Obesity, diabetes, Plasmodium infection, and severe malaria in adults: A systematic review and meta-analysis.

BACKGROUND: This study aimed to investigate existing evidence regarding the associations of obesity and diabetes with Plasmodium infection and severe malaria in adults. METHODS: We comprehensively searched relevant studies using EMBASE, MEDLINE, Global Health, and CINAHL. The primary exposures were obesity and diabetes. The primary outcomes were Plasmodium infection and severe malaria. We performed meta-analyses to pool unadjusted and adjusted odds ratios (ORs) using a random-effects model. RESULTS: We found 9 studies that met our inclusion criteria; all these studies were eligible for meta-analyses. None of the 9 studies investigated the potential link between obesity and Plasmodium infection. The meta-analysis results showed that there was no statistically significant relationship between obesity and severe malaria (two studies), diabetes and Plasmodium infection (five studies), or diabetes and severe malaria (three studies). CONCLUSION: Our study findings showed that obesity was not associated with severe malaria, and diabetes was not associated with neither Plasmodium infection nor severe malaria. Additional epidemiological studies should be conducted to elucidate the relationships between obesity, diabetes, and Plasmodium infection.

Comparison of predictive models using logistic regression, classification tree, and structural equation model for severe dengue.

BACKGROUND: The aim of this study was to compare the predictive performance of three statistical models-logistic regression, classification tree, and structural equation model (SEM)-in predicting severe dengue illness. METHODS/FINDINGS: We adopted modified classification of dengue illness severity based on WHO 1997 guideline. Predictive models were constructed using demographic factors and laboratory indicators on the day of fever occurrence. We developed statistical predictive models using data from two hospital cohorts in Thailand, consisting of 257 Thai children. Different predictive models for each category of severe dengue illness were developed employing logistic regression, classification tree, and SEM. The probability of discrimination of each model for severe output of disease was analyzed with external validation data sets from 55 and 700 patients not used in model development. From external validation using predictors on the day of presentation to the hospital, the area under the receiver operating characteristic curve was between 0.65 and 0.84 for the regression model. It was between 0.73 and 0.85 for SEM models. Classification tree models showed good results of sensitivity, ranging from 0.95 to 0.99. However, they showed poor specificity ranging from 0.10 to 0.44. CONCLUSIONS: Our study showed that SEM is comparable to logistic regression or classification tree, which was widely used for more severe form of dengue prediction.

Stretchable Magneto-Mechanical Configurations with High Magnetic Sensitivity Based on "Gel-Type" Soft Rubber for Intelligent Applications.

"Gel-type" soft and stretchable magneto-mechanical composites made of silicone rubber and iron particles are in focus because of their high magnetic sensitivity, and intelligence perspective. The "intelligence" mentioned here is related to the "smartness" of these magneto-rheological elastomers (MREs) to tune the "mechanical stiffness" and "output voltage" in energy-harvesting applications by switching magnetic fields. Hence, this work develops "gel-type" soft composites based on rubber reinforced with iron particles in a hybrid with piezoelectric fillers such as barium titanate. A further aspect of the work relies on studying the mechanical stability of intelligence and the stretchability of the composites. For example, the stretchability was 105% (control), and higher for 158% (60 per 100 parts of rubber (phr) of barium titanate, BaTiO3), 149% (60 phr of electrolyte iron particles, EIP), and 148% (60 phr of BaTiO3 + EIP hybrid). Then, the magneto-mechanical aspect will be investigated to explore the magnetic sensitivity of these "gel-type" soft composites with a change in mechanical stiffness under a magnetic field. For example, the anisotropic effect was 14.3% (60 phr of EIP), and 4.4% (60 phr of hybrid). Finally, energy harvesting was performed. For example, the isotropic samples exhibit ~20 mV (60 phr of BaTiO3), ~5.4 mV (60 phr of EIP), and ~3.7 mV (60 phr of hybrid). However, the anisotropic samples exhibit ~5.6 mV (60 phr of EIP), and ~8.8 mV (60 phr of hybrid). In the end, the composites prepared have three configurations, namely one with electro-mechanical aspects, another with magnetic sensitivity, and a third with both features. Overall, the experimental outcomes will make fabricated composites useful for different intelligent and stretchable applications.

Tear clearance rate in dogs: Measurement using anterior segment optical coherence tomography.

