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Haematologica May 2024Mucosal-associated invariant T (MAIT) cells are innate-like T-cells implicated in the response to fungal and bacterial infections. Their contribution to restoring T-cell...
Mucosal-associated invariant T cells are functionally impaired in pediatric and young adult patients following allogeneic hematopoietic stem cell transplantation and their recovery correlates with clinical outcomes.
Mucosal-associated invariant T (MAIT) cells are innate-like T-cells implicated in the response to fungal and bacterial infections. Their contribution to restoring T-cell immunity and influencing hematopoietic stem cell transplant (HSCT) outcomes remains poorly understood. We retrospectively studied MAIT-cell recovery in 145 consecutive children and young adults with hematological malignancies undergoing allo-HSCT, between April/2019 and May/2022, from unrelated matched donor (MUD, n=52), with standard graft-versus-host-disease (GvHD) prophylaxis, or HLA-haploidentical (Haplo, n=93) donor after in vitro αβT/CD19-cell depletion, without post-HSCT pharmacological prophylaxis. With a median follow-up of 33 months (12-49), overall survival (OS), disease-free survival (DFS) and non-relapse mortality (NRM) were 79.5%, 72% and 7%, respectively; GvHD-free, Relapse-free Survival (GRFS) was 63%, while cumulative incidence of relapse was 23%. While WWT-cells reconstituted 1-2 years post-HSCT, MAIT-cells showed delayed recovery and prolonged functional impairment, characterized by expression of activation (CD25, CD38), exhaustion (PD1, TIM3) and senescence (CD57) markers, and suboptimal ex vivo response. OS, DFS and NRM were not affected by MAIT-cells. Interestingly, higher MAIT-cells at day+30 correlated with higher incidence of grade II-IV acute GvHD (19% vs 7%, p=0.06). Furthermore, a greater MAIT-cell count tended to be associated with a higher incidence of chronic GvHD (17% vs 6%, p=0.07) resulting in lower GRFS (55% vs 73%, p=0.05). Higher MAIT-cells also correlated with greater cytomegalovirus (CMV) reactivation and lower late blood stream infections (BSI) (44% vs 24%, p=0.02 and 9% vs 18%, p=0.08, respectively). Future studies are needed to confirm the impact of early MAIT-cell recovery on cGvHD, CMV reactivation and late BSI.
PubMed: 38813718
DOI: 10.3324/haematol.2023.284649 -
BMC Health Services Research May 2024Lack of access to risk-appropriate maternity services, particularly for rural residents, is thought to be a leading contributor to disparities in maternal morbidity and...
BACKGROUND
Lack of access to risk-appropriate maternity services, particularly for rural residents, is thought to be a leading contributor to disparities in maternal morbidity and mortality. There are several existing measures of access to obstetric care in the literature and popular media. In this study, we explored how current measures of obstetric access inform the number and location of additional obstetric care facilities required to improve access.
METHODS
We formulated two facility location optimization models to determine the number of new facilities required to minimize the number of reproductive-aged women who lack access to obstetric care. We define regions with a lack of access as either maternity care deserts, designated by the March of Dimes to be counties with no obstetric care facility or obstetric providers, or regions further than 50 miles from critical care obstetric (CCO) services. We gathered information on hospitals with obstetric services from Georgia Department of Public Health public reports and estimated the female reproductive-age population by census block group using the American Community Survey.
RESULTS
Out of the 1,910,308 reproductive-aged women who live in Georgia, 104,158 (5.5%) live in maternity care deserts, 150,563 (7.9%) reproductive-aged women live further than 50 miles from CCO services, and 38,202 (2.0%) live in both maternity care desert and further than 50 miles from CCO services. Our optimization analysis suggests that at least 56 new obstetric care facilities (a 67% increase) would be required to eliminate maternity care deserts in Georgia. However, the expansion of 8 facilities would ensure all women in Georgia live within 50 miles of CCO services.
CONCLUSIONS
Current measures of access to obstetric care may not be sufficient for evaluating access and planning action toward improvements. In a state like Georgia with a large number of small counties, eliminating maternity care deserts would require a prohibitively large number of new obstetric care facilities. This work suggests that additional measures and tools are needed to estimate the number and type of obstetric care facilities that best match practical resources to meet obstetric care needs.
Topics: Humans; Female; Health Services Accessibility; Maternal Health Services; Pregnancy; Georgia; Adult; Obstetrics
PubMed: 38811929
DOI: 10.1186/s12913-024-11135-4 -
Case Reports in Women's Health Jun 2024Splenic hydatid cysts are caused by the species and rarely occur in pregnancy. This case report describes the management of a 29-year-old pregnant woman with a large...
