The range and reach of qualitative research in neurosurgery: A scoping review

by Charlotte J. Whiffin, Kathleen Joy O. Khu, Brandon G. Smith, Isla Kuhn, Santhani M. Selveindran, Laura Hobbs, Samin Davoody, Yusuf Docrat, Orla Mantle, Upamanyu Nath, Lara Onbaşı, Stasa Tumpa, Ignatius N. Esene, Harry Mee, Fergus Gracey, Shobhana Nagraj, Tom Bashford, Angelos G. Kolias, Peter J. Hutchinson

Following calls for more qualitative research in neurosurgery, this scoping review aimed to describe the range and reach of qualitative studies relevant to the field of neurosurgery and the patients and families affected by neurosurgical conditions. A systematic search was conducted in September 2024 across six databases: Medline via Ebsco; Embase via OVID; PsycINFO via Ebsco; Scopus; Web of Science Core Collection; and Global Health via Ebsco. Eligibility criteria were based on Population, Concept, and Context. The search identified 18,809 hits for screening with 812 included in the final analysis. Seven themes were identified from a content analysis of study aims: 1 Perspectives of living with a neurosurgical condition; 2 Family perspectives; 3 Perceptions of neurosurgery; 4 Perceptions of general healthcare care; 5 Decision making; 6 Advancing neurosurgery; and, 7 Understanding neurosurgical conditions. Traumatology was identified as the most researched sub-specialty (43.2%) yet few studies were led explicitly by a neurosurgeon (1.6%) or those with a neurosurgical affiliation (10.5%). Lead authors were predominantly from high income countries (93.7%), as were most multi-author teams (86.6%). There was a trend towards increasing publication over time; however, only 8.4% of papers were published in neurosurgical specific journals. The data set had an average Field Weighted Citation Impact of 0.96 and Field Weighted Views Impact of 1.11, 18.9% were cited in policy documents in 15 countries. This scoping review provides a comprehensive picture of the current qualitative research base in neurosurgery and suggests ways to improve the conduct and reporting of such studies in the future. Addressing these challenges is crucial if qualitative research is to advance the neurosurgical evidence base in a rigorous way.

Breakfast consumption patterns and associated factors among adolescent high-school students in Tullo District, Eastern Ethiopia

by Natnael Teferi, Tara Wilfong, Dawit Firdisa, Samrawit Berihun, Behailu Hawulte

Background

There is growing proof to recommend eating breakfast has positive health and school-related outcomes for adolescents, including improved performance, attention, brain development, and physical growth. However, there is a dearth of evidence on the comprehensive understanding of breakfast consumption patterns and associated factors. Therefore, this study aimed to assess breakfast consumption patterns and their associated factors among adolescent high school students in the Tullo district, Eastern Ethiopia.

Methods

An institution-based cross-sectional study design was conducted among 405 randomly selected adolescent high school students in the Tullo District, Eastern Ethiopia, from October 09–29, 2023. A self-administered questionnaire was utilized to collect the data. Epidata version 4.6 and SPSS Statistics version 27.0.1 were used for data entry and analysis, respectively. Both bivariable and multivariable logistic regression analyses were performed to identify the factors associated with breakfast consumption patterns. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was calculated to determine the strength of the association, and a p-value of 0.05 was used to determine statistical significance.

Result

Nearly half, 46.2% (95% CI: 41.5, 51.4), of participants had irregular breakfast consumption (skipped). Being female (AOR = 5.28; 95% CI: 2.69, 10.36), family size of >5 (AOR = 4.76; 95% CI: 2.41, 9.36), being a rural resident (AOR = 3.34; 95% CI: 1.78, 6.25), no formal maternal education (AOR = 3.89; 95% CI: 2.09, 7.22), chewing khat (AOR = 3.13; 95% CI: 1.59, 6.16), cigarette smoking (AOR = 3.06; 95% CI: 1.02, 9.17), and eating disorders (AOR = 6.54; 95% CI: 2.19, 19.43) were significantly associated with irregular breakfast consumption patterns among adolescents.

Conclusion

The findings of this study showed that the prevalence of irregular breakfast consumption (breakfast skipping) among adolescent high school students was high. Being female, rural residency, no formal maternal education, current smoking of cigarettes, current khat chewing, and eating disorders were identified as factors associated with breakfast consumption patterns. Given that almost half of adolescents in Tullo District skip breakfast, several modifiable factors associated with this practice, focused interventions are essential.

Absence of item origin bias on a Brazilian interinstitutional Progress Test examination: A pooled analysis of items approach

by Pedro Tadao Hamamoto Filho, Maria de Lourdes Marmorato Botta Hafner, Zilda Maria Tosta Ribeiro, Alba Regina de Abreu Lima, Leandro Arthur Diehl, Neide Tomimura Costa, Maria Cristina de Andrade, Samira Yarak, Patrícia Moretti Rehder, Júlio César Moriguti, Angélica Maria Bicudo

Background

It has been proposed that the school origin of items for cross-institutional Progress Tests (PTs) may introduce a bias in favour of students from the same school, posing a potential threat to the validity and reliability of PT results and cross-institutional comparisons. The aim of this study was to examine whether origin bias is present in a Brazilian cross-institutional PT examination.

