Unexposed Group Research Articles

Association of Shock Index and Modified Shock Index with Mortality Rate in Emergency Department Trauma Patient

At the emergency room, triage was used to determine which patients were more seriously injured and in need of urgent care. Trauma remains one of the primary causes of morbidity and death even with the use of modern triage techniques. Objective: To find out the relationship between trauma patients' 48-hour mortality and the shock index and modified shock index at Emergency Departments (EDs). Methods: A study was conducted in the Emergency Ward of Ziauddin University Hospital, focusing on patients aged 18-65 who sustained trauma. The study involved 50 trauma patients admitted to a Level I trauma center. Data were collected on heart rate, blood pressure, and shock indices at the time of admission. A shock index cut-off value of 0.9 was used to determine its association with patient outcomes. Data collection involved patients visiting the emergency department, with informed consent obtained. SPSS version 21.0 was used for analysis. Results: The study involved 50 patients, with 25 in each exposed and unexposed group. Exposed patients had a higher average age, higher heart rates, and lower blood pressure. Road traffic accidents were the leading trauma mechanism in both groups. Open wounds were more common in exposed patients. Most exposed patients received intravenous fluids and inotropic support. Patients with a Shock Index ≥ 1 and a Modified Shock Index ≥ 1.3 had higher mortality rates. Conclusion: The study revealed a significant link between medical mortality in older adults and bruises in emergency departments, indicating that SI and Modified SI were effective markers for severity assessment.

Evaluation of Diagnostic Performance of Three Commercial Interferon-Gamma Release Assays for Mycobacterium tuberculosis

Interferon-gamma release assays (IGRAs) have gained attention for the diagnosis of latent tuberculosis infection (LTBI) due to their higher specificity compared to the tuberculin skin test (TST). However, the IGRA’s performance varies across different populations. This study evaluated the diagnostic performance of three IGRAs (TBF-FIA, TBF-ELISA, and QFT-Plus) in Ghana, comparing them among individuals exposed and unexposed to MTB infection. Conducted in TB clinics across three regions, this prospective and cross-sectional study included healthy individuals with no known TB exposure (unexposed group) and patients with confirmed active TB (exposed group). Blood samples were tested using all three assays as per the manufacturers’ guidelines. The TBF-ELISA showed 3.4% higher sensitivity but 4.6% lower specificity compared to QFT-Plus. The TBF-FIA had sensitivity of 78.5–87.3% and specificity of 82.9–90.0%. These findings indicate that while the three IGRAs offer similar diagnostic accuracy, the variations in specificity and limited data on assays like TBF-FIA require further investigation.

Childhood anaesthesia and autism risk: population and murine study.

Early childhood exposure to general anaesthesia has been linked to potential changes in infant brain morphology and behaviour in preclinical studies, contributing to long-term behaviours associated with autism spectrum disorder. This study investigates the association between early childhood exposure to general anaesthesia and the risk of autism, using a population-based cohort study with matching for baseline characteristics and evaluates the effect of sevoflurane exposure on autism-like behaviour in mice, using the Taiwan Maternal and Child Health Database. Children aged 0-3 who received at least one exposure to general anaesthesia between 2004 and 2014 were matched 1:1 with children who were not exposed. Risk ratios and confidence intervals were used to assess the relationship between general anaesthesia and the occurrence of autism. Additionally, mice were exposed to sevoflurane for 2 h on postnatal days 5-7, and changes in behaviour related to autism were evaluated. Propensity score matching resulted in 7530 children in each group. The incidence rates (IRs) of autism were 11.26 and 6.05 per 100 000 person-years in the exposed and unexposed groups, respectively. The incidence ratio for autism following exposure to general anaesthesia was 1.86 (95% confidence interval, 1.34-2.59). In mice, sevoflurane exposure induced autism-like behaviours and led to the downregulation of high-risk autism genes, including ARID1B, GABRA5, GABRB3, GRIN2B, SHANK3 and SUV420H1. Early childhood exposure to general anaesthesia is associated with an increased risk of autism. Repeated exposure to sevoflurane in mice induces autism-like behaviours, suggesting a potential link between anaesthesia and the development of autism.

Anti-Tumor Necrosis Factor Therapy and the Risk of Gestational Diabetes in Pregnant Women With Inflammatory Bowel Disease.

