METHODS: We analysed 24 children under 12 years old, all of whom met the criteria provided by the World Health Organization, 2020 for MIS-C diagnosis, from the Paediatric COVID-19 Registry in Kuwait (PCR-Q8). Demographic and clinical data were collected from medical records, and exome sequencing was performed on the children and their parents to identify rare exonic variants. These variants were prioritized using two approaches: a candidate genes approach employing trio segregation analysis, and a candidate variants approach using a gene panel informed by previous studies on MIS-C-related genetic variants and datasets of differentially expressed genes in MIS-C patients.
RESULTS: The candidate genes approach identified 53 unique genes in 20 of the 24 probands, including DDX60 and TMEM154, which were also differentially expressed between MIS-C and control groups. The candidate variants approach identified 33 rare, predicted deleterious heterozygous variants across 19 unique genes in 19 of the 24 probands, including both previously described and novel candidate variants for MIS-C. Pathway analysis of the identified genes from both approaches revealed significant involvement in immune response, viral defence, and inflammatory pathways.
CONCLUSION: This study underscores the monogenic susceptibility to MIS-C, enhancing the evidence base through comprehensive genetic analysis. The findings highlight the critical role of genetic predispositions in MIS-C and suggest that further functional genomics work is necessary to explore the mechanistic contributions of these genes, facilitating the development of targeted diagnostic strategies.
METHODS: An anonymous cross-sectional study was conducted in 2023 with staff at HE institutions across 16 countries. Job insecurity was measured using the Job Insecurity Scale (JIS), burnout using the Perceived Burnout measure question, psychological distress using the Kessler Psychological Distress Scale (K10), and coping using the Brief Resilient Coping Scale. Multivariable logistic regression with a stepwise variable selection method was used to identify associations.
RESULTS: A total of 2,353 staff participated; the mean age (± SD) was 43(± 10) years and 61% were females. Most staff (85%) did not feel job insecurity, one-third (29%) perceived burnout in their jobs, more than two-thirds (73%) experienced moderate to very high levels of psychological distress, and more than half (58%) exhibited medium to high resilient coping. Perceived job insecurity was associated with staff working part-time [Adjusted Odds Ratio 1.53 (95% Confidence Intervals 1.15-2.02)], having an academic appointment [2.45 (1.78-3.27)], having multiple co-morbidities [1.86 (1.41-2.48)], perceived burnout [1.99 (1.54-2.56)] and moderate to very high level of psychological distress [1.68 (1.18-2.39)]. Perceived burnout was associated with being female [1.35 (1.12-1.63)], having multiple co-morbidities [1.53 (1.20-1.97)], perceived job insecurity [1.99 (1.55-2.57)], and moderate to very high levels of psychological distress [3.23 (2.42-4.30)]. Staff with multiple co-morbidities [1.46 (1.11-1.92)], mental health issues [2.73 (1.79-4.15)], perceived job insecurity [1.61 (1.13-2.30)], and perceived burnout [3.22 (2.41-4.31)] were associated with moderate to very high levels of psychological distress. Staff who perceived their mental health as good to excellent [3.36 (2.69-4.19)] were more likely to have medium to high resilient coping.
CONCLUSIONS: Factors identified in this study should be considered in reviewing and updating current support strategies for staff at HE institutions across all countries to reduce stress and burnout and improve wellbeing.
OBJECTIVE: This study aims to assess the short-term and sustained effects of H-PBMT combined with rehabilitation exercises in patients with mild to moderate KOA, focusing on knee radiographic morphological changes over a 3-month follow-up period.