Methods

This study conducted a cross-sectional analysis of seven schools affiliated with the oldest PT consortium in Brazil, utilising a pooled analysis of differences in students’ performance concerning self and non-self items. A proportional meta-analysis of the items’ rate differences and confidence intervals with random effects was performed, providing an odds ratio (OR) for self and non-self items. Differences between the two groups of items were assessed by scrutinising whether the OR and 95% confidence intervals overlapped.

Results

The findings indicated no discernible differences in psychometric indices based on the school responsible for item creation. Three schools consistently demonstrate superior performance on items authored by their faculty, however, these they also excelled on non-self items. Furthermore, an overlap in the 95% confidence intervals for both self and non-self items was observed across all seven schools.

Conclusions

In contrast to prior reports, this study revealed the absence of origin bias, suggesting that adoption of best practices in blueprinting, item writing, and editing may have played a role in mitigating such bias.

Prolonged secondary hyperparathyroidism in adenine-induced CKD leads to skeletal changes consistent with skeletal hyporesponsiveness to PTH

by Corinne E. Metzger, Landon Y. Tak, Samantha Scholz, Matthew R. Allen

High circulating parathyroid hormone (PTH) leading to secondary hyperparathyroidism is proposed to be a key driver of the skeletal phenotype of chronic kidney disease-mineral bone disorder (CKD-MBD) leading to high bone turnover and cortical bone deterioration. The association between high PTH and the skeletal phenotype is typically clearly demonstrated in preclinical models of CKD; however, clinical studies show the relationship between PTH and skeletal outcomes is not as clear. The clinical data have led to a proposed hyporesponsiveness to PTH in the CKD setting with unclear causes. In the current study, we assessed skeletally mature male C57BL/6J mice at 12-weeks and 21-weeks of adenine-induced CKD (Ad) with the second timepoint seven weeks longer than we have previously assessed. We found that serum BUN was high in Ad mice in both groups indicating the presence of kidney disease while PTH was higher in 21-wk Ad vs. 12-wk Ad. Despite the higher PTH, bone formation rate in 21-wk Ad mice was lower than 21-wk Ad mice. Additionally, immunohistochemical assessment of the PTH receptor, PTHR1, and RANKL, a key factor upregulated by PTH, showed a lower percentage of osteocytes positive for the proteins in 21-wk Ad vs. 12-wk Ad. Furthermore, regression analyses demonstrated a positive relationship between serum PTH and PTHR1 and RANKL at 12-weeks, but this relationship was lost by 21-weeks. Overall, these data indicate that prolonged exposure to continuously elevated PTH in adenine-induced CKD mice eventually led to an altered skeletal response indicating lower responsiveness of bone, particularly osteocytes, to the chronic PTH signal. This has implications for using PTH as a surrogate marker of bone outcomes in CKD as well as pointing to the need to better understand the time-based relationship between PTH and skeletal outcomes in CKD.

Gram-negative bacterial sepsis, antimicrobial susceptibility pattern and treatment outcomes at two neonatal intensive care units in Addis Ababa, Ethiopia: A retrospective observational study

by Biniyam Tedla Mamo, Zelalem Tazu Bonger, Feyissa Regassa Senbato, Tadesse Eguale, Kibrewossen Kiflu Akililu, Samuel Muluye Welelaw, Eden Dagnachew Zeleke, Asrat Demtse, Turegne Assefa, Ruth Woldeyohannes Yirgu, Zelalem Mekuria, Joan-Miquel Balada-Llasat, Shu-Hua Wang

Background

Neonatal sepsis is a leading cause of mortality and morbidity. To improve the clinical outcomes of neonates with sepsis, treatment should be based on bacteriological identification and antibiotic susceptibility. This study aims to assess the proportion of culture-positive gram-negative bacteria (GNB), the antibiotic susceptibility patterns, and treatment outcomes of neonatal sepsis at two neonatal intensive care units (NICUs) in Addis Ababa.