Anti-tumor necrosis factor (anti-TNF) therapy may improve insulin sensitivity, and its impact during pregnancy remains unclear. We aimed to assess the risk of gestational diabetes mellitus (GDM) associated with anti-TNF treatment among pregnant women with inflammatory bowel disease (IBD). This nationwide cohort study included patients with IBD in Korea from 2010 to 2021. Anti-TNF exposure was identified from the last menstrual period (LMP) to LMP + 140 days. The development of GDM was assessed from LMP + 141 days to delivery. We performed overlap weighting to balance the covariates and used a generalized linear mixed model to measure the risk ratio (RR) and 95% confidence intervals (CIs). The anti-TNF group was compared with the unexposed group, as well as with the immunosuppressant, 5-aminosalicylate, and untreated groups. A total of 3,695 pregnancies in women with IBD were identified, of which 338 (9.2%) were exposed to anti-TNFs. GDM was found in 7.1% of the pregnancies exposed to anti-TNFs as compared with 11.0% of those unexposed. The crude and weighted RRs for GDM risk were 0.64 (95% CI 0.43-0.96) and 0.68 (95% CI 0.55-0.84), respectively. The weighted RR when compared with the immunosuppressant, 5-aminosalicylate, and untreated groups was 0.70 (95% CI 0.41-1.18), 0.71 (95% CI 0.52-0.95), and 0.85 (95% CI 0.59-1.24), respectively. This nationwide cohort reported a decreased risk of GDM among patients who used anti-TNFs during early pregnancy compared with those unexposed. GDM risk may become a consideration in the decision-making process when choosing treatment options for pregnant women with a risk factor for GDM.

Respiratory and physical health consequences in older adults in a high-risk volcanic area: Comparison of two rural villages

Introduction Volcanism is an important natural producer of pollution that impacts health and the quality of the environment. Lung changes caused by exposure to volcanoes have been previously studied. However, limited information exists regarding the effects of prolonged exposure to volcanic compounds. So, this study aimed to analyze the pulmonary effects and stress tolerance in older adults for chronic exposure to the volcanic ashes of the Galeras volcano. Methods A descriptive cross-sectional study of association included rural inhabitants aged over 60 years from Genoy, a village located in a high volcanic hazard zone of Galeras volcano, 2603 meters above sea level. Those in this group, called exposed, were contrasted with a sample of El Encano inhabitants with similar socioeconomic and cultural characteristics. Both villages belong to the rural area of San Juan de Pasto in Colombia. Results It was found that of 31 exposed participants, 18 had obstructive alteration, and in the control group, it was found that of 31 subjects, 6 presented this alteration. The difference between the two groups was significant (p<0.001). A similar situation occurred with distal airway obstruction assessed with the forced expiratory flow of 25–75%. No significant differences were found in restrictive alteration between the exposed and unexposed groups. Conclusion Chronic exposure to volcanic compounds has generated obstructive changes in the population, and these changes were greater in number and severity than those in the control group of unexposed people.

Association of education attainment, smoking status, and alcohol use disorder with dementia risk in older adults: a longitudinal observational study

BackgroundPrevious research on the risk of dementia associated with education attainment, smoking status, and alcohol use disorder (AUD) has yielded inconsistent results, indicating potential heterogeneous treatment effects (HTEs) of these factors on dementia risk. Thus, this study aimed to identify the important variables that may contribute to HTEs of these factors in older adults.MethodsUsing 2005–2021 data from the National Alzheimer’s Coordinating Center (NACC), we included older adults (≥ 65 years) with normal cognition at the first visit. The exposure of interest included college education or above, current smoking, and AUD and the outcome was all-cause dementia. We applied doubly robust learning to estimate risk differences (RD) and 95% confidence intervals (CI) between exposed and unexposed groups in the overall cohort and subgroups identified through a decision tree model.ResultsOf 10,062 participants included, 929 developed all-cause dementia over a median 4.4-year follow-up. College education or above was associated with a lower risk of all-cause dementia in the overall population (RD, -1.5%; 95%CI, -2.8 to -0.3), especially among the subpopulations without hypertension, regardless of the APOE4 status. Current smoking was not related to increased dementia risk overall (2.8%; -1.5 to 7.2) but was significantly associated with increased dementia risk among men with (21.1%, 3.1 to 39.1) and without (8.4%, 0.9 to 15.8) cerebrovascular disease. AUD was not related to increased dementia risk overall (2.0%; -7.7 to 11.7) but was significantly associated with increased dementia risk among men with neuropsychiatric disorders (31.5%; 7.4 to 55.7).ConclusionsOur studies identified important factors contributing to HTEs of education, smoking, and AUD on risk of all-cause dementia, suggesting an individualized approach is needed to address dementia disparities.

