Interactions of plumbagin with five common antibiotics against <i>Staphylococcus aureus in vitro</i>

by Songtao Bie, Qiuyue Mo, Chen Shi, Hui Yuan, Chunshuang Li, Tong Wu, Wenlong Li, Heshui Yu

Staphylococcus aureus is the main culprit, causing a variety of severe clinical infections. At the same time, clinics are also facing the severe situation of antibiotic resistance. Therefore, effective strategies to address this problem may include expanding the antimicrobial spectrum by exploring alternative sources of drugs or delaying the development of antibiotic resistance through combination therapy so that existing antibiotics can continue to be used. Plumbagin (PLU) is a phytochemical that exhibits antibacterial activity. In the present study, we investigated the in vitro antibacterial activity of PLU. We selected five antibiotics with different mechanisms and inhibitory activities against S. aureus to explore their interaction with the combination of PLU. The interaction of combinations was evaluated by the Bliss independent model and visualized through response surface analysis. PLU exhibited potent antibacterial activity, with half maximal inhibitory concentration (IC₅₀) and minimum inhibitory concentration (MIC) values against S. aureus of 1.73 μg/mL and 4 μg/mL, respectively. Synergism was observed when PLU was combined with nitrofurantoin (NIT), ciprofloxacin (CPR), mecillinam (MEC), and chloramphenicol (CHL). The indifference of the trimethoprim (TMP)-PLU pairing was demonstrated across the entire dose-response matrix, but significant synergy was observed within a specific dose region. In addition, no antagonistic interactions were indicated. Overall, PLU is not only a promising antimicrobial agent but also has the potential to enhance the growth-inhibitory activity of some antibiotics against S. aureus, and the use of the interaction landscape, along with the dose-response matrix, for analyzing and quantifying combination results represents an improved approach to comprehending antibacterial combinations.

In quest of China sports lottery development path to common prosperity in 2035

by Yaping Yao, Bin Wan, Bo Long, Te Bu, Yang Zhang

Objectives

The China sports lottery contributes to sports and welfare causes. This study aims to construct a macro forecasting model supporting its sustained growth aligned with Vision 2035.

Methods

The modeling employed a distributional regression. Sales data of the China sports lottery from 2011 to 2022 were chosen as the response variable, alongside various macro- and event-level explanatory factors.

Results

A gamma distribution best fit the data. In the stable model spanning 2011–2019, urbanization, population dynamics, and FIFA emerged as significant contributors (Chi–square p Conclusions

Beyond offering original insights into the sales trajectory until 2035, specifically concerning new urbanization, negative population growth, and the FIFA effect, this macro forecasting framework can assist in addressing the policy priority of balancing growth with risk mitigation. We recommend policymakers connect market development with mass sports, potentially garnering a dual boost from the growing population of older consumers and the inherent benefits of a “FIFA (mass sports)” effect. A people-centered approach to the China sports lottery could significantly contribute to the long–range objectives of achieving common prosperity outlined in Vision 2035.

Incidence, pathogens and antimicrobial resistance of blood and cerebrospinal fluid isolates from a tertiary neonatal unit in South Africa: A 10 year retrospective review

by Reenu Thomas, Claude Ondongo-Ezhet, Nini Motsoaledi, Mike Sharland, Michelle Clements, Sithembiso Velaphi

Objective

To determine trends in incidence, etiology and antimicrobial susceptibility of blood and cerebrospinal fluid (CSF) culture confirmed infections in hospitalized infants in a large tertiary neonatal unit in South Africa.

Methods

Single-center, retrospective review of laboratory records of bacteria and fungi, and their susceptibility profiles, isolated from blood and CSF of infants hospitalized in the neonatal unit at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, from 1^st January 2010 to 31^st December 2019. Laboratory data on isolates and their antimicrobial susceptibilities were collected. Coagulase-negative Staphylococcus, Corynebacteria and Bacillus spp. were excluded. Patient-level clinical and laboratory data were not available.

Results

There were 8,319 significant isolates, giving an infection rate of 14.3/1000 patient-days. Infection rates increased from 12.0 to 15.7/1000 patient-days (estimated average yearly change 0.6[95%CI, 0.5–0.7];p = Acinetobacter baumannii (44%) and Klebsiella pneumoniae (39%). Carbapenem resistance was seen in 31% of all Gram-negatives and increased over time (estimated average yearly change 4.8%[95%CI,4.2%-5.3%];pStaphylococcus aureus was the most common Gram-positive isolated. Rates of methicillin-resistant Staphylococcus aureus decreased from 91% to 55%(estimated average yearly change -2.8%[95%CI,-3.5%–2%],pCandida parapsilosis (52%) and Candida albicans (35%) were the most common fungi isolated.