OBJECTIVE: The tear clearance rate (TCR), determined using anterior segment optical coherence tomography (AS-OCT) images, and its correlation with ocular surface parameters, including blink rate, Schirmer tear test-1 (STT-1) and tear film breakup time (TFBUT), were evaluated. ANIMALS STUDIED: Left eyes of 20 client-owned dogs with no ocular disease symptoms. PROCEDURES: The tear meniscus height (TMH) was evaluated using AS-OCT images before the instillation of 5 µL saline (TMHbase ), immediately post-instillation (TMH0 ), 30-s post-instillation (TMH0.5 ) and at 1 min intervals for 5 min post-instillation (TMH1 , TMH2 , TMH3 , TMH4 and TMH5 ). The TCR was calculated using the formula [(TMH0  - TMH0.5 )/TMH0 ]×100 (%). The eyes were classified into two groups with the median: 'High TMHbase ' (n = 10) and 'Low TMHbase ' (n = 10). Eyes with STT-1 values ≥15 mm/min and TFBUT ≥ 12 s were assigned to the 'Satisfied' subgroup, whereas eyes not satisfying these criteria were assigned to the 'Not satisfied' subgroup. RESULTS: TMH0 was higher than TMH0.5 (p = 0.02), wherein TMH0.5 to TMH5 did not differ significantly. The TCR and blink rate were negatively correlated (p = 0.02). The 'Not satisfied' subgroup in the low TMHbase group had a lower TCR (p = 0.02) and higher blink rate (p = 0.04) than the 'Satisfied' subgroup. CONCLUSIONS: TCR can be evaluated using AS-OCT in dogs. Eyes with a lower TCR blink more frequently. TMH merits studying to understand ocular surface health.

Enhancing Rubber Vulcanization Cure Kinetics: Lowering Vulcanization Temperature by Addition of MgO as Co-Cure Activator in ZnO-Based Cure Activator Systems.

Vulcanization is a chemical modification of rubber that requires a considerable amount of thermal energy. To save thermal energy, the kinetics of rubber vulcanization should be improved. In this article, the curing properties of rubber vulcanization are thoroughly investigated using the moving die rheometer (MDR) technique. To enhance the kinetics in different stages of ZnO-based sulfur vulcanization systems, small amounts of MgO were added. The results revealed that the small amount of 1 to 2 phr (per hundred grams of rubber) of MgO in the controlled 5 phr ZnO-based curing systems can significantly improve the curing kinetics. For example, the optimum curing time of 1 phr MgO added to the 5 phr ZnO-containing semi-efficient vulcanization system at different temperatures was more than half that of the controlled 5 phr ZnO-only compound. While maintaining a similar rate of vulcanization, the vulcanization temperature can be reduced by up to 20 °C by using MgO as a co-cure activator, which exhibits similar or better rheometric mechanical properties compared to the controlled compounds. With the addition of MgO as a co-cure activator, the vulcanization reactions become very fast, enabling vulcanization to be completed, even at the boiling point of water (100 °C) with an affordable curing time (<1 h). By reducing the vulcanization temperature, the scorch safety time can be enhanced in the ZnO/MgO-based binary cure activator-containing vulcanizates. Overall, MgO could be a potential candidate as a co-cure activator with ZnO for the vulcanization of rubber, offering better economical and eco-friendly methods.

Multifunctional Aspects of Mechanical and Electromechanical Properties of Composites Based on Silicone Rubber for Piezoelectric Energy Harvesting Systems.

Energy harvesting systems fabricated from rubber composite materials are promising due to their ability to produce green energy with no environmental pollution. Thus, the present work investigated energy harvesting through piezoelectricity using rubber composites. These composites were fabricated by mixing titanium carbide (TiC) and molybdenum disulfide (MoS2) as reinforcing and electrically conductive fillers into a silicone rubber matrix. Excellent mechanical and electromechanical properties were produced by these composites. For example, the compressive modulus was 1.55 ± 0.08 MPa (control) and increased to 1.95 ± 0.07 MPa (6 phr or per hundred parts of rubber of TiC) and 2.02 ± 0.09 MPa (6 phr of MoS2). Similarly, the stretchability was 133 ± 7% (control) and increased to 153 ± 9% (6 phr of TiC) and 165 ± 12% (6 phr of MoS2). The reinforcing efficiency (R.E.) and reinforcing factor (R.F.) were also determined theoretically. These results agree well with those of the mechanical property tests and thus validate the experimental work. Finally, the electromechanical tests showed that at 30% strain, the output voltage was 3.5 mV (6 phr of TiC) and 6.7 mV (6 phr of MoS2). Overall, the results show that TiC and MoS2 added to silicone rubber lead to robust and versatile composite materials. These composite materials can be useful in achieving higher energy generation, high stretchability, and optimum stiffness and are in line with existing theoretical models.

Risk factors associated with Coxiella burnetii in wild boars: A study in South Korea.