METHODS: This protocol outlines a parallel-group, randomized, double-blind, placebo-controlled trial. Fifty participants with mild to moderate KOA (based on the Kellgren-Lawrence classification) will be randomly assigned to either the active H-PBMT plus exercise group (H-PBMT+E, n = 25) or the placebo photobiomodulation plus exercise group (PL+E, n = 25). Both groups will undergo an 8-week intervention, consisting of conventional rehabilitation exercises paired with either active or placebo photobiomodulation. H-PBMT will be delivered using the BTL-6000 HIL device with a 1064 nm wavelength, providing a total energy dose of 3190 J per 15-minute session. The treatment protocol includes both pulse mode (25 Hz, 5 W, 190 J) for analgesia and continuous mode (5 W, 3000 J) for biostimulation. Participants will be blinded to their group allocation through the use of a placebo device that mimics the active treatment without emitting therapeutic energy. Additionally, the outcome assessors will be blinded to the group allocations to ensure unbiased evaluation of the trial outcomes. The primary outcome is the Knee Injury and Osteoarthritis Outcome Score. Secondary outcomes include the Timed Up-and-Go test, Numerical Pain Rating Scale, and knee X-rays. Outcomes will be evaluated at baseline, immediately post-intervention (week 8), and at 3-month follow-up (week 20). Data will be analyzed according to the intention-to-treat principle, with a two-way repeated measures ANOVA used to assess time, group, and interaction effects.
CONCLUSION: This study is expected to provide valuable insights into the sustained effects and potential disease-modifying properties of combining H-PBMT with rehabilitation exercises in managing KOA. The findings could inform more effective treatment protocols, improving rehabilitation outcomes and patient quality of life.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12624000699561p).
METHODS: To evaluate the prevalence, risk factors, and adverse outcomes of bacterial vaginosis among pregnant women, a comprehensive systematic review was conducted based on the preferred reporting items for systematic review and meta-analyses (PRISMA) criteria. PubMed, ScienceDirect, ClinicalTrials.gov and Cochrane database searches were conducted independently by two authors until May 13th, 2023.
RESULTS: The search strategies yielded a total of 2237 records; among them, 12 studies met the inclusion criteria and were included in the qualitative synthesis. Majority of the included studies demonstrated a high prevalence of BV among African women. The risk of developing BV during pregnancy was highest among women with multiple sexual partners. Additionally, factors including age, socioeconomic status, unhygienic practices, ethnicity, 2nd trimester, spontaneous abortion, vaginal douching, symptoms, and history of sexually transmitted infections (STIs) were also associated with a higher prevalence of BV. Overall, 7 studies reported adverse outcomes during pregnancy which was directly associated with BV. Based on the review, it was found that PROM, PTB, and LBW were the most frequently reported adverse outcomes in pregnant women with BV.
CONCLUSION: In summary, the high prevalence of bacterial vaginosis necessitates a global surveillance approach to delineate the health risks imposed on both mother and child, and promote cost-effective strategic measures to alleviate the undesired consequences of BV during pregnancy.
SYSTEMATIC REVIEW REGISTRATION: OSF; https://doi.org/10.17605/OSF.IO/HEFCP.
METHODOLOGY: This study was conducted in 2 tertiary centres: Hospital Putrajaya (HPJ) and Hospital Universiti Sains Malaysia (HUSM) from February to May 2020. Muslim T1DM patients between ages 8 to18 who intended to fast during Ramadan were given Ramadan-focused education. CGM iPro2® (Medtronic) was used before and during Ramadan, complemented by finger-prick glucose monitoring or self-monitoring of blood glucose (SMBG).
RESULTS: Of the 32 patients, only 24 (12 female) were analysed. Mean age was 13.6 ± 3.1 years old, mean HbAlc was 9.6 ± 1.9% and mean duration of illness was 5.4 ± 3.4 years. Majority (91.7%) were on multiple dose injections (MDI) while only 8.3% were on continuous subcutaneous insulin infusion (CSII). All fasted in Ramadan without acute complications. Retrospective CGM analysis revealed similar results in time in range (TIR), time in hyperglycaemia and time in hypoglycaemia before and during Ramadan, indicating no increased hypoglycaemic or hyperglycaemic events related to fasting. Glycaemic variability before Ramadan as measured by the LBGI, HBGI and MAG, were similar to values during Ramadan.
CONCLUSION: Ramadan fasting among T1DM children and adolescents, by itself, is not associated with short-term glycaemic deterioration. T1DM youths can fast safely in Ramadan with the provision of focused education and regular SMBG.
METHODS: This scoping review was reported based on Preferred Reporting Items for Systematic reviews and Meta-Analyses-extension for Scoping Reviews guidelines. A systematic search identified records from 4 databases: PubMed, Embase, Cochrane Library, and Web of Science. Abstracts received 3 blind reviews. Corresponding full-text articles rated as "in-scope" and reporting data not published in any other retained article (i.e., no double reporting) were identified and assigned to 5 thematic evaluating teams. Full-text articles were reviewed using a double-blind standardized form. Level of evidence was graded, and summative statements were generated.