Conclusions

There has been a marked overall increase in rates of blood and/or CSF infections, with an absolute increase in Gram-negative infections observed, replacing Gram-positive and fungal pathogens. Extended spectrum beta-lactamase Gram-negative isolates are being replaced by carbapenem resistance, with around one third of all significant Gram-negative isolates now carbapenem resistant. Research into hospital based novel treatment and prevention interventions for neonatal sepsis should be urgently prioritized.

Exploring knowledge, perceptions, and practices of antimicrobials, and their resistance among medicine dispensers and community members in Kavrepalanchok District of Nepal

by Sabina Marasini, Sudim Sharma, Anjali Joshi, Surakshya Kunwar, Roshan Kumar Mahato, Archana Shrestha, Biraj Karmacharya

Background

Inappropriate use of antimicrobials is a global public health issue, particularly in developing countries, including Nepal, where over-the-counter sales and self-medication of antimicrobials are common.

Objectives

To explore knowledge, perceptions, and practices of antimicrobials and their resistance among medicine dispensers and community members in Nepal.

Methods

The study was conducted in three rural and five urban municipalities of the Kavrepalanchok district from May 2021 to August 2021. Data were collected using two qualitative approaches: In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). Data were analyzed using thematic analysis that combined deductive and inductive approaches to identify codes under pre-specified themes.

Results

A total of 16 In-depth interviews with medicine dispensers and 3 focus group discussions with community members were conducted. Knowledge regarding antimicrobial resistance varied among dispensers. Those with a prior educational background in pharmacy often had good knowledge about the causes and consequences of antimicrobial resistance. Meanwhile, consumers were less aware of antimicrobial resistance. Community members perceived antimicrobials as effective medicines but not long-term solution for treating diseases. They reported that dispensing without a prescription was common and that both consumers and dispensers were responsible for the inappropriate use of antimicrobials. On the contrary, several dispensers said that self-medication was common among the consumers, especially among more educated groups. The medicine dispensers and consumers expressed concerns about the weak enforcement of policies regarding pharmacy drug use and dispensing practices.

Conclusion

Promoting and strengthening the appropriate use of antimicrobials among medicine dispensers and community members is crucial. Bold policies and collective implementation of regulations could help combat antimicrobial resistance.

High-resolution genomic analysis to investigate the impact of the invasive brushtail possum (<i>Trichosurus vulpecula</i>) and other wildlife on microbial water quality assessments

by Marie Moinet, Lynn Rogers, Patrick Biggs, Jonathan Marshall, Richard Muirhead, Megan Devane, Rebecca Stott, Adrian Cookson

Escherichia coli are routine indicators of fecal contamination in water quality assessments. Contrary to livestock and human activities, brushtail possums (Trichosurus vulpecula), common invasive marsupials in Aotearoa/New Zealand, have not been thoroughly studied as a source of fecal contamination in freshwater. To investigate their potential role, Escherichia spp. isolates (n = 420) were recovered from possum gut contents and feces and were compared to those from water, soil, sediment, and periphyton samples, and from birds and other introduced mammals collected within the Mākirikiri Reserve, Dannevirke. Isolates were characterized using E. coli-specific real-time PCR targeting the uidA gene, Sanger sequencing of a partial gnd PCR product to generate a gnd sequence type (gST), and for 101 isolates, whole genome sequencing. Escherichia populations from 106 animal and environmental sample enrichments were analyzed using gnd metabarcoding. The alpha diversity of Escherichia gSTs was significantly lower in possums and animals compared with aquatic environmental samples, and some gSTs were shared between sample types, e.g., gST535 (in 85% of samples) and gST258 (71%). Forty percent of isolates gnd-typed and 75% of reads obtained by metabarcoding had gSTs shared between possums, other animals, and the environment. Core-genome single nucleotide polymorphism (SNP) analysis showed limited variation between several animal and environmental isolates (Escherichia clones are shared between possums, other wildlife, water, and the wider environment. These findings support the potential role of possums as contributors to fecal contamination in Aotearoa/New Zealand freshwater. Our study deepens the current knowledge of Escherichia populations in under-sampled wildlife. It presents a successful application of high-resolution genomic methods for fecal source tracking, thereby broadening the analytical toolbox available to water quality managers. Phylogenetic analysis of isolates and profiling of Escherichia populations provided useful information on the source(s) of fecal contamination and suggest that comprehensive invasive species management strategies may assist in restoring not only ecosystem health but also water health where microbial water quality is compromised.