Colorectal cancer in older adults after the USPSTF’s 2008 updated screening recommendation

BackgroundColorectal cancer (CRC) screenings can improve detection and prevent precancerous polyps from becoming malignant tumors. In 2008, the United States Preventive Services Task Force (USPSTF) updated their policy and no longer recommended that adults over age 75 screen for CRC. We evaluated how this policy update impacted screening behaviors and CRC outcomes in older adults. MethodsWe obtained data from the Behavioral Risk Factor Surveillance System to analyze blood stool and colonoscopy screening, the Surveillance, Epidemiological, End Results program to analyze CRC staging and survival, the National Association of Centralized Cancer Registries to analyze CRC incidence, and the National Center for Health Statistics to analyze mortality. With a difference-in-differences design, we compared the changes in outcome trends of the exposed group (age 75+), before and after 2008, with the changes in trends of a similar unexposed group (age 65–74). ResultsThere was no association between the 2008 update and blood stool tests in older adults. We did, however, find that the update was associated with a 3.0 %-point decline in the probability of older adults completing a colonoscopy within the past two years (C.I. = −4.0, −2.0). Among older adults diagnosed with CRC, the update was associated with a 1.5 %-point increase in the probability of presenting at an advanced stage (C.I. = 1.1, 1.9). Finally, the update was also associated with lower CRC incidence (Est. = −13.9 cases/100,000 population; C.I. = −22.6, −5.1) and mortality rates (Est. = −5.6 deaths/100,000 population; C.I. = −10.1, −1.1). We observed the largest associations between the policy and CRC outcomes in adults age 85+. DiscussionThe USPSTF’s 2008 recommendation was associated with reduced colonoscopies, especially in adults over age 85. Whether this recommendation, or the 2021 updated guidance, optimizes population health by reducing the burden of CRC screening in older adults remains unknown.

Integrated evaluation of workplace exposures and biomarkers of bladder cancer among textile dyeing workers

BackgroundThe textile industry is the second risk factor for bladder cancer, after smoking. Previous studies focused on the impact of exposure to high concentrations of bladder carcinogenic chemicals in the textile dyeing industry on the elevation of bladder cancer biomarkers. This study aimed to evaluate bladder carcinogenic air pollutants in a textile dyeing factory and investigate its role and the role of serum 25-hydroxyvitamin D (25-OH vit. D) on cancer bladder biomarkers in exposed workers.MethodsA cross-sectional study was conducted. Particulate and vapor forms of polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs) were monitored in the printing, dyeing, and preparing sections of a textile factory. Bladder tumor antigen (BTA), nuclear matrix protein 22 (NMP-22), and 25-OH vit. D were estimated in all the exposed workers (147 exposed workers) and in workers not occupationally exposed to chemicals (130 unexposed workers).ResultsAromatic bladder carcinogenic compounds were either in low concentrations or not detected in the air samples of working areas. BTA and NMP-22 of exposed workers were not significantly different from the unexposed. However, 25-OH vit. D was significantly lower in the exposed than unexposed workers. There was a significant inverse correlation between 25-OH vit. D and duration of exposure in exposed workers.ConclusionThe mean levels of PAHs and VOCs were within the safe standard levels in the working areas. The non-significant difference in BTA and NMP-22 between the exposed and unexposed groups suggests the presence of occupational exposures to safe levels of bladder carcinogenic aromatics, while the significantly lower 25-OH vit. D levels among the exposed than the unexposed groups could suggest the potential association of 25-OH vit. D with occupational exposures to low levels of PAHs and VOCs, and this association was found to be inversely correlated with the duration of exposures. Accordingly, more specific predictor tests must be applied for early diagnosis of bladder cancer among the exposed workers.

No Increased Risk of Major Adverse Cardiovascular Events following Nicotinamide Exposure.