Coxiella burnetii is a Gram-negative bacterium that causes the zoonotic disease Q fever. Wild boars serve as reservoirs for C. burnetii. This study aimed to identify the risk factors associated with C. burnetii infection in wild boars. We analyzed the data from 975 wild boar samples collected from June to November 2021 in South Korea. We utilized the indirect ELISA to detect antibodies against C. burnetii. A sample optical density to positive-control optical density value exceeding 50% was classified as positive. We gathered data on the forestation, terrain, weather, agriculture, and animal density of the region where the samples were collected. Continuous variables were categorized into tertiles. We performed a univariate logistic regression analysis and included variables with a p-value < 0.2 in the final multivariable logistic regression model. In our multivariable logistic regression analysis to identify risk factors for C. burnetii infection in wild boars, we used a forward selection method to enter variables based on the order of their significance. We performed the final multivariable logistic regression analyses using either continuous variables or variables categorized into tertiles. The prevalence of C. burnetii was 14.6% (n=142). Locations with the highest maximum wind speeds (3.92-8.24 m/s) showed a 59% increase in infection odds compared to locations with the lowest speeds (1.45-3.25 m/s)(p=0.044). For each 1 m/s increase in maximum wind speed, infection odds increased by 24.1% (p=0.037). Regions with the highest percentage of paddy fields per area (8.3-45%) showed a 76% increase in infection odds compared to regions with the lowest percentage (0-1.5%)(p=0.011). For each 1% increase in the proportion of paddy fields per area, infection odds increased by 3.3% (p=0.003). High maximum wind speed and a high percentage of paddy field were identified as significant risk factors for C. burnetii infection in wild boars.

Evaluation of sensitivity and specificity of Kato-Katz and circulating cathodic antigen in terms of Schistosoma japonicum using latent class analysis.

Schistosoma japonicum is endemic in the Philippines. The Kato-Katz (KK) method was used to diagnose S. japonicum. This is impractical, particularly when the sample size is limited. Knowledge on point-of-care circulating cathodic antigen (CCA) test performance for S. japonicum is limited. Determining the sensitivity and specificity of new diagnostics is difficult when the gold standard test is less effective or absent. Latent class analysis (LCA) can address some limitations. A total of 484 children and 572 adults from the Philippines were screened for S. japonicum. We performed Bayesian LCA to estimate the infection prevalence, sensitivity and specificity of each test by stratifying them into two age groups. Observed prevalence assessed by KK was 50.2% and 31.8%, and by CCA was 89.9% and 66.8%, respectively. Using Bayesian LCA, among children, the sensitivity and specificity of CCA were 94.8% (88.7-99.4) and 21.5% (10.5-36.1) while those of KK were 66.0% (54.2-83.3) and 78.1% (61.1-91.3). Among adults, the sensitivity and specificity of CCA were 86.4% (76.6-96.9) and 62.8% (49.1-81.1) while those of KK were 43.6% (35.1-53.9) and 85.5% (75.8-94.6). Overall, CCA was more sensitive than KK, regardless of the age group at diagnosis, as KK was more specific. KK and CCA have different diagnostic performance, which should inform their use in the planning and implementation of S. japonicum control programs.

Characterization of Brighton Collaboration criteria for myocarditis and pericarditis following COVID-19 vaccine in Korean adolescents.

BACKGROUND: Vaccines are vital for public health, but concerns about adverse effects, particularly myocarditis and pericarditis linked to COVID-19 vaccines-, persist. This study investigates the application of Brighton Collaboration case definition to national vaccine safety data related to post-COVID-19 vaccine myo/pericarditis, utilizing claims under the Korea National Vaccine Injury Compensation Program (NIVCP). METHODS: This study analyzed 190 medical records of individuals who claimed to have developed myo/pericarditis after receiving the COVID-19 vaccine, as reported to the NVICP between specified dates, categorizing cases based on the Brighton criteria for myocarditis or pericarditis. RESULTS: Between 2021-2022, NVICP received 190 cases meeting the Brighton criteria for myocarditis or pericarditis at levels 1, 2, or 3. Most cases fell into Level 2 (70%), followed by Level 1 (29%), and one at Level 3 (1%), with Level 1 cases showing a higher hospitalization rate (87.3%) and a notable proportion requiring admission to the Intensive Care Unit (25.5%). Chest pain and Troponin-I/T elevation were common findings in Level 1 cases, while Level 2 cases exhibited similar patterns but at a slightly lower frequency. Electrocardiogram and echocardiography findings differed between the two levels. CONCLUSION: The Brighton Collaboration case definition proved valuable for classifying and assessing AEFI data, enhancing our understanding of the potential relationship between myocarditis and the COVID-19 vaccine.

Lower Atrial Fibrillation Risk With Sodium-Glucose Cotransporter 2 Inhibitors Than With Dipeptidyl Peptidase-4 Inhibitors in Individuals With Type 2 Diabetes: A Nationwide Cohort Study.