Make or break: Succeeding in transition from incarceration

by Heba Shahaed, Sai Surabi Thirugnanasampanthar, Dale Guenter

Several factors impact successful reintegration after incarceration. We sought to better understand these factors such as pre-release preparedness or access to financial resources in provincial correctional facilities in Ontario, Canada with an underlying focus on the role of personal identification (PID) among people at risk of homelessness. We conducted a qualitative study with one-on-one telephone interviews. Eligibility criteria included having been released from a provincial correctional facility in the preceding 2 years, being over the age of 18, speaking English and having telephone access. Participants were recruited between February 2021 and July 2021. All interviews were audio recorded and transcribed. Data was analyzed using a thematic analysis framework along with strategies from grounded theory research. We interviewed 12 individuals and identified six key themes including 1) Degree of Preparedness Pre-Release 2) Managing Priorities Post-Release 3) Impact of Support Post-Release 4) Obstacles with Accessing Services 5) Influence of Personal Identification 6) Emotions and Uncertainty. We found that people with mental health and addiction challenges are uniquely at risk post-release. Solutions must include comprehensive and proactive case management that bridges the pre-release and post-release periods, simplified processes for obtaining PID, better connections to health and social services, and improved pre-release planning for community support.

Nutrient density of Bangladeshi foods and its application in planning diet for pregnant women

by Nazma Shaheen, Abira Nowar, Saiful Islam, Md. Hafizul Islam, Md. Ruhul Amin

Nutrient profiling is a method that classifies foods based on their nutrient content and identifies foods that are high in micronutrients both across and within food groups. This study aimed to identify foods that are rich sources of the seven micronutrients (iron, zinc, calcium, thiamine, riboflavin, vitamin A, and vitamin B₁₂) of public health concern for the Bangladeshi population._. This study developed a metric termed “naturally nutrient-rich score 7 (NNR₇)” specifically for third-trimester pregnant women to identify nutrient-dense foods. Further, it computed the nutrient adequacy score (NAS) of the top NNR₇-scored foods for seven micronutrients to assess the extent (percent) to which foods can meet pregnant women’s recommended dietary allowances (RDA). A linear programming technique was then used to construct a nutrient-adequate model diet for third-trimester pregnant women using the top ten NNR₇-scored foods. According to the NNR₇, food groups such as leafy vegetables, fish, meat, poultry and eggs, and vegetables are the richest sources of the problem micronutrients. Mutton liver (916.7%), soybean (39.3%), lamb liver (2160%) and duck liver (50.0%) were found to fulfill the highest percentage of the RDA of vitamin A, zinc, vitamin B_12, and iron, respectively. In the formulated nutrient-adequate diets for pregnant women, rice, potato, brown wheat flour, and soya oil were universal to all three diets and Bengal gram, orange, Ganges River sprat, and duck liver were the most common ones. The study findings highlight the need for the consumption of foods such as leafy vegetables, fish, meat, poultry, eggs, pulses and vegetables to increase the intake of problematic micronutrients. Planning a nutrient-adequate diet for pregnant women using linear programming can be an alternative approach to optimize and shape food choices to meet their nutritional requirements.

Visual acuity improvement in children with albinism beyond the first decade of life

by Claudia Yahalom, Ana Navarrete, Atara Juster, Ayan Galbinur, Anat Blumenfeld, Karen Hendler

Purpose

To determine if visual maturation continues beyond the first decade of life in children with albinism and whether this is related to albinism type, presence of nystagmus, eye muscle surgery or refractive errors.

Design

Case series based on retrospective study of children with confirmed genetic diagnosis of albinism.

Methods

Clinical data were obtained from medical files of children examined during school years, including albinism type, visual acuity, eye muscle surgery, nystagmus, and others on different visits (Visit 1: ages 7–9; Visit 2: ages: 10–12; Visit 3: ages 13–16; Visit 4: ages >16).

