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Understanding the pathogenesis of uveitis in Ebola virus disease survivors: an observational cohort and cross-sectional study protocol for clinical, molecular virologic and immunologic characterisation

Por: Hartley · C. D. · Linderman · S. · Fashina · T. · Ward · L. · Drews-Botsch · C. · Pratt · C. · Kuthyar · S. · Fernandes · A. F. · Huang · Y. · Choo · C. · Nguyen · N. · Carag · J. · Morgan · J. · Kraft · C. S. · Hewlett · A. · Brett-Major · D. · Schieffelin · J. S. · Garry · R. F. · Grant
Introduction

The 2013–2016 Western African outbreak of the Ebola virus disease (EVD), the largest recorded outbreak since the discovery of Ebola virus (EBOV) in 1976, destabilised local health systems and left thousands of survivors at risk for postacute sequelae, including vision-threatening uveitis. In an EVD survivor with severe panuveitis, the detection of persistent EBOV in the aqueous humour, long after clearance of acute viremia, focused clinical and research attention on the host-EBOV interaction in the unique terrain of ocular immune privilege. Despite the recognition that uveitis is common and consequential in EVD survivors, our understanding of pathogenesis is extremely limited, including the contributions of viral persistence and ocular-specific and systemic immune responses to disease expression. In this study protocol, we outline a multifaceted approach to characterise EVD-associated intraocular inflammation, including the clinical phenotype and complications; the presence of EBOV (or EBOV RNA/antigen) in ocular fluids and tissues; and associated local ocular-specific and peripheral immune responses.

Methods and analysis

We use an observational cohort design, which includes EVD survivors and close contacts of EVD survivors (ie, no documented history of EVD), and we propose disease (clinical examination and imaging), as well as molecular, virologic and immunologic characterisation, to meet research objectives.

Ethics and dissemination

This study has received Institutional Review Board approval from University of Nebraska Medical Centre, Emory University and Sierra Leone Ministry of Health. Findings will be disseminated through peer-reviewed publications.

Kidney failure risk equation to predict kidney transplant failure in individuals with an eGFR<30 mL/min/1.73 m2: a UK Renal Registry external validation and recalibration study

Por: Masoud · S. · Bello · A. · Santhakumaran · S. · Casula · A. · Maher · F. · Benoy-Deeney · F. · Medcalf · J. · Major · R. · Nitsch · D.
Objectives

To externally validate and subsequently repurpose/recalibrate the easily accessible kidney failure risk equation (KFRE) for a prevalent transplant population with an estimated glomerular filtration rate (eGFR)

Design

Retrospective cohort study using UK Renal Registry data.

Setting

68 adult UK kidney centres.

Participants

4092 patients with grafts at least 2 years old and eGFR2 from 2009 to 2018.

Primary outcome measure

Death-censored allograft failure at 2 years, defined as dialysis initiation, re-transplantation or, in the absence of the former two, the recorded date of transplant failure.

Prognostic model validation

The KFRE was calculated at baseline using the 2-year, 8-variable non-North American KFRE, and performance was assessed using Harrell’s C-statistic and calibration plots. The model was recalibrated using Cox Regression (2009–2013 cohort) and temporally validated using the 2014–2018 cohort. Clinical utility was assessed using decision-curve analysis, estimating per-100-patient gains in timely planning and reductions in unnecessary interventions compared with eGFR triggers.

Results

The original KFRE had excellent discrimination but was miscalibrated, underpredicting graft failure. Temporal validation demonstrated that the performance of the recalibrated KFRE could be maintained across time periods (Harrell’s C-index of 0.81 (95% CI 0.80 to 0.83); O/E (Observed/Expected events) ratio 1.00 (95% CI 0.93 to 1.07). It identified 9/100 more patients for timely intervention and 13/100 more for whom intervention could be delayed compared with a late clinical trigger of an eGFR2.

Conclusions

While there are other prognostic models, this is the first study to focus on the understudied and clinically important cohort of patients with an eGFR

Evaluating economic outcomes in the management of temporomandibular disorders: a protocol for a systematic review of randomised controlled trials

Por: Komarraju · P. · AlSabbagh · B. · Ohinmaa · A. · Armijo-Olivo · S. · Morris · M. · Li · J. · Major · P. W. · Goldberg · M. · Naik · A. · Abdelkarim · A. · Velly · A. M.
Introduction

Systematic reviews (SRs) on the management of temporomandibular disorders (TMDs) have predominantly focused on evaluating the effectiveness of various treatments, identifying those that provide the greatest benefits. However, the economic evaluation of these treatments has not been systematically explored. This SR aims to address this gap by evaluating the economic outcomes of the most common treatment modalities for TMDs, including cost-effectiveness, cost-utility, cost-benefit, cost-minimisation and the burden of illness.

Methods and analysis

This SR will be conducted using the following electronic databases Business Source Complete, CINAHL, EconLit (ProQuest), Embase (Ovid), MEDLINE (PubMed), MEDLINE (Ovid) and Scopus to identify studies evaluating the economic outcomes of treatments for TMDs. The eligibility criteria are as follows: (1) studies examining the costs and/or impact of treatments for TMDs and (2) articles published between 2000 and 2025. The primary outcomes of interest are the economic findings outlined earlier. Data extraction will include the following: author(s), year of publication, country, study objectives, study design, eligibility criteria, TMD diagnosis and screening, study groups, randomisation, blinding, sample size, number of participants invited, enrolled and completed, duration of treatment, follow-up, study duration, settings, assessment instruments, study outcomes, statistical analyses, results, limitations, strengths and funding sources. The quality of studies will be evaluated using the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist, with risk of bias assessed using the Cochrane Effective Practice and Organization of Care’s risk-of-bias tool; where applicable, the Outcome Reporting Bias in Trials will be used to detect reporting biases. A narrative synthesis and summary tables will outline study characteristics, economic outcomes and the overall quality of evidence. We will conduct qualitative secondary and sensitivity analyses.

Ethics and dissemination

This SR does not require an ethics approval. The results will be disseminated through international and national conferences and peer-reviewed journals.

PROSPERO registration number

CRD42024613553.

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