0.002) and in percentiles for Polish children (p = 0.030) in the water group. The age-independent total score of the EMQ before and after the intervention did not change significantly (p = 0.149). The water environment has the potential to support the motor development of infants aged 3–12 months.

Evaluation of otoacoustic emissions and brainstem auditory evoked potential in infants with birth asphyxia

Background: Recent technological evolutions allow for the identification of hearing level (HL) in infants soon after birth. The goal of early hearing detection and intervention is to maximize linguistic and communication skills and literacy development for children who are deaf or hard of hearing. Infants whose HL has been confirmed before 6 months of age must be provided early intervention. Aims and Objectives: The aim of the study was to observe the changes in the otoacoustic emissions (OAE) and brainstem auditory evoked potential (BAEP) in infants with birth asphyxia (BA). Materials and Methods: The present study was a case–control study. A total of 50 cases of infants with BA and 50 normal-term infants were part of the study after obtaining informed consent as per the ICMR guidelines. A through clinical examination and otoscopy examination were done to rule out any conductive hearing loss. Then, OAE and BAEP were recorded to estimate the hearing loss and hearing threshold of infants. Results: BAEP waveform I, III, and V absolute latencies were significantly prolonged among BA infants than normal infants. The interpeak latency (IPL) of the right ear III-V was significantly increased in BA infants. However, III-V and I-V latencies though prolonged in BA infants, they are not statistically significant. No significant interaural difference was noted in absolute and IPLs of both BA and normal infants. No significant relationship existed between the mode of delivery and the degree of hearing loss in both ears. Significant association was observed between the degree of hearing loss and severity of BA (hypoxic-ischemic encephalopathy) in both ears. Conclusion: BAEP recording in BA infants is useful to identify the hearing impairment at the earliest. The implication of this research work will help in early detection of hearing impairment, so that speech and language developmental delay in the child can be prevented.

DNA repair efficiency in young hypertensive: Is lifestyle a prooxidant factor?

Background: High prevalence of hypertension (HTN) is of major concern among the middle-aged population of Kerala. Understudied in the context of HTN is oxidative damage to DNA, which is caused by free radical assaults. The modern lifestyle associated with an unhealthy diet and lack of exercise plays a key role in oxidative stress induction. Aims and Objectives: The objective of this study was to assess the significance of oxidative stress and the effectiveness of DNA repair mechanisms in young hypertensives along with how it correlates with aspects of lifestyle. Materials and Methods: This prospective case–control study enrolled clinically proven hypertensive patients referred from the outpatient department of Hridayalaya, Institute of Preventive Cardiology, Thiruvananthapuram, to Genetika, a research center for Cytogenetic Studies in South Kerala. Hypertensive patients (n=180) within the age group of 18–39 were compared with matched healthy controls (n=140). Associated lifestyle factors were determined. Results: In comparison to controls, cases had noticeably higher mean levels of malondialdehyde (MDA) and mean break per cell (P&lt;0.05). There was a difference that was statistically significant (P&lt;0.05) between the patients and controls in terms of diet, exercise, physical activity, obesity, mental stress, alcohol, and tobacco use. On comparing MDA and mean break per cell values with lifestyle factors, a statistically significant difference was detected (P&lt;0.05). Observed a significant positive correlation of break per cell value with MDA (P&lt;0.05). Conclusion: The current study demonstrated increased DNA damage and decreased DNA repair efficiency in young hypertensive and was strongly associated with lifestyle factors. Appropriate measures such as regular BP checkups, regular exercises, and abstinence from alcohol and smoking are to be taken for the prevention and control of HTN.