Nicotinamide metabolites have recently been implicated in increased risk of major cardiovascular events (MACE). Supportive data about clinical risk of MACE for nicotinamide users is lacking. To determine whether nicotinamide use results in an increase of MACE. Retrospective cohort study of two patient cohorts, Vanderbilt University Medical Center (VUMC) and Military Veteran Program (MVP). The risk of MACE in patients exposed to nicotinamide was compared to the risk of MACE in unexposed patients. In the VUMC cohort, 1228 patients were exposed to nicotinamide based on keyword entry for "nicotinamide" or "niacinamide" and hand-review of charts, while 253 were unexposed but had documented recommendation for use. In the MVP cohort, there were 1594 with exposure to nicotinamide propensity score matched to 2694 without exposure. The primary exposure for the VUMC cohort was a confirmed exposure to nicotinamide in chart review. The primary exposure for the MVP cohort was medication entry for "nicotinamide" or "niacinamide". The primary outcome was development of MACE based on a validated phenotype. Between both cohorts, 6039 patients were included, of whom 5125 were male with a mean age of 63.2 years. Neither cohort had significant differences in mean age, sex, race and ethnicity between the nicotinamide exposed and unexposed groups. In the VUMC cohort, there was no significant association between nicotinamide exposure and the primary outcome of MACE (HR 0.76, 95% CI 0.46 - 1.25, p = 0.28). MACE prior to nicotinamide exposure was strongly associated with subsequent MACE (HR 9.01, 95% CI 5.90 - 13.70, p < 0.001). In the MVP cohort, we adjusted for MACE risk factors as potential confounding variables and saw no significant association between nicotinamide exposure and MACE (HR 1.00 95% CI 0.75 - 1.32), while history of prior MACE remained strongly associated with subsequent MACE (HR 9.50, 95% CI 6.38 - 14.1). In this retrospective cohort study of 6039 adults from two different patient populations, we found no increased risk of MACE in patients with nicotinamide exposure.

Multiple risks for children of incarcerated mothers: A descriptive study

Objectives and ApproachSurvey data suggests that children of incarcerated mothers are exposed to a range of risk factors that can have negative impacts on life-course outcomes. This retrospective cohort study uses a population sample to describe the extent and mix of risk factors to which children of incarcerated mothers are exposed. Administrative data from health, justice, child protective services, births, and deaths were merged for 9,380 children exposed to maternal incarceration and an unexposed comparison group of 22,716 children. Risk ratios and 95% confidence intervals were calculated for birth complications and adverse childhood experiences (ACEs) for children exposed to maternal incarceration compared to those not exposed, adjusted for sociodemographic risk factors. A multiple risk score summed the number of recorded risk factors (0-17) for children with and without maternal incarceration exposure. ResultsCompared to unexposed children, children of incarcerated mothers had a higher risk of preterm birth, low birthweight, and all ACEs, including a 15-times (95%CI 14.2, 16.3) higher risk of exposure to maternal substance use disorders and 18-times (95%CI 16.8, 20.7) higher risk of placement in out-of-home care. Only 1% of children of incarcerated mothers did not experience any of the included risk factors, compared to 26% of unexposed children (p&lt;0.001). ConclusionsChildren of incarcerated mothers disproportionately experience multiple risks, especially maltreatment, placement in out-of-home care, and maternal substance use. ImplicationsThere is a significant public health opportunity to identify and address the needs of children of incarcerated mothers at the points of maternal arrest, sentencing, and incarceration.

Neonatal Anthropometric Measurements: A Comparison of Neonates With 3-T Fetal MRI Exposure, With 1.5-T Fetal MRI Exposure, and Without In-Utero MRI Exposure.