Results

Seventy-five children with albinism were included in the study. Patients were divided into different groups according to the albinism type including OCA1A: 17; OCA1B: 28; OCA2: 26; HPS: 3; OCA4: 1. Follow-up ranged from 3–13 years. Progressive visual acuity improvement was seen in all three main groups. T-test paired samples showed a statistically significant improvement when comparing vision from Visit 1 and Visit 3 in both OCA1A and OCA2 groups, with a mean vision improvement of 2 lines. There was no correlation between visual improvement and refractive error, eye muscle surgery or nystagmus.

Conclusion

An improved visual performance was seen in a large percentage of children with albinism during the second decade of life. The reason for this late improvement in vision is not clear but may be related to late foveal maturation or improvement in nystagmus with time. This information is useful for clinicians of these patients and when counseling parents.

Morphological and ultrastructural investigation of the posterior atlanto-occipital membrane: Comparing children with Chiari malformation type I and controls

by Vijay M. Ravindra, Lorraina Robinson, Hailey Jensen, Elena Kurudza, Evan Joyce, Allison Ludwick, Russell Telford, Osama Youssef, Justin Ryan, Robert J. Bollo, Rajiv R. Iyer, John R. W. Kestle, Samuel H. Cheshier, Daniel S. Ikeda, Qinwen Mao, Douglas L. Brockmeyer

Introduction

The fibrous posterior atlanto-occipital membrane (PAOM) at the craniocervical junction is typically removed during decompression surgery for Chiari malformation type I (CM-I); however, its importance and ultrastructural architecture have not been investigated in children. We hypothesized that there are structural differences in the PAOM of patients with CM-I and those without.

Methods

In this prospective study, blinded pathological analysis was performed on PAOM specimens from children who had surgery for CM-I and children who had surgery for posterior fossa tumors (controls). Clinical and radiographic data were collected. Statistical analysis included comparisons between the CM-I and control cohorts and correlations with imaging measures.

Results

A total of 35 children (mean age at surgery 10.7 years; 94.3% white) with viable specimens for evaluation were enrolled: 24 with CM-I and 11 controls. There were no statistical demographic differences between the two cohorts. Four children had a family history of CM-I and five had a syndromic condition. The cohorts had similar measurements of tonsillar descent, syringomyelia, basion to C2, and condylar-to-C2 vertical axis (all p>0.05). The clival-axial angle was lower in patients with CM-I (138.1 vs. 149.3 degrees, p = 0.016). Morphologically, the PAOM demonstrated statistically higher proportions of disorganized architecture in patients with CM-I (75.0% vs. 36.4%, p = 0.012). There were no differences in PAOM fat, elastin, or collagen percentages overall and no differences in imaging or ultrastructural findings between male and female patients. Posterior fossa volume was lower in children with CM-I (163,234 mm³ vs. 218,305 mm³, p Conclusions

In patients with CM-I, the PAOM demonstrates disorganized architecture compared with that of control patients. This likely represents an anatomic adaptation in the presence of CM-I rather than a pathologic contribution.

Educational technologies for teaching hand hygiene: Systematic review

by Daiane Rubinato Fernandes, Bruna Nogueira dos Santos, Carolina Scoqui Guimarães, Elaine Barros Ferreira, Amanda Salles Margatho, Paula Elaine Diniz dos Reis, Didier Pittet, Renata Cristina de Campos Pereira Silveira

Aim

To gather available scientific evidence on technologies used to teach hand hygiene to professional populations and lays involved in health care in the hospital setting. This systematic review was designed as proposed by Preferred Reporting Items for Systematic Reviews and Meta-Analysis, included studies reporting primary, original, quantitative research findings with no date limit and written in English, Spanish or Portuguese. The search was performed in the following electronic databases: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde, US National Library of Medicine, Scopus, Web of Science, Google Scholar and ProQuest. The eligibility criteria were applied independently by two reviewers to select the studies, first by reading the titles and abstracts on the Rayyan platform and then by full text reading of the eligible studies. After a descriptive analysis, the studies were subjected to critical evaluation of their methodological quality using JBI tools.

Results

Seven studies were included, addressing various methods for teaching hand hygiene using different technological resources, such as audiovisual electronic devices, videos, virtual reality, and gamification using tablets and smartphones, in different populations.

