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Attrition is a notable challenge in paediatric endocrine disorders. |
Reasons for attrition and ways to terminate these challenges need to be identified and put into practice. |
Keywords: |
Diabetes; Nigeria; Paediatric; Rickets; awareness; endocrine disorders. |
How do changing levels of local economic inequality affect households' social capital? |
This article contributes to answering this question by examining the impact of village-level economic inequality in Andhra Pradesh on household levels of bridging and bonding social-network capital, using Two-Stage Least-Squares regressions of data from household surveys conducted between 2002 and 2014 by the Young Liv... |
The results of the study suggest that as local economic inequality rises, households' bridging social capital, measured through participation in efforts to resolve broader communal issues, declines whilst their bonding social capital, measured through membership in relatively demographically and socio-economically homo... |
Existing research suggests that the consequently growing fragmentation of communities along demographic and socio-economic division lines is likely to contribute to social conflicts. |
Perioperative atrial fibrillation (POAF) after cardiac surgery has been associated with an increased risk of stroke in some studies. |
However, the exact magnitude of this association during short-term and long-term follow-up remains unclear. |
We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) for the time period from database inception to October 2020. |
We included observational studies with ≥ 100 patients that reported data on short-term or long-term stroke risk in patients with and without POAF after cardiac surgery. |
Data were pooled using random-effects models. |
We reported summary risk ratios (RRs) for studies reporting multivariable adjusted results and calculated absolute risk differences (ARDs) with 95% confidence intervals (CIs). |
A total of 55 studies with 540,209 patients were included. |
POAF was associated with both an increased relative risk (RR 1.69; 95% CI, 1.41-2.03; I<sup>2</sup> = 82%; 9 studies) and absolute risk of short-term stroke (4.5% vs 2.5%; ARD 2.0%; 95% CI, 1.28-2.89). |
POAF was associated with an increased relative risk (RR 1.20; 95% CI, 1.12-1.29; I<sup>2</sup> = 16%; 10 studies) and absolute risk of long-term stroke (1.06 vs 0.88 per 100 patient-years; ARD 0.18 per 100 patient-years; 95% CI, 0.07-0.26). |
Sensitivity analyses of high-quality studies and studies reporting either ischemic or embolic strokes yielded similar findings. |
POAF after cardiac surgery was associated with an increased risk of both short-term and long-term stroke. |
However, the long-term stroke ARD was small, and whether these patients will benefit from long-term oral anticoagulation therapy is unclear. |
Canadian Guidelines for Hereditary Transthyretin Amyloidosis Polyneuropathy Management |
Hereditary transthyretin-mediated (hATTR) amyloidosis is a progressive disease caused by mutations in the TTR gene leading to multisystem organ dysfunction. |
Pathogenic TTR aggregation, misfolding, and fibrillization lead to deposition of amyloid in multiple body organs and frequently involve the peripheral nerve system and the heart. |
Common neurologic manifestations include: sensorimotor polyneuropathy (PN), autonomic neuropathy, small-fiber PN, and carpal tunnel syndrome. |
Many patients have significant progression due to diagnostic delays as hATTR PN is not considered within the differential diagnosis. |
Recently, two effective novel disease-modifying therapies, inotersen and patisiran, were approved by Health Canada for the treatment of hATTR PN. |
Early diagnosis is crucial for the timely introduction of these disease-modifying treatments that reduce impairments, improve quality of life, and extend survival. |
In this guideline, we aim to improve awareness and outcomes of hATTR PN by making recommendations directed to the diagnosis, monitoring, and treatment in Canada. |
Background: |
Previous studies have shown that patch testing with food extracts can assist formulation of elimination diets (ED) in human patients with suspected adverse food reactions (AFR). |
Little is known about the use of these tests in dogs. |
Objectives: |
To evaluate the effectiveness of a combination of prick and patch testing in current protocols, and food challenge (FC) tests in dogs with AFR. |
Methods and materials: |
Prick and patch tests were performed on 21 dogs with chronic, nonseasonal pruritus. |
Dogs then were fed an ED formulated on the basis of the results. |
All dogs with improved clinical signs then were challenged with a food to which there had been a positive reaction in the tests. |
Six dogs subsequently were challenged with a food to which they had been negative on testing. |
Pruritus Visual Analog Scale (pVAS) and Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) were evaluated on Day (D)0, D30 and D60 of the ED. |
Sensitivity (SE), specificity (SP), positive (PPV) and negative (NPV) predictive values, and the Kappa (κ)value were calculated. |
Results: |
Of the 21 dogs, there was a significant mean improvement in pVAS and CADESI-04 scores in 16 (76%) dogs after D30 (P < 0.01) and D60 (P < 0.01) of the ED. |
There were no statistical differences between D30 and D60. |
The combination of tests had SE, SP, PPV, NPV and κ values of 80%, 66.7%, 66.7%, 80% and -0.17, respectively. |
Conclusions and clinical relevance: |
