Potential biomarkers in breast cancer drug development: application of the biomarker qualification evidentiary framework.

Breast cancer treatments have evolved rapidly, and clinically meaningful biomarkers have been used to guide therapy. These biomarkers hold utility within the drug development process to increase the efficiency and effectiveness. To this purpose, the US FDA developed an evidentiary framework. Literature searches conducted of literature published between 2016 and 2022 identified biomarkers in breast cancer. These biomarkers were reviewed for drug development utility through the biomarker qualification evidentiary framework. In the breast cancer setting, several promising biomarkers (ctDNA, Ki-67 and PIK3CA) were identified. There is a need for increased transparency regarding the requirements for qualification of specific biomarkers and increased awareness of the processes involved in biomarker qualification.

Trajectories of resting energy expenditure and performance of predictive equations in children hospitalized with an acute illness and malnutrition: a longitudinal study.

There is scarce data on energy expenditure in ill children with different degrees of malnutrition. This study aimed to determine resting energy expenditure (REE) trajectories in hospitalized malnourished children during and after hospitalization. We followed a cohort of children in Bangladesh and Malawi (2-23 months) with: no wasting (NW); moderate wasting (MW), severe wasting (SW), or edematous malnutrition (EM). REE was measured by indirect calorimetry at admission, discharge, 14-and-45-days post-discharge. 125 children (NW, n = 23; MW, n = 29; SW, n = 51; EM, n = 22), median age 9 (IQR 6, 14) months, provided 401 REE measurements. At admission, the REE of children with NW and MW was 67 (95% CI [58, 75]) and 70 (95% CI [63, 76]) kcal/kg/day, respectively, while REE in children with SW was higher, 79 kcal/kg/day (95% CI [74, 84], p = 0.018), than NW. REE in these groups was stable over time. In children with EM, REE increased from admission to discharge (65 kcal/kg/day, 95% CI [56, 73]) to 79 (95% CI [72, 86], p = 0.0014) and was stable hereafter. Predictive equations underestimated REE in 92% of participants at all time points. Recommended feeding targets during the acute phase of illness in severely malnourished children exceeded REE. Acutely ill malnourished children are at risk of being overfed when implementing current international guidelines.

Data describing effects of different phosphorus concentrations on growth and chymotrypsin inhibitors in Microcystis aeruginosa NIVA Cya 43 using LC-MS.

Cyanobacteria's abundant production of bioactive compounds concerns unselective filter feeders in the aquatic food chain, but the factors driving this production remain poorly understood. Notably, nutrient availability, particularly concerning phosphorus and nitrogen, is believed to be a pivotal determinant of cyanobacterial mass development. In this data investigation, we aimed to explore the influence of dissolved phosphorus (PO43-) on the presence of chymotrypsin inhibitors, specifically Cyanopeptolin 954 (CP954) and Nostopeptin 920 (BN920), within Microcystis aeruginosa NIVA Cya 43. A carefully controlled 15-day batch culture experiment was conducted, with three distinct phosphate concentrations (30, 50, and 75 µM). Liquid Chromatography-Mass Spectrometry (LC-MS) was employed for quantitative analysis, and the findings underscored the intricate interplay between nutrient availability, particularly phosphorus, and the content of chymotrypsin inhibitors (CP954 and BN920) by Cyanobacteria. More precisely, a significant 53% increase in CP954 content was noticed as the phosphate concentration decreased, revealing the intricate connection between nutrient availability, particularly phosphorus, in Cyanobacteria. Future research should further investigate the impacts of environmental factors, including light intensity and other nutrients like nitrogen, on the content of chymotrypsin inhibitors in Cyanobacteria.

Improvement of Recalcitrant Dissecting Cellulitis of the Scalp After a Trial of Upadacitinib.

Dissecting cellulitis of the scalp (DCS) is a rare condition characterized by painful inflammatory nodules and abscesses on the scalp, often leading to sinus tracts and scarring alopecia. We present a case of DCS in a 26-year-old male who experienced significant clinical improvement following a short course of upadacitinib, a Janus kinase (JAK) inhibitor. The patient received multiple standard treatments such as topical antimicrobials, oral antibiotics, corticosteroids, and intralesional triamcinolone injections, with limited success. However, following the initiation of upadacitinib, the patient reported reduced pain, pustular draining, and bleeding, with significantly improved quality of life. To our knowledge, there is currently a paucity of literature documenting the use of JAK inhibitors for DCS. This case aims to highlight the potential of JAK inhibitors as a therapy for refractory DCS, a condition with limited treatment options.