Conclusion

Using technologies to teach hand hygiene considerably helps patients, visitors, and relatives in learning the procedures and efficiently improves hand hygiene compliance rates among healthcare professionals, creating evidence-based repetitive learning opportunities for patients and caregivers.

AGO2-RIP-Seq reveals miR-34/miR-449 cluster targetome in sinonasal cancers

by Marco Tomasetti, Federica Monaco, Corrado Rubini, Marzia Rossato, Concetta De Quattro, Cristina Beltrami, Giacomo Sollini, Ernesto Pasquini, Monica Amati, Gaia Goteri, Lory Santarelli, Massimo Re

Sinonasal tumours are heterogeneous malignancies, presenting different histological features and clinical behaviour. Many studies emphasize the role of specific miRNA in the development and progression of cancer, and their expression profiles could be used as prognostic biomarkers to predict the survival. Recently, using the next-generation sequencing (NGS)-based miRNome analysis the miR-34/miR-449 cluster was identified as miRNA superfamily involved in the pathogenesis of sinonasal cancers (SNCs). In the present study, we established an Argonaute-2 (AGO2): mRNA immunoprecipitation followed by high-throughput sequencing to analyse the regulatory role of miR-34/miR-449 in SNCs. Using this approach, we identified direct target genes (targetome), which were involved in regulation of RNA-DNA metabolic, transcript and epigenetic processes. In particular, the STK3, C9orf78 and STRN3 genes were the direct targets of both miR-34c and miR-449a, and their regulation are predictive of tumour progression. This study provides the first evidence that miR-34/miR-449 and their targets are deregulated in SNCs and could be proposed as valuable prognostic biomarkers.

Trends in social determinants of inequality in child undernutrition from the Ethiopian Demographic and Health Surveys, 2005–2016

by Frehiwot Birhanu, Kiddus Yitbarek, Evan Atlantis, Mirkuzie Woldie, Firew Bobo

Background

While child undernutrition has been eliminated in some middle-income countries, it remains highly prevalent in sub-Sahara African (SSA) and South Asian regions, and is disproportionately concentrated among the poor. In this study, we estimated trends in child undernutrition by social determinants and related risks from wealth inequality in Ethiopia, from 2005 to 2016.

Method

We analyzed data from three consecutive surveys (2005, 2011, and 2016) from the Ethiopian Demographic and Health Survey. First, we estimated trends in the prevalence of childhood undernutrition variables (stunting, underweight, and wasting) and social determinants (household wealth status, education level, place of residence, and administrative regions). Then we assessed evidence of undernutrition by wealth-related inequality with concentration curves (visual) and concentration indeces (quantitative). A multilevel mixed-effect Poisson regression model was used to identify predictors of undernutrition variables expressed as covariate-adjusted rate ratios, with 95% confidence intervals (RRs, 95%CI).

Result

A total of 23,934 mother-child pairs were obtained from the three surveys. The average prevalence decreased by 12.4 percentage points for stunting (from 50.8 to 38.4%, P Conclusion

Despite the decreased burden of stunting and underweight, the prevalence of wasting remained relatively unchanged in Ethiopia from 2005 to 2016. Moreover, wealth-related inequality in child undernutrition increased for most of the child undernutrition indicators during this period. Social determinants of child undernutrition warrant urgent implementation of strategies to reduce their health impacts in SSA.

Nasopharyngeal carriage of <i>Streptococcus pneumoniae</i> among children <5 years of age in Indonesia prior to pneumococcal conjugate vaccine introduction

by Dodi Safari, Wa Ode Dwi Daningrat, Jennifer L. Milucky, Miftahuddin Majid Khoeri, Wisiva Tofriska Paramaiswari, Wisnu Tafroji, Korrie Salsabila, Yayah Winarti, Amin Soebandrio, Sri Rezeki Hadinegoro, Ari Prayitno, Lana Childs, Fabiana C. Pimenta, Maria da Gloria Carvalho, Tamara Pilishvili

Pneumococcal conjugate vaccines (PCVs) prevent nasopharyngeal colonization with vaccine serotypes of Streptococcus pneumoniae, leading to reduced transmission of pneumococci and stronger population-level impact of PCVs. In 2017 we conducted a cross-sectional pneumococcal carriage study in Indonesia among children aged