An eight-year retrospective study on the clinical outcomes of laser surface-treated implants

PurposeTo retrospectively evaluate peri-implant bone loss and health status associated with the long-term use of laser surface-treated implants.MethodsFor control study, total of 23 titanium ASTM F136 grade 23 implants were placed in the edentulous molar area of the mandible. When the Implant Stability Quotient (ISQ) ≥ 70 and insertion torque value (ITV) ≥ 35–50 Ncm at the insertion site, an immediate provisional restoration was connected to the implant within a week after surgery. The definitive restorations were placed 2 months after surgery for all implants. 13 implants were immediately loaded, while 10 implants were conventionally loaded. For comparative study, Radiographs were taken from third years for and then annually for the subsequent eight years to monitor marginal bone loss.ResultsAfter eight year of implant installation, the average change in vertical bone loss was 0.009 mm (P < 0.001), while the average change in horizontal bone loss 8 year after implant placement was 0.026 mm (P < 0.001). The mean marginal bone loss was < 0.2 mm on average.ConclusionsIn this retrospective study, laser-treated implants exhibit a low rate of bone absorption around the implants.

Maternal prenatal systemic inflammation indexes predicts premature neonatal respiratory distress syndrome

Neonatal respiratory distress syndrome (NRDS) is one of the leading causes of neonatal mortality in low-income countries. It is caused by a lack of surface-active substances in the lungs, and the maternal inflammatory response plays an important role in the formation of surface-active substances in the fetal lungs. We aimed to investigate the correlation between maternal prenatal systemic inflammatory indices and respiratory distress syndrome in preterm neonates. This is a retrospective case–control study that collected data from all patients who delivered between 28 and 36 weeks of gestation at Longhua District People's Hospital in Shenzhen City and whose infants were admitted to the neonatal unit, newborns with respiratory distress syndrome were in the experimental group (NRDS group), and newborns without NRDS were in the control group (non-NRDS group). To minimize the effect of confounders on the results, propensity score matching was performed on baseline characteristics. Totally, 524 patients were included (93 in the NRDS group and 431 in the non-NRDS group), and 71 matched pairs (142 patients). The neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI) and neutrophil lymphocyte to platelet ratio (NLPR) were higher in the NRDS group than in the non-NRDS group (p < 0.05). The ROC curves of NLR, dNLR, SII, SIRI, AISI and NLPR for the diagnosis of NRDS were plotted, and it was found that the combined diagnostic efficacy of these six systemic inflammatory markers was better (AUC: 0.643, P = 0.003). Patients were divided into two groups based on the cut-off values determined from the ROC curves, and analysis using binary regression models revealed that SII ≥ 1199.94 (OR, 2.554; 95% CI 1.245–5.239, P = 0.011) and NLPR ≥ 0.0239 (OR, 2.175; 95% CI 1.061–4.459, P = 0.034) were independent risk factors predicting NRDS. Maternal prenatal SII ≥ 1199.94 and NLPR ≥ 0.0239 are independent risk factors for NRDS, and clinicians may be used to prevent neonatal respiratory distress in advance to reduce the incidence of NRDS.

Variants of human DECTIN-1 rs16910526 are linked to differential reactive oxygen species production and susceptibility to tuberculosis