Background: Fetal MRI is increasingly performed at 3 T. Nonetheless, safety concerns persist regarding potential increased risk of intrauterine growth restriction from in-utero 3-T MRI exposure. Objective: To compare neonatal anthropometric measurements between newborns who underwent 3-T fetal MRI, newborns who underwent 1.5-T fetal MRI, and newborns without in utero MRI exposure. Methods: This single-center retrospective study included gravid patients who underwent fetal ultrasound and possible 1.5-T or 3-T fetal MRI within 10 days from January 2017 to January 2022. For each included patient who also underwent 3-T fetal MRI, one matched patient who also underwent 1.5-T MRI and two matched patients without in-utero MRI exposure, were randomly selected. Matching was based on gestational age per the fetal ultrasound. Neonatal anthropometric characteristics were compared among groups. Results: The final sample included 416 patients (mean age, 32±5 years), 104 in the 3-T MRI group, 104 in the 1.5-T MRI group, and 208 in the MRI-unexposed group. Mean gestational age at the time of fetal ultrasound used for matching was 27 weeks 2 days in the 3-T group, 25 weeks 2 days in the 1.5-T group, and 26 weeks 0 days in the MRI-unexposed group (p=.07). The distribution of indications for fetal MRI was not significantly different between the 3-T and 1.5-T groups (p=.62). Mean gestational age at delivery was 37 weeks 5 days in the 3-T group, 38 weeks 0 day in the 1.5-T group, and 38 weeks 2 days in the unexposed group (p=.51). No significant difference (p=.09) was observed among groups in mean neonatal weight (3-T: 3120±753 g; 1.5-T: 3104±704 g; unexposed: 2967±614 g); neonatal weight percentile (3-T: 45±27; 1.5-T: 42±26; MRI: 41±24); neonatal head circumference (3-T: 34±3 cm; 1.5-T: 34±3 cm; unexposed: 34±2 cm), or neonatal head circumference percentile (3-T: 48±29; 1.5-T: 42±23; unexposed: 43±30). Conclusion: There were no significant differences in neonatal anthropometric measurements among newborns who underwent in-utero 3-T MRI, newborns who underwent in-utero 1.5-T MRI, and newborns without in-utero MRI exposure. Clinical Impact: The results support the safety of 3-T MRI with respect to growth of the developing fetus.

Neurotoxic effects associated with chronic inhalation and oral exposure to glyphosate-based herbicide IN adult rats.

The use of glyphosate-based herbicides (GBHs) for agricultural production has increased substantially around the world, as have their residues in the environment. Its effects on the central nervous system and neurotoxicity pathways are still not fully understood. The aim of this study was to evaluate the neurotoxic effect of chronic exposure to a GBH in adult rats. Sixty adult male albino Wistar rats were allocated into 6 groups, 2 control groups, and four GBH exposure groups (n=10/group). The animals were exposed to two concentrations of GBH, orally and by inhalation: 2.99 × 10-3grams of active ingredient per hectare (g.a.i./ha) and 7.48 × 10-3g.a.i./ha. The animals were exposed for six months. Behavioral studies were performed. Brain tissue was collected for histopathological, immunohistochemical, and oxidative stress analyses. Animals exposed by inhalation to GBH spent more time in the central area of the open field test, whereas animals exposed to a high oral concentration of GBH spent less time in the open arms in the elevated plus-maze test. Tissue hyperemia occurred only in animals exposed to high concentrations of GBH. There was a greater thickness of the cerebral cortex and an increase in the expression of the BCL-2 in the animals exposed by inhalation to GBH. There was no difference in the doses of malonaldehyde and protein carbonylation between exposed and unexposed groups. The exposure to GBH caused increased levels of anxiety, regardless of the route, high concentrations caused hyperemia and inhalation exposure cause increased cortex thickness and increased BCl-2 expression.

Protective Effect of Aloe vera (L.) on Diabetes-Induced Oxidative Stress Linked Spermiological Co-Morbidity in Human and Rat: An In-Vitro Analysis.

Diabetes linked reproductive complications are rising problems nowadays. The study focused on the protective efficacy of Aloe vera (L.) on sperm cell damage in an oxidative stress milieu encumbered by a chronic diabetes in human and streptozotocin treated Wistar rat (Rattus norvegicus). Spermatozoa from rat's epididymal washing, and human semen after 3-4days of abstinence of mating or masturbation were collected from control and diabetes groups. Spermatozoa of human and rat were incubated for 1 or 2h at 370C in an in-vitro medium separately and considered as normo-glycemic control and diabetes sub-groups. Dose of 1 or, 2 or, 4mg/ml of Aloe vera (L.) hydro-ethanolic (40:60) extract (AVHE) was given to diabetes samples, considered as sub-sub-group for assessing its protective effect on spermiological and oxidative stress parameters. The motility, viability, plasma membrane integrity, nuclear chromatin decondensation for DNA fragmentation, acrosome cap status, and antioxidative status of human and rat spermatozoa were decreased whereas spermatozoal apoptosis was elevated significantly (p < 0.05), noted by TUNEL assay in diabetes samples compared to the duration-matched control group. Exposure of AVHE to diabetes samples resulted significant rectification (p < 0.05) in the said parameters than the unexposed diabetes group. In control group, AVHE exposure has significant protective effect from spermiological deterioration compared to unexposed control group. Identification of major phytomolecules in AVHE was done by LC-MS study. Diabetes-induced oxidative stress-mediated spermatozoal injuries can be protected by AVHE extract, raise the possibility for potentiating sperm of human for increasing the success rate of in-vitro fertilization-blastocyst implantation.