Removal efficiencies of microplastics of the three largest drinking water treatment plants in Bangladesh.

Drinking water treatment plants (DWTPs) are intended to provide safe water to the municipality, typically by treating surface waters from rivers, lakes, and streams. Regrettably, all of these water sources for DWTPs have been reported to be contaminated by microplastics (MPs). Hence, there is an urgent need to investigate the removal efficiencies of MPs from raw waters in the conventional DWTPs anticipating public health concerns. In this experiment, MPs in the raw and treated waters of the three major DWTPs of Bangladesh, having different water treatment processes, were evaluated. The concentrations of MPs in the inlet points of Saidabad Water Treatment Plant phase-1 and 2 (SWTP-1 and SWTP-2), which share a similar water source of the Shitalakshya River, were 25.7 ± 9.8 and 26.01 ± 9.8 items L-1. The third plant, Padma Water Treatment Plant (PWTP) utilizes water from the Padma River and had an initial MP concentration of 6.2 ± 1.6 items L-1. The studied DWTPs, with their existing treatment processes, were found to reduce the MP loads substantially. The final MP concentrations in treated waters of SWTP-1, SWTP-2, and PWTP were 0.3 ± 0.03, 0.4 ± 0.01, and 0.05 ± 0.02 items L-1 with the removal efficiencies of 98.8, 98.5, and 99.2 %, respectively. The considered size range of MP was 20 µm to <5000. Fragments and fibers were the two predominant MP shapes. In terms of polymer, the MPs were polypropylene (PP, 48 %), polyethylene (PE, 35 %), polyethylene terephthalate (PET, 11 %), and polystyrene (PS, 6 %). The field emission scanning electron microscopy-energy dispersive X-ray spectroscopy (FESEM-EDX) revealed the fractured and rough surfaces of the remaining MPs, which were also found to be contaminated with heavy metals, like lead (Pb), cadmium (Cd), chromium (Cr), arsenic (As), copper (Cu), and zinc (Zn). Hence, additional initiatives are required to remove the residual MPs from the treated waters to safeguard the city dwellers from potential hazards.

Microplastics pollution in mud crab (Scylla sp.) aquaculture system: First investigation and evidence.

Microplastics (MPs) occurrence in farmed aquatic organisms has already been the prime priority of researchers due to the food security concerns for human consumption. A number of commercially important aquaculture systems have already been investigated for MPs pollution but the mud crab (Scylla sp.) aquaculture system has not been investigated yet even though it is a highly demanded commercial species globally. This study reported the MPs pollution in the mud crab (Scylla sp.) aquaculture system for the first time. Three different stations of the selected aquafarm were sampled for water and sediment samples and MPs particles in the samples were isolated by the gravimetric analysis (0.9% w/v NaCl solution). MP abundance was visualized under a microscope along with their size, shape, and color. A subset of the isolated MPs was analyzed by scanning electron microscope (SEM), and Fourier transform infrared spectroscopy (FTIR) for the surface and chemical characterization respectively. The average MPs concentration was 47.5 ± 11.875 particles/g in sediment and 127.92 ± 14.99 particles/100 L in the water sample. Fibrous-shaped (72.17%) and transparent-colored (59.37%) MPs were dominant in all the collected samples. However, smaller MPs (>0.05-0.5 mm) were more common in the water samples (47.69%) and the larger (>1-5 mm) MPs were in the sediment samples (47.83%). SEM analysis found cracks and roughness on the surface of the MPs and nylon, polyethylene, polypropylene, and polystyrene MPs were identified by FTIR analysis. PLI value showed hazard level I in water and level II in sediment. The existence of deleterious MPs particles in the mud crab aquaculture system was well evident. The other commercial mud crab aquafarms must therefore be thoroughly investigated in order to include farmed mud crabs as an environmentally vulnerable food security concern.

Floating raft culture of Gracilariopsis longissima for optimum biomass yield performance on the coast of Cox's Bazar, Bangladesh.