Methods

A retrospective observational study was conducted among gram-negative sepsis suspected neonates admitted at Zewditu Memorial Hospital and Tikur Anbessa Specialized Hospital NICUs from January to December 2023. All neonates who were suspected of having sepsis were included in this study. Standard microbiological culture and biochemical tests were used to identify bacterial species and the Kirby-Bauer disc diffusion assay using Mueller-Hinton agar was employed to test the antimicrobial susceptibility of bacterial isolates as per Clinical Laboratory Standard Institute guidelines. Descriptive statistics were used to describe the study variables. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with the treatment outcomes of neonatal sepsis. A p-value  Results

A total of 933 neonates were diagnosed with sepsis during the study period, of which 166 neonates were enrolled in the study for gram-negative sepsis: 84 (51%) were female and 97 (58%) had early onset sepsis. The median length of hospital stay was nine days with interquartile range of 16 days. The predominant GNB identified was Klebsiella spp. (n = 89; 49%), followed by Acinetobacter spp. (n = 38; 21%) and Escherichia coli (n = 19; 11%). In both hospitals, Klebsiella spp. was resistant to most of the routinely prescribed antibiotics: (n = 68; 89%) were resistant to ceftriaxone, (n = 56, 89%) cefepime and (n = 60; 75%) to gentamicin. Lower rates of resistance were recorded for other antibiotics such as ciprofloxacin (n = 12; 18%), ertapenem (n = 11; 16%), meropenem (n = 9; 13%), and amikacin (n = 3; 4%). A total of 92 (55%) neonates with the GNB isolated in the current study had multidrug-resistant (MDR) organisms. The study found that newborns with MDR infections were five times more likely to experience poor treatment outcomes compared to those with non-resistant strains (AOR, 5.23 95% CI [2.59, 11.11]). In addition, newborns who stayed less than seven days, compared to those who spent seven or more days in the hospital was four times (AOR: 4.16, 95% CI (2.0–9.01) more likely to experience poor health outcomes.

Conclusion

Klebsiella spp. was the most common GNB isolated from the NICUs. More than half neonatal sepsis was caused by MDR organisms and associated with significant poor treatment outcomes. high prevalence of MDR-gram-negative bacteremia is alarming and highlights the need for the implementation of routine surveillance and infection control measures to decrease morbidity and mortality and to combat the development of antimicrobial resistance.

Burnout syndrome and healthy lifestyle among Egyptian physicians: A cross-sectional study

by Nehal Mohamed Eisa, Mohamed A. M. El-Tabakh, Nourhan M. Kamal, Sara M. Gharbia, Mahmoud M. Samir, Wajid Syed, Mahmood Basil A. Al-Rawi, Ahmed Essam Abou Warda, Abdelrahman S. H. Refaee

Introduction

The phenomenon of burnout and the lifestyle of physicians significantly influence the delivery of healthcare. Over time, burnout intensifies, negatively impacting professional performance, which in turn leads to decreased quality of treatment, patient satisfaction, and productivity. Additionally, it increases the occurrence of medical mistakes and turnover among physicians. In addition to the direct influence of lifestyle on those components.

Aim of the study

The purpose of this study is to assess burnout syndrome among Egyptian physicians, as well as to investigate factors that contribute to burnout, especially demographic characteristics, lifestyle patterns, and health habits.

Methods

A cross-sectional study examined burnout prevalence and determinants among 502 Egyptian physicians in different governorates. An electronic questionnaire was used to collect data for the study. Questionnaire covered socio-demographics, The abbreviated Maslach Burnout Inventory (aMBI), and The Health Lifestyle and Personal Control Questionnaire (HLPCQ).

Results

Younger physicians under 30 showed higher burnout on emotional exhaustion and depersonalization scales, with significant findings (P = 0.047), (P Conclusion

These findings highlight the intricate relationship between burnout and lifestyle among physicians. A healthy lifestyle, including diet, routines, social support, and physical activity was linked to reduced burnout, while dietary harm avoidance was negatively correlated. This suggests opportunities to enhance the well-being of medical professionals through lifestyle interventions.

Urdu adaptation and validation of a disease-specific quality-of-life questionnaire in a Pakistani population of Achalasia

by Sameen Abbas, Syed Sikandar Shah, Tayyab Saeed Akhhtar, Kiran Hameed, Saima Mushtaq, Amjad Khan

Background

Achalasia, a rare esophageal disease marked by dysphagia, impacts health-related quality-of-life (HRQoL), measurable by disease-specific tools like achalasia-specific questionnaire (ASQ) that assess symptom severity and QoL. However, to ensure its reliability and validity across different populations, cross-cultural adaptation is necessary. So, for this reason, this study aimed to validate an Urdu-translated version of an ASQ in a Pakistani population of achalasia patients.

Methodology

A prospective cross-sectional study involving 52 participants was conducted at the Center for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi. ASQ was translated into the Urdu language by a forward-backwards translation process with expert input. Validation included factor analysis, known-group techniques, Cronbach’s alpha for reliability, and an independent t-test comparing ASQ scores with Eckardt scores for criterion validity.

Results

Among 52 participants (27 males, median age 30 years; 25 females, median age 48 years), 63.5% had Achalasia type I, 26.9% type II, and 9.6% type III. Factor analysis confirmed a well-defined construct with good validity, and internal consistency was strong (Cronbach’s alpha = 0.89). The ASQ scores significantly correlated with Eckardt scores (p Conclusion

Urdu-translated ASQ proved to have good psychometric properties, with strong evidence of validity, reliability, and feasibility regarding health status in Pakistani achalasia patients. It can be recommended as a reliable QoL measure for clinical and research purposes. Future studies should explore its application in larger, more diverse cohorts and further refine its use in achalasia management.