Challenges with pediatric antiretroviral therapy administration: Qualitative perspectives from caregivers and HIV providers in Kenya

by Michala Sliefert, May Maloba, Catherine Wexler, Frederick Were, Yvonne Mbithi, George Mugendi, Edward Maliski, Zachary Nicolay, Gregory Thomas, Shadrack Kale, Nicodemus Maosa, Sarah Finocchario-Kessler

Background

Current formulations of pediatric antiretroviral therapy (ART) for children with HIV present significant barriers to adherence, leading to drug resistance, ART ineffectiveness, and preventable child morbidity and mortality. Understanding these challenges and how they contribute to suboptimal adherence is an important step in improving outcomes. This qualitative study describes how regimen-related challenges create barriers to adherence and impact families.

Methods

We conducted key informant interviews (KIIs) with 30 healthcare providers and 9 focus group discussions (FGDs) with a total of 72 caregivers, across three public hospitals in Siaya and Mombasa Kenya. The KIIs and FGDs were audio recorded, translated, and transcribed verbatim. The transcripts were hand coded based on emergent and a-priori themes.

Results

Caregivers discussed major regimen-related challenges to adherence included poor palatability of current formulations, complex preparation, and administration (including measuring, crushing, dissolving, mixing), complex drug storage, and frequent refill appointments and how these regimen-related challenges contributed to individual and intrapersonal barriers to adherence. Caregivers discussed how poor taste led to child anxiety, refusal of medications, and the need for caregivers to use bribes or threats during administration. Complex preparation led to concerns and challenges about maintaining privacy and confidentiality, especially during times of travel. Providers corroborated this patient experience and described how these challenges with administration led to poor infant outcomes, including high viral load and preventable morbidity. Providers discussed how the frequency of refills could range from every 2 weeks to every 3 months, depending on the patient. Caregivers discussed how these refill frequencies interrupted work and school schedules, risked unwanted disclosure to peers, required use of financial resources for travel, and ultimately were a challenge to adherence.

Conclusion

These findings highlight the need for improved formulations for pediatric ART to ease the daily burden on caregivers and children to increase adherence, improve child health, and overall quality of life of families.

MAGA Republicans’ views of American democracy and society and support for political violence in the United States: Findings from a nationwide population-representative survey

by Garen J. Wintemute, Sonia L. Robinson, Elizabeth A. Tomsich, Daniel J. Tancredi

Background

Identifying groups at increased risk for political violence can support prevention efforts. We determine whether “Make America Great Again” (MAGA) Republicans, as defined, are potentially such a group.

Methods

Nationwide survey conducted May 13-June 2, 2022 of adult members of the Ipsos KnowledgePanel. MAGA Republicans are defined as Republicans who voted for Donald Trump in the 2020 presidential election and deny the results of that election. Principal outcomes are weighted proportions of respondents who endorse political violence, are willing to engage in it, and consider it likely to occur.

Findings

The analytic sample (n = 7,255) included 1,128 (15.0%) MAGA Republicans, 640 (8.3%) strong Republicans, 1,571 (21.3%) other Republicans, and 3,916 (55.3%) non-Republicans. MAGA Republicans were substantially more likely than others to agree strongly/very strongly that “in the next few years, there will be civil war in the United States” (MAGA Republicans, 30.3%, 95% CI 27.2%, 33.4%; strong Republicans, 7.5%, 95% CI 5.1%, 9.9%; other Republicans, 10.8%, 95% CI 9.0%, 12.6%; non-Republicans, 11.2%, 95% CI 10.0%, 12.3%; p Interpretation

MAGA Republicans, as defined, are more likely than others to endorse political violence. They are not more willing to engage in such violence themselves; their endorsement may increase the risk that it will occur.

Prevalence of undernutrition and associated factors among street adolescents in adama town, oromia regional state, Ethiopia, 2023: A cross sectional study

by Tsinukal Tesfaye, Ebissa Bayana Kebede, Vinod Bagilkar, Fentahun Meseret

Background

Undernutrition remains a serious public health problem in developing countries, including Ethiopia. In particular, street adolescents are more at risk for undernutrition because they are the most underprivileged population. However, there is a paucity of information about undernutrition among street adolescents in Ethiopia.

Objective

To assess the prevalence of undernutrition (stunting and thinness) and factors associated with undernutrition among street adolescents in Adama town, Oromia regional state, Ethiopia, 2023.