Seaweed cultivation is an eco-friendly method and attracts growing interest which needs a multi-criteria approach for its sustainability. In our present study, an economically significant red alga, Gracilariopsis longissima was cultured using a floating raft method on the coast of Cox's Bazar, Bangladesh for a period of 90 days from January to March 2022. The effects of different factors such as rope materials, culture type, raft shape, seeding intensity, harvesting phase and water depth on the biomass yield production of G. longissima were evaluated during a 90-day culture period. The biomass yield production and daily growth rate (DGR% day-1) were estimated to evaluate the possibilities of G. longissima cultures in a floating raft culture method. The range of biomass yield production (3.03-13.37 kg/m2) and DGR (3.08-4.72% day-1) is satisfactory in the floating raft culture method. Different water quality variables, the seasonal appearance of epiphytic algae and a cost-benefit analysis of seaweed culture were also performed. A total of eight epiphytic algal species were recorded, which resulted in major challenges for the growth of Gracilariopsis. The per month income for a seaweed farmer was estimated to be US$175.17 for 20 rafts. Our research concluded that farming of G. longissima in the floating raft method could be successfully performed from January to March on the coast of Cox's Bazar.

Microplastics biodegradation by biofloc-producing bacteria: An inventive biofloc technology approach.

Microplastics pollution has become a threat to aquaculture practices, as nearly all farming systems are saturated with microplastics (MPs) particles. Current research on MPs is limited considering their effects on aquatic organisms and human health. However, limited research has been conducted on potential cures and treatments. In today's world, bioremediation of needful parameters in different culture systems is being successfully practiced by introducing floc-forming bacteria. Researchers had found that some bacteria are efficacious in degrading microplastics particles including polyethylene (PE), polystyrene (PS), and polypropylene (PP). In addition, some bacteria that can form floc, are being used in fish and shellfish culture systems to treat toxic pollutants as the heterotrophic bacteria use organic compounds to grow and are effective in degrading microplastics and minimizing toxic nitrogen loads in aquaculture systems. In this review, the ability of biofloc bacteria to degrade microplastics has been summarized by collating the results of previous studies. The concept of this review may represent the efficacy of biofloc technology as an implicit tool in the fish culture system restricting the MPs contamination in water resources to safeguard ecological as well as human health.

Abundance, characteristics, and spatial-temporal distribution of microplastics in sea salts along the Cox's Bazar coastal area, Bangladesh.

Microplastics (MPs), together with microfibers, have emerged as a contaminant of concern all around the globe. MPs have been detected in freshwater, seawater, sediment, and aquatic species among others. As suggested by several recent investigations, sea salts, a daily intake item by humans, are also contaminated by MPs. The current article describes MPs' occurrence, distribution, type, and timeline variation in raw sea salts from Cox's Bazar, Bangladesh. MPs have been detected in every collected salt sample, and quantity varied from 28.53 ± 2.43 to 93.53 ± 4.21 particles per kg, which was about 52.48 ± 1.72 to 67.46 ± 3.81 µg/kg of raw salt. Microfibers were MPs' dominant shape category, and the plastic types were mainly polyester or nylon. Other types of MPs were polyethylene (PE), polypropylene (PP), polycarbonate (PC), polyurethane (PU), and polystyrene (PS) in decreasing amounts. The majority of the MPs in the sea salts were in the size range of ˂ 3-1 mm. The total amount of MPs and plastic-type variation due to sampling location (p ˃ 0.05) and because of the time period (p ˃ 0.05) was found insignificant. Acetaldehyde, a volatile toxic substance produced by the degradation of polyester polymer chains, was detected in MPs in the range of 0.37 to 1.72 µg/g by headspace GC-MS analysis. Hence, the sea salts contaminated with MPs pose a public health hazard. Microplastics extraction from sea salts and their characterization.

Dataset describing the growth pattern, amino acid and fatty acid profile of five indigenous marine microalgae species of Bangladesh.