Splenic hydatid cysts are caused by the species and rarely occur in pregnancy. This case report describes the management of a 29-year-old pregnant woman with a large (11 × 8.7 × 10.5 cm) splenic hydatid cyst. The cyst had been identified before she became pregnant by her general practitioner with imaging investigations undertaken for her persistent left upper abdominal pain. The patient also had laboratory investigations which were positive for echinococcosis species. Hydatid splenic cysts are very rare and even more so in pregnancy. Risk of splenic cyst rupture exists, and rupture has significant risk of maternal and perinatal morbidity and mortality. Among the few case reports in the literature there is no clear consensus on conservative or surgical management during pregnancy and no clear guidelines for intrapartum care or delivery. The case report reviews the literature on splenic hydatid cyst disease in pregnancy and explores the management and outcome of this patient through her fourth pregnancy, which resulted in an uncomplicated vaginal birth.
PubMed: 38808175
DOI: 10.1016/j.crwh.2024.e00611 -
Clinical risk factors for preterm birth and evaluating maternal psychology in the postpartum period.World Journal of Psychiatry May 2024Although the specific pathogenesis of preterm birth (PTB) has not been thoroughly clarified, it is known to be related to various factors, such as pregnancy...
BACKGROUND
Although the specific pathogenesis of preterm birth (PTB) has not been thoroughly clarified, it is known to be related to various factors, such as pregnancy complications, maternal socioeconomic factors, lifestyle habits, reproductive history, environmental and psychological factors, prenatal care, and nutritional status. PTB has serious implications for newborns and families and is associated with high mortality and complications. Therefore, the prediction of PTB risk can facilitate early intervention and reduce its resultant adverse consequences.
AIM
To analyze the risk factors for PTB to establish a PTB risk prediction model and to assess postpartum anxiety and depression in mothers.
METHODS
A retrospective analysis of 648 consecutive parturients who delivered at Shenzhen Bao'an District Songgang People's Hospital between January 2019 and January 2022 was performed. According to the diagnostic criteria for premature infants, the parturients were divided into a PTB group ( = 60) and a full-term (FT) group ( = 588). Puerperae were assessed by the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS), based on which the mothers with anxiety and depression symptoms were screened for further analysis. The factors affecting PTB were analyzed by univariate analysis, and the related risk factors were identified by logistic regression.
RESULTS
According to univariate analysis, the PTB group was older than the FT group, with a smaller weight change and greater proportions of women who underwent artificial insemination and had gestational diabetes mellitus ( < 0.05). In addition, greater proportions of women with reproductive tract infections and greater white blood cell (WBC) counts ( < 0.05), shorter cervical lengths in the second trimester and lower neutrophil percentages ( < 0.001) were detected in the PTB group than in the FT group. The PTB group exhibited higher postpartum SAS and SDS scores than did the FT group ( < 0.0001), with a higher number of mothers experiencing anxiety and depression ( < 0.001). Multivariate logistic regression analysis revealed that a greater maternal weight change, the presence of gestational diabetes mellitus, a shorter cervical length in the second trimester, a greater WBC count, and the presence of maternal anxiety and depression were risk factors for PTB ( < 0.01). Moreover, the risk score of the FT group was lower than that of the PTB group, and the area under the curve of the risk score for predicting PTB was greater than 0.9.
CONCLUSION
This study highlights the complex interplay between postpartum anxiety and PTB, where maternal anxiety may be a potential risk factor for PTB, with PTB potentially increasing the incidence of postpartum anxiety in mothers. In addition, a greater maternal weight change, the presence of gestational diabetes mellitus, a shorter cervical length, a greater WBC count, and postpartum anxiety and depression were identified as risk factors for PTB.
PubMed: 38808088
DOI: 10.5498/wjp.v14.i5.661 -
BMC Public Health May 2024The United Nations' Millennium Development Goals and Sustainable Development Goals both underscore the critical need to reduce the under-five mortality rate globally....
BACKGROUND
The United Nations' Millennium Development Goals and Sustainable Development Goals both underscore the critical need to reduce the under-five mortality rate globally. China has made remarkable progress in decreasing the mortality rate of children under five. This study aims to examine the trends in child mortality rates from 2002 to 2022 and the causes of deaths among neonates, infants, and children under 5 years of age from 2013 to 2022 in Huangshi.
METHODS
The data resource was supported and provided by the Huangshi Health Commission, Huangshi Maternal and Child Health Hospital, and the Huangshi Statistics Bureau. Figures were drawn using Origin 2021.