Method

A community-based cross sectional study was conducted among 358 street adolescents from January 15–30, 2023. A convenience sampling technique was used to select the required sample size. A structured, interviewer-administered questionnaire was used to collect the data from the respondents. The collected data were checked, coded, entered into Epidata 4.6 and exported to Statistical Package for Social Sciences version 25. Both Bivariable and Multivariable logistic regression analyses were conducted to determine the factors that are associated with thinness and stunting. P values below 0.05 at the 95% confidence interval were considered indicative of a statistically significant association. Finally, statements, graphs, tables and charts were used for result presentation.

Result

This study revealed that, the prevalence of undernutrition was 47.2%. Thinness and stunting accounted for 20.4% and 34.1% respectively and 7.3% both thinness and stuting. Age (adusted odd ratio = 1.41; 95% confidence interval: 1.17–1.71), skipped one or more meals per day ((adusted odd ratio = 3.50; 95% confidence interval: 1.23–9.94), drinking unprotected water source ((adusted odd ratio = 3.23; 95% confidence interval: 1.49–6.98) and use of mastish ((adusted odd ratio = 2.91; 95% confidence interval: 1.19–7.12) were factors statistically associated with thinness. Being skipped one or more meals per day ((adusted odd ratio = 4.14; 95% confidence interval: 1.87–9.14), washing hands before meals ((adusted odd ratio = 0.46; 95% confidence interval: 0.26–0.81) and moderate depression ((adusted odd ratio = 2.93; 95% confidence interval: 1.05–8.15) were factors significantly associated with stunting.

Conclusion and recommendation

In conculusion, the prevalence of undernutrition (thinness, stunting or both together) was high among street adolescents. To enhance street adolecents’ nutritional status, targeted nutritional treatments, providing health services and good hygiene and sanitatios practices are urgently needed.

Feasibility and metabolic outcomes of a well-formulated ketogenic diet as an adjuvant therapeutic intervention for women with stage IV metastatic breast cancer: The Keto-CARE trial

by Alex Buga, David G. Harper, Teryn N. Sapper, Parker N. Hyde, Brandon Fell, Ryan Dickerson, Justen T. Stoner, Madison L. Kackley, Christopher D. Crabtree, Drew D. Decker, Bradley T. Robinson, Gerald Krystal, Katherine Binzel, Maryam B. Lustberg, Jeff S. Volek

Purpose

Ketogenic diets may positively influence cancer through pleiotropic mechanisms, but only a few small and short-term studies have addressed feasibility and efficacy in cancer patients. The primary goals of this study were to evaluate the feasibility and the sustained metabolic effects of a personalized well-formulated ketogenic diet (WFKD) designed to achieve consistent blood beta-hydroxybutyrate (βHB) >0.5 mM in women diagnosed with stage IV metastatic breast cancer (MBC) undergoing chemotherapy.

Methods

Women (n = 20) were enrolled in a six month, two-phase, single-arm WFKD intervention (NCT03535701). Phase I was a highly-supervised, ad libitum, personalized WFKD, where women were provided with ketogenic-appropriate food daily for three months. Phase II transitioned women to a self-administered WFKD with ongoing coaching for an additional three months. Fasting capillary βHB and glucose were collected daily; weight, body composition, plasma insulin, and insulin resistance were collected at baseline, three and six months.

Results

Capillary βHB indicated women achieved nutritional ketosis (Phase I mean: 0.8 mM (n = 15); Phase II mean: 0.7 mM (n = 9)). Body weight decreased 10% after three months, primarily from body fat. Fasting plasma glucose, plasma insulin, and insulin resistance also decreased significantly after three months (p Conclusions

Women diagnosed with MBC undergoing chemotherapy can safely achieve and maintain nutritional ketosis, while improving body composition and insulin resistance, out to six months.