This paper presents the data on the growth pattern, amino acid, and fatty acid profile of five (5) selected indigenous marine microalgae (Chaetoceros sp.; Isochrysis sp.; Skeletonema sp.; Nannochloropsis sp.; and Tetraselmis sp.) of Bay of Bengal, Bangladesh. The microalgae species were cultured in f/2 Guillard's medium with maintaining standard physico-chemical parameters. The growth pattern was determined for all the microalgae as a prerequisite for further necessary experimental works. All the species were mass cultured using the same culture medium and harvested (centrifuging method), and dried (60 â„ƒ for 12 h) at their stationary phase. Finally, the amino acid and fatty acid analyses were performed. In many contexts, the amino acid and fatty acid data showed significant differences (p < 0.05) among these experimental species. However, by understanding these experimental species' nutritional profiles, one can easily choose the desired one that is most appropriate for their intended application.

Pervasiveness and characteristics of microplastics in surface water and sediment of the Buriganga River, Bangladesh.

Microplastics (MPs) are an emerging environmental problem due to their all-around existence and extraordinary stability. A significant number of studies are found in recent literature on the occurrence, distribution, transport, and fate of the MPs in several environmental compartments. In this study, we have investigated the occurrence and characteristics of MPs in the surface water and sediment of the Buriganga river, located beside the mega-city of Dhaka in Bangladesh. In the Buriganga river, the concentration of MPs in the surface water was found from 4.33 ± 0.58 to 43.67 ± 0.58 items L-1, and in the sediment, MPs varied from 17.33 ± 1.53 to 133.67 ± 5.51 items kg-1 of dry sediment. Fragment-type MPs were predominant in the surface water and sediment, which was 72.7% and 85.5% respectively. The most abundant polymer type polypropylene (PP) was found -to be 46% in the surface water and 61% in the sediment sample. The next major category, polyethylene (PE) was found to be 26% and 21%, respectively. Polystyrene (PS), polyvinyl chloride (PVC), polyethylene terephthalate (PET), and polyamide (PA) were other commonly detected polymer types. The MPs were found to be contaminated by Pb, Cd, Cr, Zn, Cu, and Sn from Energy dispersive-X-ray fluorescence (ED-XRF) analysis. Tannery-induced Cr was detected in the highest concentrations in the MPs, which were 20.67 ± 1.66 mg kg-1 (in surface water) and 14.2 ± 1.25 mg kg-1 (in sediment). The pollution load index (PLI) of the MPs contamination in different sampling sites along the Buriganga river was found in the risk level category of I and II. The anthropogenic influence of the city area was reflected in the PLI values, which had an increasing trend from the upstream sampling points (1.00 ± 1.00, 1.00 ± 1.00) to the downstream sites (10.09 ± 1.00, 7.71 ± 3.60).

QbD Approach towards Robust Design Space for Flutamide/PiperineSelf-Emulsifying Drug Delivery System with Reduced Liver Injury.

Flutamide which is used to treat prostate cancer and other diseases induces liver damage during and after the therapy. The aim of this study was to develop a flutamide/piperineco-loaded self-emulsifying drug delivery system (FPSEDDS) to inhibit flutamide-induced liver injury by utilizing piperine as a metabolic inhibitor. The development of SEDDS was carried out following a quality by design (QbD) approach. The risk assessment study was performed to identify critical quality attributes (CQAs) and critical material attributes (CMAs)/critical process parameters (CPPs). I-optimal mixture design was executed with three CMAs as the independent variables and CQAs as the dependable variables. The effectiveness of optimized SEDDS to circumvent flutamide-induced hepatotoxicity was assessed in mice. The numerical optimization suggested an optimal formulation with a desirability value of 0.621, using CQAs targets as optimization goals with 95% prediction intervals (α = 0.05). The optimal formulation exhibited the grade A SEDDS characteristics with the guarantee of high payloads in self-formed oily droplets. The design space was also obtained from the same optimization goals. All CQA responses of verification points were found within the 95% prediction intervals of the polynomial models, indicating a good agreement between actual versus predicted responses within the design space. These obtained responses also passed CQAs acceptance criteria. Finally, hematoxylin-eosin staining revealed the minimal flutamide-induced hepatotoxicity from the optimal SEDDS formulation as compared to the control and flutamide/piperine normal suspension. We demonstrate that the piperine containing optimized SEDDS formulation developed by QbD significantly reduces the flutamide-induced liver injury in mice.

Health-related quality of life in women with breast cancer: a review of measures.

