Effect of maternal aflatoxin exposure through diet on growth of infants 0 - 3 months in Kisumu county, Kenya

Aflatoxins are naturally occurring carcinogenic toxins associated with poor growth outcomes in young children. Although evidence supports mother-to-infant exposure during pregnancy and breastfeeding, evidence of its effect on growth is limited to the period after introduction of complementary foods. It is, therefore, unclear whether early maternal exposure to aflatoxins affects infant growth right from birth. Prevalence of aflatoxin levels of 40% has been observed in Nyanza region, Kenya, and 22.7% of children under 5 years are stunted. The purpose of this study was to determine the effect of maternal aflatoxin exposure on growth of infants 0-3 months old in Kisumu County, Kenya. Specific objectives were to: establish association between maternal baseline characteristics and aflatoxin exposure; establish association between infant baseline characteristics at birth and maternal aflatoxin exposure; determine effect of maternal aflatoxin exposure on infant growth indicators at 3 months of age. Out of 553 pregnant women who were screened for aflatoxin exposure, 137 exposed and 137 non-exposed women, matched for age and household income, participated in an 8-month cohort study. The women were followed up to delivery and their infants up to 3 months after delivery. Infant length and weight data was collected monthly. Length-for-age (LAZ), weight-for-length (WLZ)) and weight-for-age (WAZ) z-scores were generated. Aflatoxin levels were analyzed using Enzyme Linked Immunosorbent Assay (ELISA) in parts per billion (ppb). Effects of aflatoxin on infant growth outcomes were assessed using multi-variate linear and logistic regression. Effect of maternal aflatoxin exposure on infant length, weight, LAZ, WLZ, WAZ was determined using Cox regression with constant time at risk. Infants of exposed women had lower weight (95% CI:-0.85,-0.53), length (95% CI: -4.08, -3.36), LAZ (95% CI: -1.93, -1.16) and WAZ (95% CI:-1.03, -0.54) at 3 months of age, but there was no difference in WLZ (95% CI:-0.03, 0.74). Risk for stunting was higher in infants of exposed women (RR=4.08; 95% CI: 1.35, 12.29). There was no difference in the risk for underweight (RR=6.61; 95% CI: 0.80-54.33) and wasting (RR=0.37; 95% CI: 0.40, 3.39, P=0.38).These results underpin the need to reduce aflatoxin exposure in infants and young children who are very vulnerable.

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Unsafe Drinking Water Is Associated with Environmental Enteric Dysfunction and Poor Growth Outcomes in Young Children in Rural Southwestern Uganda

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.18-0143 ◽

2018 ◽

Vol 99 (6) ◽

pp. 1606-1612 ◽

Cited By ~ 4

Author(s):

Jacqueline M. Lauer ◽

Christopher P. Duggan ◽

Lynne M. Ausman ◽

Jeffrey K. Griffiths ◽

Patrick Webb ◽

...

Keyword(s):

Drinking Water ◽

Young Children ◽

Poor Growth ◽

Growth Outcomes ◽

Environmental Enteric Dysfunction ◽

Southwestern Uganda

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Impact of immunosuppressive agents on clinical manifestations and outcome of Staphylococcus aureus bloodstream infection – A propensity score matched analysis in two large, prospectively evaluated cohorts

Clinical Infectious Diseases ◽

10.1093/cid/ciab385 ◽

2021 ◽

Author(s):

Johannes Camp ◽

Lina Glaubitz ◽

Tim Filla ◽

Achim J Kaasch ◽

Frieder Fuchs ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Propensity Score ◽

Bloodstream Infection ◽

Cox Regression ◽

Immunosuppressive Agents ◽

Late Complications ◽

Competing Risk ◽

Immunosuppressed Patients ◽

Staphylococcus Aureus Bloodstream Infection ◽

Baseline Characteristics

Abstract Background Staphylococcus aureus bloodstream infection (SAB) is a common, life-threatening infection. The impact of immunosuppressive agents on the outcome of patients with SAB is incompletely understood. Methods Data from two large prospective, international, multicenter cohort studies (INSTINCT and ISAC) between 2006 and 2015 were analyzed. Patients receiving immunosuppressive agents were identified and a 1:1 propensity score (PS) matched analysis was performed to adjust for baseline characteristics of patients. Overall survival and time to SAB-related late complications (SAB relapse, infective endocarditis, osteomyelitis, or other deep-seated manifestations) were analyzed by Cox regression and competing risk analyses, respectively. This approach was then repeated for specific immunosuppressive agents (corticosteroids [CSMT] and immunosuppressive agents other than steroids [IMOTS]). Results Of 3,188 analyzed patients, 309 were receiving immunosuppressive treatment according to our definitions and were matched to 309 non-immunosuppressed patients. After PS matching, baseline characteristics were well balanced. In the Cox regression analysis, we observed no significant difference in survival between the two groups (death during follow-up: 105/309 (33.9 %) immunosuppressed patients vs. 94/309 (30.4 %) non-immunosuppressed, hazard ratio 1.20 (95% CI 0.84–1.71). Competing risk analysis showed a cause-specific hazard ratio (CSHR) of 1.81 (95% CI 0.85–3.87) for SAB-related late-complications in patients receiving immunosuppressive agents. CSHR was higher in patients taking IMOTS (3.69; 95% CI 1.41–9.68). Conclusions Immunosuppressive agents were not associated with an overall higher mortality. The risk for SAB-related late complications in patients receiving specific immunosuppressive agents such as IMOTs warrants further investigations.