RESULTS: On November 9, 2022, 2,167 documents had been identified; 132 articles were retained, of which 33 (25%) were published over the past 5 years. Overall, 2,161 individuals met the inclusion criteria; female patients were 527 of 1,554 (33.9%) cases included, whose sex was identifiable. Of 132 articles, 57 (43.2%) were single case reports and only 5 (3.8%) clinical trials; the level of evidence was prevalently low (80/132; 60.6%). Most studies included neurobehavioral measures (84/127; 66.1%) and neuroimaging (81/127; 63.8%); 59 (46.5%) were mainly related to diagnosis, 56 (44.1%) to prognosis, and 44 (34.6%) to treatment. Most frequently used neurobehavioral tools included the Coma Recovery Scale-Revised, Coma/Near-Coma Scale, Level of Cognitive Functioning Assessment Scale, and Post-Acute Level of Consciousness scale. EEG, event-related potentials, structural CT, and MRI were the most frequently used instrumental techniques. In 29/53 (54.7%) cases, DoC improvement was observed, which was associated with treatment with amantadine.
DISCUSSION: The literature on pediatric DoCs is mainly observational, and clinical details are either inconsistently presented or absent. Conclusions drawn from many studies convey insubstantial evidence and have limited validity and low potential for translation in clinical practice. Despite these limitations, our work summarizes the extant literature and constitutes a base for future guidelines related to the diagnosis, prognosis, and treatment of pediatric DoC.
METHODS AND STUDY DESIGN: This prospective cohort study included healthy motherinfant pairs. Maternal diet during the last trimester was determined with a validated food frequency questionnaire. Infant respiratory morbidity was solicited at 1, 3 and 6 months.
RESULTS: Three hundred mother-baby pairs were recruited. Maternal consumption of milk and dairy products was associated with reduced respiratory symptoms at 1 month (aOR 0.29 [95% CI: 0.10, 0.86], p=0.03) and 3 months old (aOR 0.43 [95% CI: 0.20, 0.93], p=0.03), while intake of confectionery items was associated with increased unscheduled doctor visits at 3 months (aOR 2.01 [95% CI 1.33, 3.06], p=0.001) and increased nebuliser treatment at both 3 months (aOR 1.88 [95% CI 1.12, 3.17], p=0.02) and 6 months (aOR 1.64 [95% CI 1.05, 2.54], p=0.03). Finally, at 6 months, hypertensive disorders during pregnancy was associated with increased nebuliser treatment (aOR 17.3 [95% CI 1.50, 199], p=0.02) while exclusive breastfeeding was associated with reduced incidence of respiratory symptoms (OR 0.47 [95% CI 0.26, 0.83], p=0.01).
CONCLUSIONS: Increased antenatal maternal consumption of milk and dairy products may reduce respiratory morbidity while increased consumption of confectionery items may increase respiratory morbidity in their infants during the first 6 months of life.
METHODS AND STUDY DESIGN: This is a cross-sectional study and a total of 408 primary school-aged children (male: 72.3%; female: 27.7%), with a mean age of 9.68±1.48 years, were recruited from 10 urban-poor flats through cluster sampling at the central region of Malaysia. Their anthropometry, nutrition knowledge, attitude and practice, physical activity, dietary practices, and HRQoL were assessed.
RESULTS: A quarter (24.5%) of the urban-poor children were either overweight or obese in the present study. The HRQoL total score among the urban-poor children was 65.0±18.5. The result of multiple linear regression analysis shown that higher nutrition attitude (B=0.34, p=0.001) and practices (B=0.39, p=0.001), higher physical activity (B=3.73, p=0.004), higher lunch intake (B=1.35, p<0.001), lower supper intake (B=-1.35, p<0.001), and lower fast-food intake (B=-1.61, -1.17, p<0.001) are the significant predictors of better HRQoL among the urban-poor children (R2=0.32, F(8,399)=23.72, p<0.001).
CONCLUSIONS: Future studies should focus on these predictors to formulate interventions that could enhance the HRQoL among the Malaysian urban-poor children.