Impact of Cystic Fibrosis Transmembrane Conductance Regulator Modulators on Maternal Outcomes During and After Pregnancy

Cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulators are available to the majority of people with CF in the United States; little is known about pregnancy outcomes with modulator use. The aim of this retrospective study was to determine the impact of CFTR modulators on maternal outcomes. Does pregnancy differentially affect outcomes in female subjects with CF with and without CFTR modulator exposure? Data on pregnancies from 2010 to 2021 were collected from 11 US adult CF centers. Multivariable longitudinal regression analysis was performed to assess whether changes in percent predicted FEV1 (ppFEV1), BMI, pulmonary exacerbations (PEx), and Pseudomonas aeruginosa prevalence differed from prior to, during, and following pregnancy according to CFTR modulator use while adjusting for confounders. Infant outcomes are also described based on maternal modulator use. Among 307 pregnancies, mean age at conception was 28.5 years (range, 17-42 years), prepregnancy ppFEV1 was 74.2, and BMI was 22.3kg/m2. A total of 114 pregnancies (37.1%) had CFTR modulator exposure during pregnancy (77 with highly effective modulator therapy [HEMT] and 37 with other modulators). The adjusted mean change in ppFEV1 from prepregnancy to during pregnancy was -2.36 (95%CI, -3.56 to -1.16) in the unexposed group and 2.60 (95%CI, 0.23 to 4.97) in the HEMT group, with no significant change from during pregnancy to 1 year postpregnancy. There was an overall decline in ppFEV1 from prepregnancy to postpregnancy in the no modulator group (-2.56; 95%CI, -3.62 to -1.49) that was not observed in the HEMT group (1.10; 95%CI, -1.13 to 3.34). PEx decreased from prepregnancy to postpregnancy in the HEMT group, and BMI increased from prepregnancy to during pregnancy in all groups but with no significant change postpregnancy. Missing infant outcomes data precluded firm conclusions. We observed superior pregnancy and postpregnancy pulmonary outcomes in individuals who used HEMT, including a preservation of ppFEV1, compared with those unexposed to HEMT.

Real-world effectiveness and tolerability of switching to doravirine-based antiretroviral therapy in people with HIV: a nationwide, matched, prospective cohort study

Currently, real-world data on doravirine are scarce. In a national prospective cohort, we assessed the effectiveness and tolerability of switching to doravirine-based antiretroviral therapy (ART) in people with HIV. We did a nationwide, matched, prospective cohort study of people with HIV without previous virological failure and stable for at least 12 months on non-doravirine-containing triple or dual ART switching to doravirine before Sept 1, 2020 (exposed group). Participants in the exposed group were matched 1:2 to individuals continuing stable non-doravirine-containing ART, on age, sex, HIV acquisition category, time since ART initiation, calendar time, pre-ART CD4-count, pre-ART plasma viral load (PVL) and anchor drug class before switching. The primary outcome was protocol-defined virological failure (PDVF; PVL of ≥200 copies per mL) in the intention-to-treat (ITT) population at week 104, with participants modifying their regimen or becoming lost to follow-up considered as PDVF (non-inferiority margin +5%). In contrast, in the on-treatment population, those who modified their regimen or became lost to follow-up were censored from that moment onwards. Tolerability was a secondary outcome. In total, 590 participants in the exposed group and 1180 participants in the unexposed group (of whom 55·3% used integrase strand transfer inhibitor-based regimens) were included. In the ITT analysis, PDVF occurred in 135 (22·9%) exposed participants and in 295 (25·0%) unexposed participants (risk difference -2·12%, upper limit of the one-sided 95% CI +1·40%). In the on-treatment analysis, 10 (2·2%) of 455 non-censored exposed participants and 26 (2·9%) of 885 non-censored unexposed participants had PDVF (risk difference -0·70%, upper limit of the one-sided 95% CI +0·73%). All exposed participants with a PVL of 200 copies or more per mL resuppressed without regimen modification: no confirmed virological failure (two consecutive PVLs of ≥200 copies per mL) was observed. 104 (17·6%) exposed participants and 211 (17·9%) unexposed participants modified their regimen. 73 (12.4%) exposed participants discontinued doravirine due to adverse events: abnormal dreams (1·7%) and insomnia (1·5%) were most common. Switching to doravirine in well suppressed people with HIV without previous virological failure was non-inferior compared with continuing non-doravirine-containing regimens after 2 years in a real-world setting. None.