Atrial fibrillation as a novel risk factor for retinal stroke: A protocol for a population-based retrospective cohort study

by Jay B. Lusk, Lauren Wilson, Vinit Nalwade, Ailin Song, Matthew Schrag, Valerie Biousse, Fan Li, Sven Poli, Jonathan Piccini, Ying Xian, Emily O’Brien, Brian Mac Grory

Central retinal artery occlusion (CRAO; retinal stroke or eye stroke) is an under-recognized, disabling form of acute ischemic stroke which causes severe visual loss in one eye. The classical risk factor for CRAO is ipsilateral carotid stenosis; however, nearly half of patients with CRAO do not have high-grade carotid stenosis, suggesting that other cardiovascular risk factors may exist for CRAO. Specifically, prior studies have suggested that cardioembolism, driven by underlying atrial fibrillation, may predispose patients to CRAO. We describe the design of an observational, population-based study in this protocol. We evaluate two specific objectives: 1) To determine if atrial fibrillation is an independent risk factor for CRAO after adjusting for medical and cardiovascular risk; 2) To determine if use of oral anticoagulation can modify the risk of CRAO for patients with atrial fibrillation. This protocol lays out our strategy for cohort definition, case and control definition, comorbidity ascertainment, and statistical methods.

Puberty, brain network connectivity and neuropsychiatric outcomes following pediatric traumatic brain injury in females: A research protocol

by Abigail Livny, Tamar Silberg

Background

Examining the role of sex on recovery from pediatric TBI (pTBI) is a complex task, specifically when referring to injuries occurring during critical developmental and maturation periods. The effect of sex hormones on neurological and neuropsychiatric outcomes has been studied among adult TBI females, but not in children. During development, puberty is considered a key milestone accompanied by changes in physical growth, neuronal maturation, sex hormones, and psychological symptoms. Following pTBI, such changes might have a significant effect on brain re-organization and on long-term neuropsychiatric outcomes. While hormonal dysfunction is a common consequence following pTBI, only few studies have systematically evaluated hormonal changes following pTBI.

Aims

To describe a multimodal protocol aimed to examine the effect of puberty on brain connectivity and long-term neuropsychiatric outcomes following TBI in female girls and adolescents.

Methods

A case-control longitudinal prospective design will be used. 120 female participants aged 9 to 16 years (N = 60 per group) will be recruited. In the acute phase (T0-1 month), participants will undergo an MRI protocol for brain connectivity, as well as a clinical evaluation for puberty stage and hormonal levels. In the chronic phase (T1-18-24 months), participants will complete a neuropsychiatric assessment in addition to the MRI and puberty evaluations. Hormonal levels will be monitored at T0 and T1. A moderation-mediation model will be used to examine the moderating effects of puberty on the association between pTBI and neuropsychiatric symptoms in female girls and adolescents, through the mediating effect of brain network connectivity.

Significance

This study will highlight sex-specific factors related to outcomes among females following pTBI and enhance our understanding of the unique challenges they face. Such information has a substantial potential to guide future directions for research, policy and practice.

Portosystemic shunting prevents hepatocellular carcinoma in non-alcoholic fatty liver disease mouse models

by Andrea Peloso, Stéphanie Lacotte, Quentin Gex, Florence Slits, Beat Moeckli, Graziano Oldani, Matthieu Tihy, Aurélie Hautefort, Brenda Kwak, Laura Rubbia-Brandt, Christian Toso

Background and aims

Non-alcoholic fatty liver disease (NAFLD) is one of the leading cause of hepatocellular carcinoma (HCC). This association is supported by the translocation of bacteria products into the portal system, which acts on the liver through the gut-liver axis. We hypothesize that portosystemic shunting can disrupt this relationship, and prevent NAFLD-associated HCC.

Methods

HCC carcinogenesis was tested in C57BL/6 mice fed a high-fat high-sucrose diet (HFD) and injected with diethylnitrosamine (DEN) at two weeks of age, and in double transgenic LAP-tTA and TRE-MYC (LAP-Myc) mice fed a methionine-choline-deficient diet. Portosystemic shunts were established by transposing the spleen to the sub-cutaneous tissue at eight weeks of age.

Results

Spleen transposition led to a consistent deviation of part of the portal flow and a significant decrease in portal pressure. It was associated with a decrease in the number of HCC in both models. This effect was supported by the presence of less severe liver steatosis after 40 weeks, and lower expression levels of liver fatty acid synthase. Also, shunted mice exhibited lower liver oxygen levels, a key factor in preventing HCC as confirmed by the development of less HCCs in mice with hepatic artery ligation.

Conclusions

The present data show that portosystemic shunting prevents NAFLD-associated HCC, utilizing two independent mouse models. This effect is supported by the development of less steatosis, and a restored liver oxygen level. Portal pressure modulation and shunting deserve further exploration as potential prevention/treatment options for NAFLD and HCC.