Multivariate Gaussian Bayes classifier with limited data for segmentation of clean and contaminated regions in the small bowel capsule endoscopy images

by Vahid Sadeghi, Alireza Mehridehnavi, Maryam Behdad, Alireza Vard, Mina Omrani, Mohsen Sharifi, Yasaman Sanahmadi, Niloufar Teyfouri

A considerable amount of undesirable factors in the wireless capsule endoscopy (WCE) procedure hinder the proper visualization of the small bowel and take gastroenterologists more time to review. Objective quantitative assessment of different bowel preparation paradigms and saving the physician reviewing time motivated us to present an automatic low-cost statistical model for automatically segmenting of clean and contaminated regions in the WCE images. In the model construction phase, only 20 manually pixel-labeled images have been used from the normal and reduced mucosal view classes of the Kvasir capsule endoscopy dataset. In addition to calculating prior probability, two different probabilistic tri-variate Gaussian distribution models (GDMs) with unique mean vectors and covariance matrices have been fitted to the concatenated RGB color pixel intensity values of clean and contaminated regions separately. Applying the Bayes rule, the membership probability of every pixel of the input test image to each of the two classes is evaluated. The robustness has been evaluated using 5 trials; in each round, from the total number of 2000 randomly selected images, 20 and 1980 images have been used for model construction and evaluation modes, respectively. Our experimental results indicate that accuracy, precision, specificity, sensitivity, area under the receiver operating characteristic curve (AUROC), dice similarity coefficient (DSC), and intersection over union (IOU) are 0.89 ±  0.07, 0.91 ±  0.07, 0.73 ±  0.20, 0.90 ±  0.12, 0.92 ± 0.06, 0.92 ±  0.05 and 0.86 ±  0.09, respectively. The presented scheme is easy to deploy for objectively assessing small bowel cleansing score, comparing different bowel preparation paradigms, and decreasing the inspection time. The results from the SEE-AI project dataset and CECleanliness database proved that the proposed scheme has good adaptability.

Relationship of sleep and activity, assessed via a wristwatch-type pulsimeter with an accelerometer, with health status in community-dwelling older adults: A preliminary study

by Akiyo Sasaki-Otomaru, Kyoko Saito, Kotaro Yamasue, Osamu Tochikubo, Yuka Kanoya

Wearable devices have the potential to promote a healthy lifestyle; however, studies on the use of wearable devices in monitoring health in older adults are limited. We aimed to investigate the relationship of sleep and activity data with health status among older adults. Fifty-five community-dwelling older adults were asked to wear a wristwatch-type wearable device (the Pulsense [PS]) and measure home blood pressure (HBP) over a period of 5–7 consecutive days. Deep-sleep duration, physical and mental activity duration, and body-movement duration were obtained from PS data using special software. We also collected data on demographics and physical and mental health status. We found that the body-movement duration in women was longer than that in men. Among men, body-movement duration was strongly and negatively correlated with the Kihon Checklist (KCL) score. It also showed moderate correlations with the Geriatric Depression score, physical functioning, bodily pain, vitality, social function, and role emotional scores from the Medical Outcomes Survey Short Form-8 questionnaire, as well as with hand-grip strength. There was no significant correlation between monitoring data and health status in women. In the multiple linear regression analysis, body-movement duration was negatively associated with age and the KCL score. KCL is a common questionnaire for screening frailty in Japan. Our results showed that body-movement duration was negatively associated with age and the KCL score, suggesting the potential of PS in guiding personalized health management of older community-dwelling adults with risks of frailty.

Effect of music therapy on behavioral and physiological neonatal outcomes: A systematic review and dose-response meta-analysis

by Fatemeh Shahbazi, Marzieh Fattahi-Darghlou, Samad Moslehi, Minoo Dabiri-Golchin, Marjan Shahbazi

Background

Previous studies have documented the effectiveness of music therapy in improving adverse neonatal outcomes in premature infants. However, this review aims to address the question of how long listening to music can enhance these neonatal outcomes.

Methods

To conduct this dose-response meta-analysis, we searched the PubMed, Scopus, Web of Science, and Cochrane Library databases. The inclusion criteria comprised randomized clinical trials that investigated the effects of music therapy on improving adverse neonatal outcomes. Preterm infants were defined as those born between 27 and 37 weeks of gestation, as fetuses are known to respond to auditory stimuli starting at the 27th week of pregnancy. The initial search was performed on January 28, 2024, and there were no restrictions on the time frame for the search. Ultimately, we employed a two-stage random effects model using the “drmeta” package in Stata software to perform this dose-response meta-analysis.