Repetitive Head Impacts and Perivascular Space Volume in Former American Football Players

Exposure to repetitive head impacts (RHI) is associated with increased risk for neurodegeneration. Accumulation of toxic proteins due to impaired brain clearance is suspected to play a role. To investigate whether perivascular space (PVS) volume is associated with lifetime exposure to RHI in individuals at risk for RHI-associated neurodegeneration. This cross-sectional study was part of the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project, a 7-year multicenter study consisting of 4 US study sites. Data were collected from September 2016 to February 2020 and analyses were performed between May 2021 and October 2023. After controlling for magnetic resonance image (MRI) and processing quality, former American football players and unexposed asymptomatic control participants were included in analyses. Prior exposure to RHI while participating in American football was estimated using the 3 cumulative head impact indices (CHII-G, linear acceleration; CHII-R, rotational acceleration; and CHII, number of head impacts). Individual PVS volume was calculated in the white matter of structural MRI. Cognitive impairment was based on neuropsychological assessment. Linear regression models were used to assess associations of PVS volume with neuropsychological assessments in former American football players. All analyses were adjusted for confounders associated with PVS volume. Analyses included 224 participants (median [IQR] age, 57 [51-65] years), with 170 male former football players (114 former professional athletes, 56 former collegiate athletes) and 54 male unexposed control participants. Former football players had larger PVS volume compared with the unexposed group (mean difference, 0.28 [95% CI, 0.00-0.56]; P = .05). Within the football group, PVS volume was associated with higher CHII-R (β = 2.71 × 10-8 [95% CI, 0.50 × 10-8 to 4.93 × 10-8]; P = .03) and CHII-G (β = 2.24 × 10-6 [95% CI, 0.35 × 10-6 to 4.13 × 10-6]; P = .03). Larger PVS volume was also associated with worse performance on cognitive functioning in former American football players (β = -0.74 [95% CI, -1.35 to -0.13]; P = .04). These findings suggest that impaired perivascular brain clearance, as indicated by larger PVS volume, may contribute to the association observed between RHI exposure and neurodegeneration.

Intimate Partner Violence Against Women: Survivor’s Report on Well-Being and Perpetrator’s Attributions

ABSTRACT Intimate Partner Violence (IPV) against women persists as a critical public health and human rights issue, demanding nuanced understanding of its impacts and underlying dynamics. We performed cross-sectional, quantitative and qualitative, analyses on an online questionnaire from a snowball sample of 326 women aged 18 and above. Participants, defined as IPV-exposed (N = 202) and unexposed (N = 124), rated their well-being at the beginning and end of a relationship, based on 19 factors. Exposed women identified examples of the perpetrator’s attributions following violent episodes, which were analyzed and themed. No statistically significant disparity in well-being was observed between exposed and unexposed groups at the onset of the relationships. The trajectory of well-being then clearly diverged as the relationship progressed. Positive factors contributing to exposed women’s well-being declined, while negative factors increased, contrary to unexposed women. Three themes were found in the perpetrators’ attributions: (1) her personality traits and behavior (56%), (2) perpetrator’s external factors in life (33%), and (3) his distorted norms (11%). The results support and add to previous research on how to approach survivors as well as perpetrators of IPV.

A new understanding of the regulatory mechanism by which Fe/Mn nanoparticles boost Bisphenol A removal using Comamonas testosteroni

Green synthesized iron/manganese nanoparticles (Fe/Mn NPs), acted as an exogenous promoter to enhance the lignin-degrading bacteria Comamonas testosteroni FJ17 resulting in more efficient removal of bisphenol A (BPA). Batch experiments demonstrated that removal efficiency of BPA via cells at a BPA concentration of 10 mg·L−1 increased by 20.9 % when exposed to 100 mg·L−1 Fe/Mn NPs after 48 h (93.63 %) relative to an unexposed control group (72.70 %). TEM and 3D-EEM analysis confirmed that the cell membrane thickness increased from 47 to 80 nm under Fe/Mn NPs exposure, and the TB-EPS secretion was promoted. Meanwhile, Fe/Mn NPs facilitated greater electron transfer capacity of c-cytochrome (0.55 V reduction peak) and an unknown cytochrome substance (0.7 V oxidation peak) on the surface of cells. Studies of the effect of Fe/Mn NPs on both the growth and activity of laccase cells showed that both biomass and laccase secretion increased significantly during the logarithmic growth period (6–36 h). LC-MS analysis and toxicity assessment indicated that Fe/Mn NPs decreased the degradation time of BPA and efficiently reduced the toxicity of its by-products. Transcriptomic analysis revealed 315 up-regulation of the key genes associated with energy supply, membrane translocation, and metabolic pathways upon exposure to Fe/Mn NPs. Such as MFS transporter (2.27-fold), diguanylate cyclase (1.76-fold) and protocatechuate-3,4-dioxygenase (1.62-fold). Overall, Fe/Mn NPs accelerated proliferation by enhancing metabolic capacity and nutrient transport processes, which serves to improve the efficiency of BPA removal.