RESULTS
The mortality rate among children under 5 years old significantly decreased, from 21.38 per 1,000 live births in 2002 to 3.53 per 1,000 live births in 2022. The infant mortality rate also saw a significant decline, to 15.06 per 1,000 live births. Among the 1,929 recorded child deaths from 2013 to 2022, the top three causes were: F2 (Disorders related to short gestation and low birth weight), accounting for 17.26% (333 deaths); I1 (Accidental drowning and submersion), for 14.83% (286 deaths); and I3 (Other accidental threats to breathing), for 12.29% (237 deaths). Of the 1,929 deaths, 1,117 were male children, representing 57.91%. The gender disparity in the Under-5 Mortality Rate (U5MR) was calculated to be 1.38 (boys to girls). The leading causes of death under the age of five shifted from F2 (Disorders related to short gestation and low birth weight) to I1 (Accidental drowning and submersion) as children aged, highlighting the need for policymakers and parents to intensify care and vigilance for children.
CONCLUSIONS
Huangshi has achieved significant progress in lowering child mortality rates over the past two decades. The study calls for policymakers to enact more effective measures to further reduce the mortality rate among children under 5 years of age in Huangshi. Furthermore, it advises parents to dedicate more time and effort to supervising and nurturing their children, promoting a safer and healthier development.
Topics: Humans; China; Infant; Child Mortality; Child, Preschool; Female; Infant, Newborn; Male; Retrospective Studies; Infant Mortality; Cause of Death
PubMed: 38807078
DOI: 10.1186/s12889-024-18955-3 -
BMC Pregnancy and Childbirth May 2024The worldwide occurrence of triplet pregnancy is estimated to be 0.093%, with a natural incidence of approximately 1 in 8000. This study aims to analyze the neonatal...
BACKGROUND
The worldwide occurrence of triplet pregnancy is estimated to be 0.093%, with a natural incidence of approximately 1 in 8000. This study aims to analyze the neonatal health status and birth weight discordance (BWD) of triplets based on chorionicity from birth until discharge.
METHODS
This was a retrospective study. We reviewed a total of 136 triplet pregnancies at our tertiary hospital between January 1, 2001, and December 31, 2021. Maternal and neonatal outcomes, inter-triplet BWD, neonatal morbidity, and mortality were analyzed.
RESULTS
Among all cases, the rates of intrauterine death, neonatal death, and perinatal death were 10.29, 13.07, and 24.26%, respectively. Thirty-seven of the cases resulted in fetal loss, including 13 with fetal anomalies. The maternal complications and neonatal outcomes of the 99 triplet pregnancies without fetal loss were compared across different chorionicities, including a dichorionic (DC) group (41 cases), trichorionic (TC) group (37 cases), and monochorionic (MC) group (21 cases). Neonatal hypoproteinemia (P < 0.001), hyperbilirubinemia (P < 0.019), and anemia (P < 0.003) exhibited significant differences according to chorionicity, as did the distribution of BWD (P < 0.001). More than half of the cases in the DC and TC groups had a BWD < 15%, while those in the MC group had a BWD < 50% (47.6%). TC pregnancy decreased the risk of neonatal anemia (adjusted odds ratio [AOR] = 0.084) and need for blood transfusion therapy after birth (AOR = 0.119). In contrast, a BWD > 25% increased the risk of neonatal anemia (AOR = 10.135) and need for blood transfusion after birth (AOR = 7.127). TC pregnancy, MCDA or MCTA, and BWD > 25% increased neonatal hypoproteinemia, with AORs of 4.629, 5.123, and 5.343, respectively.
CONCLUSIONS
The BWD differed significantly according to chorionicity. Additionally, TC pregnancies reduced the risk of neonatal anemia and need for blood transfusion, but increased the risk of neonatal hypoproteinemia. In contrast, the BWD between the largest and smallest triplets increased the risk of neonatal anemia and the need for blood transfusion. TC pregnancy, MCDA or MCTA, and BWD > 25% increased the risks of neonatal hypoproteinemia. However, due to the limited number of triplet pregnancies, further exploration of the underlying mechanism is warranted.
Topics: Humans; Female; Pregnancy; Retrospective Studies; Pregnancy, Triplet; Chorion; Infant, Newborn; Adult; Pregnancy Outcome; Birth Weight; Triplets; Fetal Death
PubMed: 38807069
DOI: 10.1186/s12884-024-06599-5 -
Scientific Reports May 2024Hypertensive disorders of pregnancy (HDP) are among the major causes of high maternal and fetal/neonatal morbidity and mortality rates. Patients with HDP have...