BackgroundDectin-1 is a transmembrane receptor that plays a pivotal role in recognising fungi and Mycobacterium tuberculosis (Mtb). A specific variant, DECTIN-1 rs16910526, results in a truncated receptor that disrupts membrane expression and ligand binding and is clinically associated with recurrent cutaneous mycoses. Previous research has clarified the role of Dectin-1 in boosting immune defenses against mycobacteria by enhancing reactive oxygen species (ROS) production in neutrophils (PMNs). Here, we investigated the association between the rs16910526 variant and Dectin-1 expression in PMNs, as well as intracellular ROS production in response to Mtb. Furthermore, we explored the potential link between the rs16910526 gene variant and TB outcomes in Argentina.MethodsDNA was extracted from blood samples obtained from a cohort of 178 TB patients and healthy subjects (HS) in Argentina. PCR amplification and sequencing were performed to identify the rs16910526 variant. Flow cytometry was utilised to assess Dectin-1 expression on the PMN plasma membrane and to measure intracellular ROS levels, as indicated by the oxidation of DHR123 in response to the Mtb antigen.ResultsPMNs carrying the rs16910526 variant exhibited diminished Dectin-1 expression and ROS production in response to Mtb (p < 0.0001). In a case‒control study, the rs16910526 variant had an allelic frequency of 0.112 in TB patients and 0.051 in HS. Notably, 10 out of 88 HS and 18 out of 62 TB patients harboured the variant (odds ratio [OR]: 2.55 [95% CI 1.1–5.9, p = 0.03]), indicating a potential association with TB disease. Furthermore, TB patients with the rs16910526 variant exhibited a delayed sputum smear conversion time (p < 0.004) and 100% positivity for acid-fast bacilli smears (p < 0.00001).ConclusionOur study identified a significant association between the SNP variant rs16910526 in the DECTIN-1 gene and Dectin-1 expression in the PMN, leading to altered ROS production. The higher frequency of this variant in TB patients compared to HS suggests a possible link with susceptibility to TB disease in Argentina.Graphical

Risk factors of chronic endometritis in women who have undergone hysteroscopy: a prospective nested case–control study

There is limited research on risk factors for chronic endometritis regarding reproductive history and clinical symptoms. Thus, this nested case–control study identified risk factors for chronic endometritis in women who have undergone hysteroscopy. Endometrial tissue sections were obtained from 502 women with intrauterine disorders who underwent hysteroscopy. Chronic endometritis was diagnosed via CD138 immunostaining. The women were divided into two groups: 271 women without chronic endometritis and 231 women with chronic endometritis. The prevalence of chronic endometritis was 46%. Univariate logistic regression revealed that prolonged menstruation and intermenstrual bleeding were associated with chronic endometritis, and subsequent multivariate logistic regression analyses showed that these were further independently associated. With univariable logistic regression, the gravidity and abortion history were correlated with chronic endometritis; however, no significant correlation was found with the adjusted odds ratio (OR) of 0.74 (95% confidence interval [CI] 0.46–1.19) or 0.76 (95% CI 0.58–1.11), respectively. No significant correlation was found between caesarean section history and the rates of chronic endometritis. No significant difference was found in all other variables between the three groups with > 5, ≤ 5 plasma cells and in a unknown group. Prolonged menstruation and intermenstrual bleeding were risk factors associated with chronic endometritis. Chronic endometritis should be considered and CD138 immunohistochemical examination should be recommended in women with these symptoms.

Risk factors for postoperative urinary retention in patients underwent surgery for benign anorectal diseases: a nested case–control study

BackgroundPostoperative urinary retention (POUR) is a common complication of anorectal surgery. This study was to determine the incidence of POUR in anorectal surgery for benign anorectal diseases, identify its risk factors, and establish a nomogram for prediction of POUR.MethodsA nested case–control study was conducted. The clinical data of patients were collected, and the incidence of POUR was analyzed. Univariate analysis was used to identify the risk factors associated with POUR, and multivariate logistic regression analysis was used to determine independent risk factors for POUR. A nomogram for the preoperative prediction of POUR using a logistic regression model was developed (n = 609).ResultsThe incidence of POUR after anorectal surgery for benign anorectal diseases was 19.05%. The independent risk factors for POUR were: female (P = 0.007); male with benign prostatic hyperplasia (BPH) (P = 0.001); postoperative visual analogue scale (VAS) score > 6 (P = 0.002); patient-controlled epidural analgesia (PCEA) (P = 0.016); and a surgery time > 30 min (P = 0.039). In the nomogram, BPH is the most important factor affecting the occurrence of POUR, followed by a postoperative VAS score > 6, PCEA, surgery time > 30 min, and sex has the least influence.ConclusionFor patients undergoing anorectal surgery for benign anorectal diseases, preventive measures can be taken to reduce the risk of POUR, taking into account the following risk factors: female or male with BPH, severe postoperative pain, PCEA, and surgery time > 30 min. Furthermore, we developed and validated an easy-to-use nomogram for preoperative prediction of POUR in anorectal surgery for benign anorectal diseases.Trial registrationChina Clinical Trial Registry: ChiCTR2000039684, 05/11/2020.