Impact of the Treatment-Free Interval on Health-Related Quality of Life in Patients with Early-Stage Serous Epithelial Ovarian Cancer

Background: Although the incidence of ovarian cancer is less than that of other female cancers, the morbidity and mortality associated with the disease course is high. Because treatment involves radical surgery and intense courses of chemotherapy, health-related quality of life (HRQOL) is often compromised. Most patients recur post-first-line therapy and undergo multiple rounds of chemotherapy. Thus, HRQOL is further disrupted. Objective: The aim of this study is to assess impact of the treatment-free interval on health-related quality of life in patients with early-stage serous epithelial ovarian cancer. Methods: The cross-sectional observational study was conducted in the Department of Gynecological Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total 38 women with histopathologically confirmed serous epithelial ovarian cancer were included in the study. Participants were divided into two groups according to their mutation status; patients with BRCA mutation were Exposed Group and those without BRCA mutation as Unexposed Group. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, maximum study subjects 26 (68.4%) were in &gt;45 years age group and 12 (31.6%) were in ≤45 years age group. Mean age of the study subjects was 52.43±4.22 years and majority of the patients 29 (76.3%) were literate and 9 (23.7%) were illiterate. About 25 (65.8%) respondents had family history of breast / ovarian cancer and 11 (28.9%) had no family history of breast / ovarian cancer. Majority 20 (52.6%) respondents underwent Primary Debulking Surgery as primary treatment modality, whereas 18 (47.4%) did not receive Primary Debulking Surgery and majority respondents 21 (55.3%) received neoadjuvant chemotherapy and interval debulking surgery, whereas 19 (44.7%) ..........

Whole-body exposure to filtered fraction of diesel exhaust induced localized testicular damage through attenuated functional response of glutathione-s-transferase in adult male Wistar rats

The possible vulnerability of the male reproductive system to environmental pollutants such as air pollution necessitates a thorough investigation of the underlying mechanisms involved in the dysregulation of male reproductive function. The present study was designed to investigate the influence of the filtered fraction of diesel exhaust (predominantly comprising gases) on male reproductive function in Wistar rat model. Adult male rats were randomly assigned into three groups (n=8/group): Control (unexposed) group (CG-A), the Clean air group in WBE chamber (CAG-A), and Filtered diesel exhaust group in WBE chamber (FDG-A). The exposure protocol for CAG-A and FDG-A was 6 h/day x 5d/week x 6 weeks,evaluation of sperm parameters, testicular histopathology, quantification of hormones (testosterone, LH, FSH, 17β-Estradiol, and prolactin), and GST levels were performed. Results showed that WBE to FDE leads to a significant decline in sperm concentration (p=0.008, CG-A vs FDG-A; p=0.014, CAG-A vs FDG-A), motility (p=0.008, CG-A vs FDG-A; p=0.029, CAG-A vs FDG-A), serum testosterone (p=0.024, CG-A vs FDG-A; p=0.007, CAG-A vs FDG-A), testicular testosterone (p=0.008, CG-A vs FDG-A; p=0.028, CAG-A vs FDG-A), 17β-Estradiol (p=0.007, CG-A vs FDG-A), and GST levels (p=0.0002, CG-A vs FDG-A; p=0.0019, CAG-A vs FDG-A). These findings demonstrate the disruption of testosterone-estradiol balance in the intratesticular milieu without significant alterations in other principal pituitary hormones in adult rats exposed to FDE. The predominant presence of gaseous components in FDE can cause testicular damage due to oxidative imbalance. This underscores the causality of FDE exposure and impaired male reproductive outcomes.