Hypertensive disorders of pregnancy (HDP) are among the major causes of high maternal and fetal/neonatal morbidity and mortality rates. Patients with HDP have significantly elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at diagnosis; however, the NT-proBNP levels during early pregnancy are largely unknown. This study aimed to validate the association between HDP and NT-proBNP levels. This retrospective study evaluated 103 pregnant women who developed HDP diagnosed after 35 weeks of gestation and 667 who did not. The HDP group had significantly lower early-pregnancy NT-proBNP levels than the without HDP group. However, the two groups did not significantly differ in terms of the late-pregnancy NT-proBNP levels. After adjusting for confounding factors such as age, body mass index, parity, and blood pressure levels, high early-pregnancy NT-proBNP levels were associated with a lower HDP risk. Early-pregnancy NT-proBNP levels ≥ 60.5 pg/mL had a negative predictive value of 97.0% for ruling out HDP, with a sensitivity of 87.4% and specificity of 62.5%. In conclusion, elevated early-pregnancy NT-proBNP levels were associated with a lower HDP risk. Moreover, a cutoff point of ≥ 60.5 pg/mL for early-pregnancy NT-proBNP levels had a high negative predictive value and sensitivity for ruling out HDP. These findings can provide new clinical implications.
Topics: Humans; Female; Pregnancy; Natriuretic Peptide, Brain; Adult; Peptide Fragments; Hypertension, Pregnancy-Induced; Retrospective Studies; Biomarkers; Gestational Age
PubMed: 38806648
DOI: 10.1038/s41598-024-63206-5 -
Clinics and Practice Apr 2024: SARS-CoV-2 is the coronavirus responsible for the COVID-19 pandemic. Even though we are no longer in a pandemic situation, people are still getting infected, some of...
: SARS-CoV-2 is the coronavirus responsible for the COVID-19 pandemic. Even though we are no longer in a pandemic situation, people are still getting infected, some of them need hospitalization and a few of them die. : We conducted a retrospective study including 445 patients who accessed the Emergency Section of Policlinico Umberto I, Rome, Italy, where they had routine blood exams. In this study, we focused on the complete blood count, serum creatinine and azotemia. The data were analyzed using ANOVA, Spearman correlation and ROC analyses. They were divided into four groups based on their clinical outcomes: (1) the (patients who had mild forms and were quickly discharged); (2) the group (patients who were admitted to the emergency section and were then hospitalized in a COVID-19 ward); (3) the intensive care unit () group (patients who required intensive assistance after the admission in the emergency section); (4) the group (patients who had a fatal outcome after admission to the emergency section). : We found significant changes for creatinine, azotemia, hematocrit, mean corpuscular hemoglobin concentration, basophils, monocytes, red blood cell distribution width, hemoglobin, hematocrit and red blood cell numbers using ANOVA according to their clinical outcomes, particularly for the deceased group. Also, we found linear correlations of clinical outcomes with eosinophils, hemoglobin, hematocrit, mean corpuscular hemoglobin concentration, lymphocyte, neutrophil, platelet and red blood cell number and red blood cell distribution width. : This study discloses an early association between "classical" routine blood biomarkers and the severity of clinical outcomes in Omicron patients.
PubMed: 38804387
DOI: 10.3390/clinpract14030055 -
Health Science Reports May 2024Leka Dullecha District, situated in East Wollega, Ethiopia, represents a region where infant and young child feeding practices play a crucial role in the health and...
BACKGROUND AND AIM
Leka Dullecha District, situated in East Wollega, Ethiopia, represents a region where infant and young child feeding practices play a crucial role in the health and well-being of the population. Understanding the prevailing feeding practices among children under 2 years old is essential for devising effective interventions to improve child nutrition and reduce mortality rates. The context of this study involves examining various factors influencing infant and young child feeding (IYCF) practices, including socioeconomic, cultural, and environmental determinants. The main aim of the study was conducted to investigate the infant and young child feeding practice and associated factors among mothers of children 0-23 months in Leka Dullecha District, East Wollega, and Ethiopia.
METHOD
A community-based, cross-sectional study design was carried out using 590 sample sizes. A stratified sampling method was used with simple random sampling technique. Bi-variable and multivariable logistic regression models were used to identify factors associated with infant and young child feeding practices.
RESULTS
The overall prevalence of appropriate infant and young child feeding practice was estimated to 62.3%. According to this finding, age of child, place of delivery, and knowledge of mother were positively associated factors for inappropriate Infant and Young Child Feeding Practices.
CONCLUSION
The overall infant and young child feeding practices in this study is not meeting the WHO guidelines for appropriate feeding practices. To achieve better feeding practices among 0-23 months aged children, intervention should focus on encouraging institution delivery and capacitating all health workers providing health education focusing on infant and young child feeding practices.
PubMed: 38803653
DOI: 10.1002/hsr2.2119 -
Frontiers in Reproductive Health 2024
PubMed: 38803453
DOI: 10.3389/frph.2024.1419178