An optimal transport approach to estimating causal effects via nonlinear difference-in-differences

Abstract We propose a nonlinear difference-in-differences (DiD) method to estimate multivariate counterfactual distributions in classical treatment and control study designs with observational data. Our approach sheds a new light on existing approaches like the changes-in-changes estimator and the classical semiparametric DiD estimator, and it also generalizes them to settings with multivariate heterogeneity in the outcomes. The main benefit of this extension is that it allows for arbitrary dependence between the coordinates of vector potential outcomes and includes higher-dimensional unobservables, something that existing methods cannot provide in general. We demonstrate its utility on both synthetic and real data. In particular, we revisit the classical Card &amp; Krueger dataset, which reports fast food restaurant employment before and after a minimum wage increase. A reanalysis with our methodology suggests that these restaurants substitute full-time labor with part-time labor on aggregate in response to a minimum wage increase. This treatment effect requires estimation of the multivariate counterfactual distribution, an object beyond the scope of classical causal estimators previously applied to this data.

The influence of adverse events on inpatient outcomes in a tertiary hospital using a diagnosis-related group database

Adverse events (AEs) are a significant concern for healthcare systems. However, it is difficult to evaluate their influence because of the complexity of various medical services. This study aimed to assess the influence of AEs on the outcomes of hospitalized patients using a diagnosis-related group (DRG) database. We conducted a case–control study of hospitalized patients at a multi-district tertiary hospital with 2200 beds in China, using data from a DRG database. An AE refers to an unintended physical injury caused or contributed to by medical care that requires additional hospitalization, monitoring, treatment, or even death. Relative weight (RW), a specific indicator of DRG, was used to measure the difficulty of diagnosis and treatment, disease severity, and medical resources utilized. The primary outcomes were hospital length of stay (LOS) and hospitalization costs. The secondary outcome was discharge to home. This study applied DRG-based matching, Hodges–Lehmann estimate, regression analysis, and subgroup analysis to evaluate the influence of AEs on outcomes. Two sensitivity analyses by excluding short LOS and changing adjustment factors were performed to assess the robustness of the results. We identified 2690 hospitalized patients who had been divided into 329 DRGs, including 1345 patients who experienced AEs (case group) and 1345 DRG-matched normal controls. The Hodges–Lehmann estimate and generalized linear regression analysis showed AEs led to prolonged LOS (unadjusted difference, 7 days, 95% confidence interval [CI] 6–8 days; adjusted difference, 8.31 days, 95% CI 7.16–9.52 days) and excess hospitalization costs (unadjusted difference, $2186.40, 95% CI: $1836.87-$2559.16; adjusted difference, $2822.67, 95% CI: $2351.25-$3334.88). Logistic regression analysis showed AEs were associated with lower odds of discharge to home (unadjusted odds ratio [OR] 0.66, 95% CI 0.54–0.82; adjusted OR 0.75, 95% CI 0.61–0.93). The subgroup analyses showed that the results for each subgroup were largely consistent. LOS and hospitalization costs increased significantly after AEs in complex diseases (RW ≥ 2) and in relation to high degrees of harm subgroups (moderate harm and above groups). Similar results were obtained in sensitivity analyses. The burden of AEs, especially those related to complex diseases and severe harm, is significant in China. The DRG database serves as a valuable source of information that can be utilized for the evaluation and management of AEs.