BACKGROUND: To identify and describe the breast cancer-specific health-related quality of life (HRQoL) instruments with evidence of validation in the breast cancer population for potential use in patients treated for breast cancer (excluding surgery). METHODS: We conducted a systematic literature review using PubMed, Embase, and PsycINFO databases to identify articles that contain psychometric properties of HRQoL instruments used in patients with breast cancer. Relevant literature from January 1, 2009, to August 19, 2019, was searched. Articles published in English that reported psychometric properties (reliability, validity) of HRQoL instruments were identified. RESULTS: The database search yielded 613 unique records; 131 full-text articles were reviewed; 80 articles presented psychometric data for instruments used in breast cancer (including generic measures). This article reviews the 33 full articles describing psychometric properties of breast cancer-specific HRQoL instruments: EORTC QLQ-C30, EORTC QLQ-BR23, FACT-B, FBSI, NFBSI-16, YW-BCI36, BCSS, QuEST-Br, QLICP-BR, INA-BCHRQoL, and two newly developed unnamed measures, one by Deshpande and colleagues (for use in India) and one by Vanlemmens and colleagues (for use among young women and their partners). The articles that described the EORTC QLQ-C30, QLQ-BR23, and FACT-B centered on validating translations, providing additional support for content validity, and demonstrating acceptability of electronic patient-reported outcome administration. Psychometric properties of the measures were acceptable. Several new measures have been developed in Asia with an emphasis on development on cultural relevance/sensitivity. Others focused on specific populations (i.e., young women with breast cancer). CONCLUSIONS: Historically, there have been limited options for validated measures to assess HRQoL of patients with breast cancer. A number of new measures have been developed and validated, offering promising options for assessing HRQoL in this patient population. This review supports the reliability and validity of the EORTC QLQ-C30 and FACT-B; new translations and electronic versions of these measures further support their use for this population.

Moringa oleifera is a Prominent Source of Nutrients with Potential Health Benefits.

Nowadays, the socioeconomic status has been changed a lot, so people are now more concerned about their life style and health. They have knowledge about the detrimental effects of synthetic products. That is why they are interested in natural products. Utilization of natural products of plant origin having fewer side effects has gained popularity over the years. There is immense scope for natural products that can intimate health benefits beyond traditional nutrients. Moringa oleifera is one such tree having tremendous nutritional and medicinal benefits. It is rich in macro- and micronutrients and other bioactive compounds which are important for normal functioning of the body and prevention of certain diseases. Leaves, flowers, seeds, and almost all parts of this tree are edible and have immense therapeutic properties including antidiabetic, anticancer, antiulcer, antimicrobial, and antioxidant. Most of the recent studies suggested that Moringa should be used as a functional ingredient in food. The aim of this review is to focus the use of Moringa oleifera as a potential ingredient in food products.

Prognostic factors of brain metastasis and survival among HER2-positive metastatic breast cancer patients: a systematic literature review.

BACKGROUND: Patients with breast cancer who overexpress the human epidermal growth factor receptor 2 (HER2) and subsequently develop brain metastasis (BM) typically experience poor quality of life and low survival. We conducted a comprehensive literature review to identify prognostic factors for BM and predictors of survival after developing BM, and the effects of therapies with different mechanisms of action among patients with HER2+ breast cancer (BC). METHODS: A prespecified search strategy was used to identify research studies investigating BM in patients with HER2+ BC published in English during January 1, 2009-to June 25, 2021. Articles were screened using a two-phase process, and data from selected articles were extracted. RESULTS: We identified 25 published articles including 4097 patients with HER2+ BC and BM. Prognostic factors associated with shorter time to BM diagnosis after initial BC diagnosis included younger age, hormone receptor negative status, larger tumor size or higher tumor grade, and lack of treatment with anti-HER2 therapy. Factors predictive of longer survival after BM included having fewer brain lesions (< 3 or a single lesion) and receipt of any treatment after BM, including radiosurgery, neurosurgery and/or systemic therapy. Patients receiving combination trastuzumab and lapatinib therapy or trastuzumab and pertuzumab therapy had the longest median survival compared with other therapies assessed in this review. CONCLUSIONS: More research is needed to better understand risk factors for BM and survival after BM in the context of HER2+ BC, as well as the assessment of new anti-HER2 therapy regimens that may provide additional therapeutic options for BM in these patients.

Immobilized Tetraselmis sp. for reducing nitrogenous and phosphorous compounds from aquaculture wastewater.