Results

In total, 30 articles (1855 participants) were identified for inclusion in our meta-analysis. According to pooled analysis with each minute increase in music therapy, the means of respiratory rate, pain score, SBP, DBP, behavioral score, and body temperature decrease by 35.3 beats per minutes, 15.3 VAS, 30.7 mmHg, 8.9 mmHg, 2.7, and 0.27°C. On the other hand, with each minute increase in listening to the music, the mean of O2 saturation, heart rate and sleep duration increase 1.7%, 89.2 beats per minutes and 5.081 minutes per day, respectively.

Conclusion

Music therapy improves the neonatal outcomes of O2 saturation, heart rate, respiratory rate, sleep duration, body temperature and systolic and diastolic blood pressures. Therefore, the existence of a dose-response relationship can indicate a causal relationship between music therapy and the improvement of neonatal outcomes.

Creativity research in medicine and nursing: A scoping review

by Alex Thabane, Sarah Saleh, Sushmitha Pallapothu, Tyler McKechnie, Phillip Staibano, Jason W. Busse, Goran Calic, Ranil Sonnadara, Sameer Parpia, Mohit Bhandari

Background

Creativity fuels societal progress and innovation, particularly in the field of medicine. The scientific study of creativity in medicine is critical to understanding how creativity contributes to medical practice, processes, and outcomes. An appraisal of the current scientific literature on the topic, and its gaps, will expand our understanding of how creativity and medicine interact, and guide future research.

Objectives

We aimed to assess the quantity, trends, distribution, and methodological features of the peer-reviewed on creativity in medicine.

Methods

We searched the MEDLINE, EMBASE, and PsycINFO databases for peer-reviewed primary research publications on creativity in medicine. Screening, full-text review, and data extraction were performed independently and in duplicate by pairs of reviewers, with discrepancies resolved by a third reviewer. We performed descriptive analyses, graphically displaying the data using charts and maps where appropriate.

Results

Eighty-one studies were eligible for review, enrolling a total of 18,221 physicians, nurses and midwifes across all studies. Most research on creativity in medicine was published in the last decade, predominately in the field of nursing (75%). Researchers from Taiwan (22%) and the United States (21%) produced the most eligible publications, and the majority research was cross-sectional in nature (54%). There was substantial variability in the definitions of creativity adopted, and most studies failed to specify a definition of creativity. Forty-five different measurement tools were used to assess creativity, the most popular being divergent thinking tests such as the Torrance Test of Creative Thinking (24%) and Guilford Creativity Tests (16%).

Conclusions

Peer-reviewed scientific research on creativity in medicine, mostly conducted in the nursing profession, is sparse and performed on variable methodological grounds. Further scientific research on the topic, as well as the development of medicine-specific definitions and measurement tools, is required to uncover the utility of creativity in the medical domain.

The combined use of scRNA-seq and network propagation highlights key features of pan-cancer Tumor-Infiltrating T cells

by Adèle Mangelinck, Elodie Molitor, Ibtissam Marchiq, Lamine Alaoui, Matthieu Bouaziz, Renan Andrade-Pereira, Hélène Darville, Etienne Becht, Céline Lefebvre

Improving the selectivity and effectiveness of drugs represents a crucial issue for future therapeutic developments in immuno-oncology. Traditional bulk transcriptomics faces limitations in this context for the early phase of target discovery as resulting gene expression levels represent the average measure from multiple cell populations. Alternatively, single cell RNA sequencing can dive into unique cell populations transcriptome, facilitating the identification of specific targets. Here, we generated Tumor-Infiltrating regulatory T cells (TI-Tregs) and exhausted T cells (Tex) gene signatures from a single cell RNA-seq pan-cancer T cell atlas. To overcome noise and sparsity inherent to single cell transcriptomics, we then propagated the gene signatures by diffusion in a protein-protein interaction network using the Patrimony high-throughput computing platform. This methodology enabled the refining of signatures by rescoring genes based on their biological connectivity and shed light not only on processes characteristics of TI-Treg and Tex development and functions but also on their immunometabolic specificities. The combined use of single cell transcriptomics and network propagation may thus represent an innovative and effective methodology for the characterization of cell populations of interest and eventually the development of new therapeutic strategies in immuno-oncology.

Assessing the impact of the COVID-19 pandemic on uptake and experiences of gestational diabetes mellitus screening in Ontario: A parallel convergent mixed-methods study

by Dima Hadid, Rebecca H. Correia, Sarah D. McDonald, Elizabeth K. Darling, David Kirkwood, Aaron Jones, Andrea Carruthers, Cassandra Kuyvenhoven, Michelle Howard, Devon Greyson, Sujane Kandasamy, Meredith Vanstone

Objective

Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy that leads to adverse outcomes for both infants and pregnant people. Early detection and treatment can mitigate these negative outcomes. The COVID-19 pandemic strained healthcare and laboratory services, including GDM screening programs. Adapted GDM screening guidelines were introduced in many jurisdictions. This study examined changes in uptake, modality, and experiences of GDM screening in Ontario, Canada during the COVID-19 pandemic.