Comparing Corneal Biomechanic Changes between Solo Cataract Surgery and Microhook Ab Interno Trabeculotomy

Background/Objectives: This study aimed to examine the postoperative changes in the corneal biomechanical properties between solo cataract surgery and solo microhook ab interno trabeculotomy (LOT). Methods: This retrospective case–control study included 37 eyes belonging to 26 patients who underwent solo cataract surgery and 37 eyes belonging to 31 patients who underwent solo µLOT. These two groups were matched according to their preoperative intraocular pressure (IOP), axial length (AL), and age. Corneal Visualization Scheimpflug Technology (Corvis ST) was used to obtain four biomechanical parameters representing the corneal stiffness or corneal deformation at the highest concavity, including stiffness parameter A1 (SP-A1), stress–strain index (SSI), peak distance (PD), and deflection amplitude max (DefAmpMax). These parameters were compared preoperatively and 6 months postoperatively, and between the two surgical groups. Results: Preoperatively, the patients’ IOP, age, and AL, as well as their results in four Corvis ST parameters, were similar between the two groups (p &gt; 0.05). No significant difference was observed in SP-A1; however, PD and DefAmpMax were significantly larger, and SSI was significantly smaller postoperatively in the LOT group than in the cataract group. Conclusions: Corneal stiffness was reduced, and the cornea was more deformed with LOT than cataract surgery.

Patient socio-demographics and clinical factors associated with malaria mortality: a case control study in the northern region of Ghana

BackgroundGhana is a malaria-endemic country with the entire population at risk. The Northern region of the country recorded the highest malaria case fatality rate (CFR) for two consecutive years: 1.11% in 2013 and 1.07% in 2014. Even though the National Malaria Elimination Programme (NMEP) has achieved a reduction in malaria mortality, the existence of high case fatality in the Northern region was alarming. This study, therefore, aimed to determine the factors associated with malaria mortality in the northern region of Ghana to institute control measures.MethodsAn unmatched case control study was conducted from July 2015 to August 2015. The study population consisted of patients admitted to health facilities for severe malaria in the Northern region of Ghana. A case was defined as a patient diagnosed with severe malaria at an eligible health facility who died as a result of malaria. A control was a patient diagnosed with severe malaria admitted to an eligible health facility who did not die. Health facilities that recorded CFRs of 1.0% and above were randomly sampled for this study, after which, 10 cases and 20 controls were recruited from each health facility. Information on cases and controls was then abstracted from hospital records using an electronically deployed abstraction tool. Continuous variables were expressed as means and medians, and categorical variables as frequencies and proportions. Multivariable logistic regression was used to assess the strength of the association between malaria mortality and factors predictive of malaria mortality. A p-value of < 0.05 was considered statistically significant.ResultsIn all, a total of 95 cases and 190 controls participated in this study. The median ages of cases and controls were 4.1 years (IQR = 21.6) and 5.7 years (IQR = 18.2), respectively. Fifty-four (56.8%) cases were females, while 93 (49.0%) of the controls were females. Factors associated with malaria mortality included: duration of hospital stay less than 24 h [aOR: 12.0, 95% CI (5.9–24.6)], severe pallor [aOR: 2.3, 95% CI (1.1–4.6)], children under 5 years [aOR: 2.8, 95% CI (1.4–5.6)], oral Artesunate/Amodiaquine administration [aOR: 0.4, 95% CI (0.2–0.9)] and sepsis as an additional diagnosis [aOR: 4.1, 95% CI (1.8–9.5)].ConclusionPredictors of malaria mortality in the Northern region include children under 5 years, severe pallor, sepsis as an additional diagnosis, and use of oral anti-malarial. Patients with severe pallor and sepsis as co-morbidities should receive proactive management. The NMEP and its partners should implement measures to strengthen the referral system, anaemia prevention and management, and retrain health workers on malaria case management. Malaria control interventions targeted at under five children in the region should be reviewed and enhanced.

Bone conducted cervical vestibular evoked myogenic potentials: comparison of tone burst stimulus vs chirp stimulus.