The combination of prick and patch testing reached high values of SE and NPV. |
A diagnosis of AFR was made in 76% of the dogs, and test results were useful for the selection of an ED. |
One of the challenging problems in neuroimaging is the principled incorporation of information from different imaging modalities. |
Data from each modality are frequently analyzed separately using, for instance, dimensionality reduction techniques, which result in a loss of mutual information. |
We propose a novel regularization method, generalized ridgified Partially Empirical Eigenvectors for Regression (griPEER), to estimate associations between the brain structure features and a scalar outcome within the generalized linear regression framework. |
griPEER improves the regression coefficient estimation by providing a principled approach to use external information from the structural brain connectivity. |
Specifically, we incorporate a penalty term, derived from the structural connectivity Laplacian matrix, in the penalized generalized linear regression. |
In this work, we address both theoretical and computational issues and demonstrate the robustness of our method despite incomplete information about the structural brain connectivity. |
In addition, we also provide a significance testing procedure for performing inference on the estimated coefficients. |
Finally, griPEER is evaluated both in extensive simulation studies and using clinical data to classify HIV+ and HIV- individuals. |
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The adoption and maintenance of healthy behaviours including age-appropriate amounts of physical activity, limited sedentary and screen time, and healthy eating are the foundations for youth development and thriving. |
In reviewing extant evidence, we observe that the COVID-19 pandemic has been associated with marked reductions in physical activity, increased sedentary and screen time, and increased food intake and unhealthy snacking. |
Deleterious effects in movement behaviours appear to be more pronounced among vulnerable groups and food insecurity has become more widespread. |
To contribute to mitigating these impacts, we advocate for strengthened evidence-based public health. |
Towards this end, ongoing surveillance should be intensified and augmented with additional indicators of social inequalities. |
Differentiation between precapillary and postcapillary pulmonary hypertension (PH) classically relies on mean pulmonary artery wedge pressure (mPAWP). |
The left ventricular end-diastolic pressure (LVEDP) is proposed as an equivalent alternative. |
However, mPAWP and LVEDP may differ substantially. |
We compared the impact of the choice of using the mPAWP vs the LVEDP on PH classification and mortality prediction in patients with severe aortic stenosis (AS) undergoing valve replacement. |
In 335 patients with severe AS , both mPAWP and LVEDP were measured. |
A mean pulmonary artery pressure ≥ 25 mm Hg was used to define PH, and either mPAWP or LVEDP was used to differentiate between precapillary and postcapillary PH (≤ 15 vs > 15 mm Hg). |
Mortality after a median follow-up of 1484 days after aortic valve replacement was assessed. |
Overall, mPAWP was lower than LVEDP (16 ± 8 mm Hg vs 21 ± 8 mm Hg; <i>P</i> < 0.001). |
Among 140 patients (42%) with PH, the PAWP-based classification revealed 76 (54% of those with PH) with isolated postcapillary PH, 48 (34%) with combined pre- and postcapillary PH, and 16 (12%) with precapillary PH. |
When the LVEDP was used, 59 patients (42%) were differently classified. |
These patients had higher mortality than those who were not differently classified [hazard ratio 2.79 (95% confidence interval, 1.17-6.65); <i>P</i> = 0.02]. |
Higher mPAWP was associated with increased mortality [hazard ratio 1.07 (95% confidence interval, 1.03-1.11) per 1 mm Hg; <i>P</i> = 0.001], whereas higher LVEDP was not. |
Use of LVEDP rather than mPAWP results in a divergent PH classification in nearly every second patient with severe AS. |
These patients have higher mortality after aortic valve replacement. |
The mPAWP, but not the LVEDP, predicts mortality. |
To determine the influence of induced fatigue on dynamic balance in healthy athletes. |
Systematic review. |
PUBMED, MEDLINE, CINAHL, Sports Discus, and the Cochrane library from onset to May 28, 2019. |
Eligible studies included any study examining the effects of induced-fatigue on dynamic balance, as measured by the SEBT/YBT, in healthy athletic populations. |
Studies with a low risk of bias were considered scientifically admissible for a best evidence synthesis. |
Fifteen studies with low risk of bias were included - seven investigated recreational athletes while eight focused on competitive athletes. |
In the recreational population, five of the studies found significant decrease in dynamic balance following the fatiguing intervention. |
However, the remaining two concluded with insignificant changes. |
As for the competitive population, three studies showed significant effects of induced fatigue on dynamic balance, while five showed no effects. |
There are conflicting results regarding the effects of induced fatigue on dynamic balance. |
The majority of studies focused on competitive athletes found that fatigue did not alter their dynamic balance. |
Per contra, the majority of studies focused on recreational athletes concluded the opposite - fatigue did indeed affect dynamic balance. |
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