Methods

This convergent mixed-method study involved a population-based retrospective cohort analysis of Ontario-based health administrative data to describe and compare gestational diabetes screening rates among 85,228 individuals with live, in-hospital births between January 1-March 31 before (2019) and during the COVID-19 pandemic (2021 and 2022). Descriptive analyses were conducted for GDM screening pathways aligning with usual and pandemic-adapted screening guidance. Qualitative descriptive interviews were conducted about experiences and decision-making of GDM screening with 43 Ontario residents who gave birth between May 2020 and December 2021. Data were integrated during the design and interpretation phases.

Results

There were small but significant increases in GDM screening during the pandemic; likelihood of screening completion using any modality increased in 2021 and 2022 compared to 2019. Testing modality shifted; the alternate screening strategies introduced during COVID-19 were adopted by clinicians. Interview participants perceived GDM screening to be important and obligatory but accompanied by a degree of stress about potential COVID-19 exposure.

Conclusion

Despite health system challenges experienced in Ontario during the COVID-19 pandemic, GDM screening rates increased in the study population, demonstrating the success of adapted GDM screening guidelines. Decisions about screening modalities were driven by clinician expertise, and interview participants were satisfied to provide informed consent to these recommendations.

Effect of traffic volumes on polycyclic aromatic hydrocarbons of particulate matter: A comparative study from urban and rural areas in Malaysia

by Samer Al-Battawi, Mohd Talib Latif, Vivien How, Karuppiah Thilakavathy, Haris Hafizal Abd Hamid, Chung Keat Tan, Yu Bin Ho

Motor vehicles emit most Malaysian PAHs in particulate matter of 2.5 μm (PM_2.5-bound PAHs). Although traffic-related air pollution harms healthy people, there is a knowledge gap regarding PAHs’ effects on Malaysians. This study examines PM_2.5-bound PAH concentrations, distribution, sources, and health risks in Malaysia’s high and low-traffic zones. Kuala Lumpur (KL) and Hulu Langat (HL) exhibit Malaysia’s high- and low-traffic areas. The high-volume air sampler collected 40 ambient PM_2.5 samples at both locations. Solid-phase extraction and gas chromatography-mass spectrometry (GC-MS) assessed PAHs. The mean PM_2.5-bound PAH concentrations in KL (5.85 ng m^-3) were significantly higher than in HL (0.55 ng m^-3) (p-3) and eleven times more high-molecular-weight PAHs (HMW-PAHs) (3.22 vs. 0.28 ng m^-3) than HL. Over 51% of PM_2.5 air samples at both sites included HMW-PAHs. Source apportionment tools (Diagnostic ratio, positive matrix factorization, and principal component analysis) showed that fossil fuel combustions (petrol and diesel) produced the greatest PAHs in both locations. Moreover, PAH exposure impinged higher carcinogenic health risks in KL than in HL. In conclusion, traffic and automobile pollution account for the short- and long-term health risks posed by PAHs in both regions.

Effect of immortal time bias on the association between immune-related adverse events and oncological outcomes following immune checkpoint inhibitors therapy for head and neck squamous cell carcinoma

by Koichi Tamura, Yukinori Takenaka, Kiyohito Hosokawa, Takashi Sato, Takeshi Tsuda, Hirotaka Eguchi, Masami Suzuki, Takahito Fukusumi, Motoyuki Suzuki, Hidenori Inohara

Immune checkpoint inhibitors (ICIs) are pharmacological agents indicated for recurrent and metastatic head and neck squamous cell carcinoma (HNCSCC). Immune-related adverse events (irAEs) have been reported as predictors of therapeutic response to ICIs. However, previous studies have not adequately addressed the immortal time bias. Therefore, we aimed to investigate the association between the onset of irAEs and oncological outcomes, accounting for immortal time bias. We conducted a retrospective study involving 130 patients with HNSCC who were treated with ICIs. The objective response, progression-free survival (PFS), and overall survival (OS) were assessed using logistic regression analysis, the Kaplan–Meier method, and the Cox proportional hazard (PH) model. The immortal time bias was considered using a landmark analysis and an extended Cox (EC) model. The odds ratios for response and disease control were smaller in the landmark than in the naïve analyses. In the landmark analysis, the 1-year PFS rates were 47.6% and 27.2% for irAE+ and irAE- patients, respectively (p = 0.049), and the 1-year OS rates were 85.7% and 66.5%, respectively (p = 0.006). Regarding PFS, the adjusted HRs for irAEs were 0.49 (95% confidence interval (CI) 0.28–0.85) in the PH analysis and 0.75 (95% CI 0.40–1.40) in the EC analysis. As for OS, the adjusted HRs for irAEs were 0.36 (95% CI 0.19–0.66) in the PH analysis and 0.51 (95% CI 0.27–0.95) in the EC analysis. IrAEs were an independent prognostic factor for OS but not PFS. Without considering the immortal time bias, the association between irAEs and oncologic outcomes in patients with HNSCC treated with ICIs was overestimated. Therefore, the balance between the benefits and risks of ICI therapy must be carefully weighed in clinical settings.