Vestibular evoked myogenic potential (VEMP) is a test used to evaluate the function of otolith organs. In healthy individuals, air-conducted (AC) responses are obtained, whereas, in conductive hearing loss, the inability to transmit the signal well enough with AC stimuli has led to the need for bone-conducted (BC) stimuli. This study aimed to compare 500Hz Chirp and Tone Burst stimuli in terms of latency and amplitude in BC cVEMP. This prospective observational case control study included 35 healthy participants (70 ears) between the age of 20-50. Participants underwent VEMP testing with BC 500Hz Tone Burst stimulus and 500Hz narrow band Chirp stimulus without changing the position of the bone conducted vibrator. The intensity of the stimuli was 50 dB nHL. Response rate of 500Hz TB Stimulus was 51.4% and 95.7% in Chirp stimulus. It was observed that significantly more responses were obtained with Chirp stimulus than TB stimulus (p < 0.001). In terms of p1 latency, n1 latency, both latencies were significantly shorter in Chirp stimulus (p < 0.001). p1n1 amplitude was found significantly larger in Chirp stimulus (p < 0.001). Compared to 500Hz TB stimulus, 500Hz Chirp stimulus results in a higher response rate, larger p1n1 amplitude, and shorter p1 and n1 latency. A higher response rate may provide a more accurate assessment of otolith organs, reducing false negatives due to signal transmission in patients.

Presepsin in Human Milk Is Delivery Mode and Gender Dependent

Breast milk (BM) is a unique food due to its nutritional composition and anti-inflammatory characteristics. Evidence has emerged on the role of Presepsin (PSEP) as a reliable marker of early sepsis diagnosis. In the present study, we aimed to investigate the measurability of PSEP in BM according to different maturation stages (colostrum, C; transition, Tr; and mature milks, Mt) and corrected for delivery mode and gender. We conducted a multicenter prospective case–control study in women who had delivered 22 term (T) and 22 preterm (PT) infants. A total of 44 human milk samples were collected and stored at −80 °C. BM PSEP (pg/mL) levels were measured by using a rapid chemiluminescent enzyme immunoassay. PSEP was detected in all samples analyzed. Higher (p &lt; 0.05) BM PSEP concentrations were observed in the PT compared to the T infants. According to the grade of maturation, higher (p &lt; 0.05) levels of PSEP in C compared to Tr and Mt milks were observed in the whole study population. The BM subtypes’ degrees of maturation were delivery mode and gender dependent. We found that PSEP at high concentrations supports its antimicrobial action both in PT and T infants. These results open the door to further studies investigating the role of PSEP.

Qualitative and quantitative return-to-sport test battery and second anterior cruciate ligament injury risk factors

ObjectiveTo determine risk factors for second anterior cruciate ligament (ACL) injury following primary ACL reconstruction (ACLR) using return-to-sport (RTS) tests consisting of qualitative and quantitative measures in young athletes.MethodsA case–control...

Cigarette smoking and its effect on coagulation profile, hematological parameters, and oxygen saturation in healthy blood donor

Background: Cigarette smoking causes millions of deaths all around the world each year as it is one of the leading causes of cancer and cardiovascular diseases. Aims and Objectives: The study aimed to study the effect of cigarette smoking on coagulation profile, hematological parameters, and oxygen saturation in healthy blood donors. Materials and Methods: A case–control study was carried out at the Department of Pathology, Era’s Lucknow Medical College which is a tertiary care center, and took place between September 2018 and September 2020 (24 months). Results: Cigarette smoking has adverse effects on hematological parameters (red blood cell count, hemoglobin, hematocrit, mean corpuscular hemoglobin, red cell distribution width, and total leukocyte count) and coagulation profile (prothrombin time, activated partial thromboplastin time, and international normalized ratio). In our study, no adverse effects are seen on oxygen saturation though. Conclusion: Our study shows that hematological parameters and coagulation profile were altered in donors who were smokers and thus, it should be considered during blood donation. Although oxygen saturation was not adversely affected, this study strongly recommends the need for further studies to be done on this parameter of donated blood.