BACKGROUND AND OBJECTIVES: Accumulating evidence shows that sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce adverse cardiovascular outcomes. However, whether SGLT2i, compared with other antidiabetic drugs, reduce the new development of atrial fibrillation (AF) is unclear. In this study, we compared SGLT2i with dipeptidyl peptidase-4 inhibitors (DPP-4is) in terms of reduction in the risk of AF in individuals with type 2 diabetes. METHODS: We included 42,786 propensity score-matched pairs of SGLT2i and DPP-4i users without previous AF diagnosis using the Korean National Health Insurance Service database between May 1, 2016, and December 31, 2018. RESULTS: During a median follow-up of 1.3 years, SGLT2i users had a lower incidence of AF than DPP-4i users (1.95 vs. 2.65 per 1,000 person-years; hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55-0.97; p=0.028]). In individuals without heart failure, SGLT2i users was associated with a decreased risk of AF incidence (HR, 0.70; 95% CI, 0.52-0.94; p=0.019) compared to DPP-4i users. However, individuals with heart failure, SGLT2i users was not significantly associated with a change in risk (HR, 1.04; 95% CI, 0.44-2.44; p=0.936). CONCLUSIONS: In this nationwide cohort study of individuals with type 2 diabetes, treatment with SGLT2i was associated with a lower risk of AF compared with treatment with DPP-4i.

Effect of hemoglobin A1c change on 24-month clinical outcomes in patients with diabetes after acute myocardial infarction.

BACKGROUND: The average glycated hemoglobin (HbA1c) may not accurately reflect glycemic control status during the mid-term after acute myocardial infarction (AMI). We aimed to evaluate changes in HbA1c and their effect on mid-term clinical outcomes in patients with diabetes and AMI. METHODS: We enrolled patients with diabetes ( n  = 967) who underwent HbA1c measurement in the Korean nationwide registry. These patients were categorized into three groups based on changes in HbA1c from index admission to the 1-year follow-up visit: a decrease in HbA1c > 1%, changes in HbA1c within 1%, and an increase in HbA1c > 1%. Clinical outcomes at 24 months were examined. RESULTS: The baseline HbA1c levels were 8.55 ±â€…0.85, 7.00 ±â€…0.98 and 7.07 ±â€…1.05 ( P  = 0.001) and HbA1c levels after 1 year were 6.62 ±â€…0.73, 7.05 ±â€…0.98 and 9.26 ±â€…1.59 ( P  = 0.001) for patients with 3 groups, respectively. Patients with a 1% decrease in HbA1c had significantly lower incidence of major adverse cardiovascular events (MACE), cardiac death, and rehospitalization after 24 months than those with a 1% increase in HbA1c. However, in the Cox regression analysis, a >1% decrease in HbA1c change was not an independent factor for MACE, cardiac death, and rehospitalization. CONCLUSIONS: Our analysis indicates that an HbA1c decrease of >1% within the first 12 months was not an independent prognostic factor until the 24-month mark. Therefore, standard diabetic control is recommended for patients with diabetes and AMI for up to 2 years.

RNF213 vasculopathy manifested in various forms within a family: A case report.

RATIONALE: The ring finger protein 213 (RNF213) p.R4810K variant has been identified as being associated with Moyamoya disease (MMD), a condition that is more prevalent in East Asians. This association extends beyond cerebral vessels and has been implicated in coronary artery disease. PATIENT CONCERNS: A 36-year-old female was admitted to the emergency room with chest pain. Although the patient had no known underlying conditions or risk factors for atherosclerosis, she was diagnosed with unstable angina and underwent percutaneous coronary intervention. Given her older sister's ongoing treatment for MMD, it was suspected that the patient's coronary artery disease might be linked to the MMD-associated gene mutation. DIAGNOSES: Coronary angiography revealed 80% narrowing of the proximal left anterior descending artery. Based on clinical symptoms and coronary angiography, we diagnosed it as unstable angina. INTERVENTION: Due to the family history of MMD and detection of the RNF213 p.R4810K heterozygous variant in the patient's older sister, genetic counseling was recommended. Next-generation sequencing for vascular diseases was performed. OUTCOMES: Genetic testing confirmed the presence of an RNF213 p.R4810K heterozygous variant in the patient, mirroring that in her sister. An RNF213 p.C4397R heterozygous variant was identified concomitantly, although it was categorized as a variant of uncertain significance. Coronary artery disease has been attributed to the RNF213 p.R4810K variant. LESSONS: Although MMD is rare in Western populations, it is more common in East Asian populations. Traditionally, MMD diagnoses have focused solely on the cerebral vessels without guidelines for the assessment of other vascular involvements. This familial case underscores the fact that a single genetic mutation can manifest in diverse ways in different diseases. Hence, the need and regularity of systemic vessel screening should be thoughtfully considered in such a context.