Non-analgesic effects of opioids: Topical application of Eucerin-based ointment containing opium on the healing process of thermal skin damage in rats

by Omid Mehrpour, Khadijeh Farrokhfall, Kobra Naseri, Samaneh Nakhaee

The present study aimed to investigate the efficacy of different doses of Eucerin-based ointment containing opium compared to routine treatment on experimentally induced burn injury. Male Wistar rats were divided into five experimental groups for topical application: silver sulfadiazine 1% (SSD), Eucerin-based ointment containing opium at concentrations of 0.05%, 0.5%, and 5%, and a Eucerin-based ointment containing 0.05% opium plus SSD (mixed group), following burn wound induction using the comb burn model. An equal volume of different ointments was administered topically. The wound appearances of different groups were photographed at different time points for 21 days. In addition, blood and skin samples were taken 2 and 10 days after thermal injury to assess inflammatory parameters and oxidative stress markers. Also, the liver enzyme activity and kidney function tests were assessed on day 10. The body weight in Opium 5% significantly decreased compared to all other groups after ten days. The wound area was significantly reduced (P0.05). The serum concentrations of interleukin-10 in the mixed group were significantly higher compared to the SSD group on day 10. After ten days, groups were not different regarding AST, ALT, and creatinine concentrations (p>0.05). Histopathological analysis revealed that the wound healing efficacy of opium at its lowest concentration (0.05%) surpassed that of silver sulfadiazine (SSD). Furthermore, the combination of 0.05% opium with SSD enhanced the wound repair potential of SSD in burn injuries. This study showed that opium ointment delayed wound closure dose-dependently. Low doses of topical opium ointment and its mixed application with silver sulfadiazine had a protective role in thermal-induced injury.

X-ray guided anatomy-based fitting: The validity of OTOPLAN

by Asma Alahmadi, Yassin Abdelsamad, Ahmed Hafez, Abdulrahman Hagr

Background

Anatomy-based fitting (ABF) for cochlear implant users is a new era that seeks improved outcomes. Recently, different imaging modalities, such as plain X-rays, have been proposed to build the ABF as an alternative to the computed tomography (CT) scan. This study aimed to assess the feasibility and validity of OTOPLAN^® software in building ABF using plain X-ray imaging.

Patients and methods

A retrospective evaluation of postoperative CT scans and plain X-ray post-op images of 54 patients was analyzed using the OTOPLAN^® software. The post-op analysis was done for the angular insertion depth (AID) and center frequency of each electrode contact using both imaging modalities. Moreover, inter-rater reliability was assessed for measurements obtained from CT scans and plain X-ray images.

Results

Non-significant statistical and clinical mismatches were detected when comparing the AID and center frequency measurements assessed using CT and X-rays. The absolute difference between CT and X-ray approaches ranged from 0.0 to 4.6 degrees for AID and 0.2 to 0.5 semitone for frequency. Moreover, the AID and the frequency measurements from CT and X-ray images demonstrated almost perfect agreement between the raters. The inter-observer reliability for CT scans showed that the intraclass correlation coefficient (ICC) exceeded 0.97 for AID and 0.95 for the frequency across all electrode contacts.

Conclusion

Our results demonstrated the validity and reliability of using post-operative X-ray images by OTOPLAN^® software to build Anatomy-based Fitting maps.

Sex prediction through machine learning utilizing mandibular condyles, coronoid processes, and sigmoid notches features

by Isabela Bittencourt Basso, Pedro Felipe de Jesus Freitas, Aline Xavier Ferraz, Ana Julia Borkovski, Ana Laura Borkovski, Rosane Sampaio Santos, Rodrigo Nunes Rached, Erika Calvano Küchler, Angela Graciela Deliga Schroder, Cristiano Miranda de Araujo, Odilon Guariza-Filho

Characteristics of the mandible structures have been relevant in anthropological and forensic studies for sex prediction. This study aims to evaluate the coronoid process, condyle, and sigmoid notch patterns in sex prediction through supervised machine learning algorithms. Cephalometric radiographs from 410 dental records of patients were screened to investigate the morphology of the coronoid process, condyle, and sigmoid notch and the Co-Gn distance. The following machine learning algorithms were used to build the predictive models: Decision Tree, Gradient Boosting Classifier, K-Nearest Neighbors (KNN), Logistic Regression, Multilayer Perceptron Classifier, Random Forest Classifier, and Support Vector Machine (SVM). A 5-fold cross-validation approach was adopted to validate each model. Metrics such as area under the curve (AUC), accuracy, recall, precision, and F1 Score were calculated for each model, and ROC curves were constructed. All tested variables demonstrated statistical significance (p