Removal of nitrogenous and phosphorus compounds from aquaculture wastewater by green microalgae (Tetraselmis sp.) was investigated using a novel method of algal cell immobilization. Immobilized microalgae removed nitrogenous and phosphorous compounds efficiently from aquaculture wastewater. Results showed that Tetraselmis beads reduced significantly (p < 0.05) the total ammonia nitrogen, nitrite nitrogen and soluble reactive phosphorous concentration (0.08; 0.10 and 0.17 mg/L, respectively) from the initial concentration of 7.7, 3.1 and 2.0 mg/L respectively within 48 h compared to other treatments. Removal rate of total ammonia nitrogen, nitrite nitrogen and soluble reactive phosphorous were 99.2, 99.2 and 94.3% respectively, for the artificial wastewater within 24 h. For the shrimp pond wastewater, total ammonia nitrogen, nitrite nitrogen and soluble reactive phosphorous were reduced 98.9, 97.7 and 91.1% respectively within 48 h. It is concluded that Tetraselmis sp. beads is an effective means to reduce nitrogen and phosphorus levels in aquaculture wastewater.

Use of comorbidity indices in patients with any cancer, breast cancer, and human epidermal growth factor receptor-2-positive breast cancer: A systematic review.

OBJECTIVE: To identify comorbidity indices that have been validated in cancer populations, with a focus on breast cancer and human epidermal growth factor receptor-2-positive (HER2+) breast cancer. STUDY DESIGN AND SETTING: A systematic review of the literature on the use of comorbidity indices in any cancer, breast cancer, and HER2+ breast cancer using Ovid and PubMed. RESULTS: The final data set comprised 252 articles (252 any cancer, 39 breast cancer, 7 HER2+ breast cancer). The most common cancers assessed were hematologic and breast, and the most common comorbidity index used was the Charlson Comorbidity Index (CCI) or a CCI derivative. Most validity testing of comorbidity indices used predictive validity based on survival outcomes. Hazard ratios for survival outcomes generally found that a higher comorbidity burden (measured by CCI) increased mortality risk in patients with breast cancer. All breast-cancer studies that validated comorbidity indices used CCI-based indices. Only one article validated a comorbidity index in HER2+ breast cancer. CONCLUSION: CCI-based indices are the most appropriate indices to use in the general breast-cancer population. There is insufficient validation of any comorbidity index in HER2+ breast cancer to provide a recommendation, indicating a future need to validate these instruments in this population.

Data on growth, productivity, pigments and proximate composition of indigenous marine microalgae isolated from Cox's Bazar Coast.

Data on growth, productivity, pigments and proximate composition of the four different indigenous marine microalgae (isolated from Cox's Bazar Coast) were collected to compare the growth performance, pigments and nutritional composition. Chlorella sp., Nannochloropsis sp., Tetraselmis sp. and Chaetoceros sp. are the four different marine microalgae. Growth curve was determined as the prerequisite to identify the stationary phase for each of the isolated microalgae. Data on growth curves were collected in terms of cell density and optical density to observe the growth rates and division per day. Isolated species were mass cultured in commercial culture medium. When the culture reached at stationary phase, microalgae were extracted to determine productivity, pigments, and proximate composition. The data of productivity (volumetric, areal and lipid productivity), pigments (Chlorophyll a, b, c, carotenoids, and phycobiliproteins), and proximate composition (protein, lipid, and carbohydrate) were significantly (p < 0.05) different among the four different microalgae. Therefore, this data will contribute to the selection of potential microalgae species through proper characterization for vast industrializations.

A qualitative evaluation of patient and healthcare provider knowledge, attitudes, and behavior for safety and use of pexidartinib.

Aim: Pexidartinib is approved in the USA for the treatment of symptomatic tenosynovial giant cell tumor associated with severe morbidity or functional limitations and not amenable to improvement with surgery. Due to risk of serious liver injury, a survey of patient and healthcare provider (HCP) knowledge, attitudes, and behavior (KAB) of the risks was required. Materials & methods: Prior to KAB survey execution, structured telephone interviews with 12 patients and 12 HCPs were conducted. Results: The interviews revealed that patients had difficulty with the complexity and wordiness of some of the questions, while HCPs noted that some questions were repetitive with terminology that was not self-explanatory. Of the 15 questions initially in the patient survey, nine were modified for survey inclusion. For the HCP survey, 10 of 18 questions were modified. Conclusion: Qualitative research prior to KAB surveys is recommended to improve comprehension and data quality.

Clinical and laboratory predictors of 30-day mortality in severe acute malnourished children with severe pneumonia.

OBJECTIVE: To determine the predictors of mortality within 30 days of hospital admission in a diarrhoeal disease hospital in Bangladesh. METHODS: Cohort study of hospitalised children aged 0-59 months with severe acute malnutrition (SAM) and severe pneumonia in Dhaka Hospital, icddr,b, Bangladesh from April 2015 to March 2017. Those discharged were followed up, and survival status at 30 days from admission was determined. Children who died were compared with the survivors in terms of clinical and laboratory biomarkers. Multivariable logistic regression analysis was used for calculating adjusted odds ratio for death within 30 days of hospital admission. RESULTS: We enrolled 191 children. Mortality within 30 days of admission was 6% (14/191). After adjusting for potential confounders (hypoxia, CRP and haematocrit) in logistic regression analysis, independent factors associated with death were female sex (aOR = 5.80, 95% CI: 1.34-25.19), LAZ <-4 (aOR = 6.51, 95% CI: 1.49-28.44) and Polymorphonuclear Leucocytes (PMNL) (>6.0 × 109 /L) (aOR = 1.06, 95% CI: 1.01-1.11). Using sex, Z-score for length for age (LAZ), and PMNL percentage, we used random forest and linear regression models to achieve a cross-validated AUC of 0.83 (95% CI: 0.82, 0.84) for prediction of 30-day mortality. CONCLUSIONS: The results of our data suggest that female sex, severe malnutrition (<-4 LAZ) and higher PMNL percentage were prone to be associated with 30-day mortality in children with severe pneumonia. Association of these factors may be used in clinical decision support for prompt identification and appropriate management for prevention of mortality in this population.

OBJECTIF: Déterminer les prédicteurs de mortalité dans les 30 jours suivant l'admission à l'hôpital dans un hôpital pour maladies diarrhéiques au Bangladesh. MÉTHODES: Etude de cohorte d'enfants hospitalisés âgés de 0 à 59 mois atteints de malnutrition aiguë sévère (MAS) et de pneumonie sévère à l'hôpital de Dhaka, icddr,b, au Bangladesh d'avril 2015 à mars 2017. Ceux qui ont été libérés ont été suivis et leur état de survie à 30 jours de l'admission a été déterminé. Les enfants décédés ont été comparés aux survivants en termes de biomarqueurs cliniques et de laboratoire. Une analyse de régression logistique multivariée a été utilisée pour calculer le rapport de cotes ajusté pour le décès dans les 30 jours suivant l'admission à l'hôpital. RÉSULTATS: Nous avons inscrit 191 enfants. La mortalité dans les 30 jours suivant l'admission était de 6% (14/191). Après ajustement pour les facteurs confusionnels potentiels (hypoxie, CRP et hématocrite) dans l'analyse de régression logistique, les facteurs indépendants associés au décès étaient le sexe féminin (aOR = 5,80 ; IC95%: 1,34 à 25,19), LAZ <-4 (aOR = 6,51 ; IC95%: 1,49-28,44) et leucocytes polymorphonucléaires (LPMN) (>6,0 x 109 /L) (aOR = 1,06 ; IC95%: 1,01-1,11). En utilisant le sexe, le score Z de la taille pour l'âge (LAZ) et le pourcentage de LPMN, nous avons utilisé des modèles de régression linéaire et de forest aléatoires pour obtenir une AUC validée croisée de 0,83 (IC95%: 0,82-0,84) pour la prédiction de la mortalité à 30 jours. CONCLUSIONS: Les résultats de nos données suggèrent que le sexe féminin, la malnutrition sévère (LAZ <-4) et un pourcentage plus élevé de LPMN étaient susceptibles d'être associés à la mortalité à 30 jours chez les enfants atteints de pneumonie sévère. L'association de ces facteurs peut être utilisée dans l'aide à la décision clinique pour une identification rapide et une prise en charge appropriée pour la prévention de la mortalité dans cette population.