CD11c+ dendritic cells PlexinD1 deficiency exacerbates airway hyperresponsiveness, IgE and mucus production in a mouse model of allergic asthma

by Lianyu Shan, Mojdeh Matloubi, Ifeoma Okwor, Sam Kung, Mohamed Sadek Almiski, Sujata Basu, Andrew Halayko, Latifa Koussih, Abdelilah S. Gounni

Dendritic cells (DCs) are pivotal in regulating allergic asthma. Our research has shown that the absence of Sema3E worsens asthma symptoms in acute and chronic asthma models. However, the specific role of PlexinD1 in these processes, particularly in DCs, remains unclear. This study investigates the role of PlexinD1 in CD11c+ DCs using a house dust mite (HDM) model of asthma. We generated CD11c+ DC-specific PlexinD1 knockout (CD11c^{PLXND1 KO}) mice and subjected them, alongside wild-type controls (PLXND1^fl/fl), to an HDM allergen protocol. Airway hyperresponsiveness (AHR) was measured using FlexiVent, and immune cell populations were analyzed via flow cytometry. Cytokine levels and immunoglobulin concentrations were assessed using mesoscale and ELISA, while collagen deposition and mucus production were examined through Sirius-red and periodic acid Schiff (PAS) staining respectively. Our results indicate that CD11c^{PLXND1 KO} mice exhibit significantly exacerbated AHR, characterized by increased airway resistance and tissue elastance. Enhanced mucus production and collagen gene expression were observed in these mice compared to wild-type counterparts. Flow cytometry revealed higher CD11c+ MHCII^high CD11b+ cell recruitment into the lungs, and elevated total and HDM-specific serum IgE levels in CD11c^{PLXND1 KO} mice. Mechanistically, co-cultures of B cells with DCs from CD11c^{PLXND1 KO} mice showed significantly increased IgE production compared to wild-type mice.These findings highlight the critical regulatory role of the plexinD1 signaling pathway in CD11c+ DCs in modulating asthma features.

Distribution and dynamics of <i>Anopheles gambiae</i> s.l. larval habitats in three Senegalese cities with high urban malaria incidence

by Fatou Ndiaye, Abdoulaye Diop, Joseph Chabi, Katherine Sturm-Ramirez, Massila Senghor, El Hadji Diouf, Badara Samb, Seynabou Mocote Diedhiou, Omar Thiaw, Sarah Zohdy, Ellen Dotson, Doudou Sene, Mame Birame Diouf, Valerie Koscelnik, Lilia Gerberg, Abdoulaye Bangoura, Tiffany Clark, Ousmane Faye, Ibrahima Dia, Lassana Konate, El Hadji Amadou Niang

Urban malaria has become a challenge for most African countries due to urbanization, with increasing population sizes, overcrowding, and movement into cities from rural localities. The rapid expansion of cities with inappropriate water drainage systems, abundance of water storage habitats, coupled with recurrent flooding represents a concern for water-associated vector borne diseases, including malaria. This situation could threaten progress made towards malaria elimination in sub-Saharan countries, including Senegal, where urban malaria has presented as a threat to national elimination gains. To assess drivers of urban malaria in Senegal, a 5-month study was carried out from August to December 2019 in three major urban areas and hotspots for malaria incidence (Diourbel, Touba, and Kaolack) including the rainy season (August-October) and partly dry season (November–December). The aim was to characterize malaria vector larval habitats, vector dynamics across both seasons, and to identify the primary eco- environmental entomological factors contributing to observed urban malaria transmission. A total of 145 Anopheles larval habitats were found, mapped, and monitored monthly. This included 32 in Diourbel, 83 in Touba, and 30 in Kaolack. The number of larval habitats fluctuated seasonally, with a decrease during the dry season. In Diourbel, 22 of the 32 monitored larval habitats (68.75%) were dried out by December and considered temporary, while the remaining 10 (31.25%) were classified as permanent. In the city of Touba 28 (33.73%) were temporary habitats, and of those 57%, 71% and 100% dried up respectively by October, November, and December. However, 55 (66.27%) habitats were permanent water storage basins which persisted throughout the study. In Kaolack, 12 (40%) permanent and 18 (60%) temporary Anopheles larval habitats were found and monitored during the study. Three malaria vectors (An. arabiensis, An. pharoensis and An. funestus s.l.) were found across the surveyed larval habitats, and An. arabiensis was found in all three cities and was the only species found in the city of Diourbel, while An. arabiensis, An. pharoensis, and An. funestus s.l. were detected in the cities of Touba and Kaolack. The spatiotemporal observations of immature malaria vectors in Senegal provide evidence of permanent productive malaria vector larval habitats year-round in three major urban centers in Senegal, which may be driving high urban malaria incidence. This study aimed to assess the presence and type of anopheline larvae habitats in urban areas. The preliminary data will better inform subsequent detailed additional studies and seasonally appropriate, cost-effective, and sustainable larval source management (LSM) strategies by the National Malaria Control Programme (NMCP).