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Angiogenin—A Proposed Biomarker for Cardiovascular Disease—Is Not Associated With Long-Term Survival in Patients With Peripheral Artery Disease

Angiology ◽

10.1177/00033197211004393 ◽

2021 ◽

pp. 000331972110043

Author(s):

Clemens Höbaus ◽

Gerfried Pesau ◽

Bernhard Zierfuss ◽

Renate Koppensteiner ◽

Gerit-Holger Schernthaner

Keyword(s):

Peripheral Artery Disease ◽

Cox Regression ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Cross Sectional Study ◽

Enzyme Linked Immunosorbent Assay ◽

Peripheral Artery ◽

Cross Sectional ◽

Term Survival ◽

Artery Disease

We evaluated angiogenin as a prospective biomarker in peripheral artery disease (PAD) patients with and without claudication symptoms. A pilot study suggested an elevation of angiogenin in critical limb ischemia. However, in PAD patients, the predictive value of angiogenin has not yet been evaluated. For this purpose, 342 patients with PAD (age: 69 ± 10 years, 34.5% women) were followed-up for 7 years in a cross-sectional study. Angiogenin was measured by enzyme-linked immunosorbent assay. All-cause and cardiovascular mortality were analyzed by Cox regression. Angiogenin levels were higher in men ( P = .001) and were associated with patient waist-to-hip ratio ( P < .001), fasting triglycerides ( P = .011), and inversely with estimated glomerular filtration rate ( P = .009). However, angiogenin showed no association with age, characteristics of diabetes, markers of lipid metabolism, or C-reactive protein. Angiogenin did not correlate with markers of angiogenesis such as vascular endothelial growth factor, angiopoietin-2, or tie-2. Furthermore, angiogenin was not associated with PAD Fontaine stages or with patient ankle-brachial index in addition to all-cause mortality (hazard ratio [HR] = 1.09 [95% CI: 0.89-1.34]) or cardiovascular morality (HR = 1.05 [0.82-1.35]). These results suggest that angiogenin does not provide further information regarding outcome prediction in patients with PAD.

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MO757COMPARISON OF ANTI-COAGULATION AND NO ANTI-COAGULATION IN DIALYSIS PATIENTS WITH ATRIAL FIBRILLATION: A SINGLE CENTER RETROSPECTIVE STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab097.0037 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Jun Young Lee ◽

Jae Won Yang ◽

Jae Seok Kim ◽

Seong Ok Choi ◽

Byoung Geun Han

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

Dialysis Patients ◽

Dialysis Therapy ◽

Cox Regression Analysis ◽

Significant Difference ◽

Baseline Characteristics ◽

Stage Renal Disease ◽

End Stage ◽

Risk And Benefit

Abstract Background and Aims Atrial fibrillation (AF) is common arrhythmia in end stage renal disease patients. Although, the need of anticoagulation to prevent stroke and thromboembolism is increasing, the efficacy of anticoagulation is not proven in most of study. We retrospectively analyzed the risk and benefit of anticoagulation in dialysis patients with AF. Method By using medical record, we retrospectively analyzed all data of 99 patients who received dialysis therapy and diagnosed AF. Results Among 99 patients who diagnosed AF with dialysis 36 patients received anticoagulation (17 coumadin, 19 apixaban 2.5mg bid), 63 patients received no anticoagulation. There was no significant difference of baseline characteristics between anticoagulation, and no anticoagulation patients. Although no anticoagulation group experienced more all-cause (39.7% vs 32.4%, p=0.572) and cardiovascular mortality (17.6% vs 10.8%, p=0.197) than anticoagulation group it was not statistically significant. Compared to apixaban 2.5mg bid patients, coumadin anticoagulation patients experienced more frequent mfig ajor adverse cardiovascular events (35.3% vs 15.8%, p=0.109) but it was not statistically significant in multi variate Cox regression analysis (Hazard ratio 1.143, 95% Confidence Interval 0.503-2.597). Conclusion Apixaban 2.5mg bid was not inferior than coumadin considering risk and benefit of anticoagulation in dialysis patients.

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Higher prevalence of stunting and poor growth outcomes in HIV-exposed uninfected than HIV-unexposed infants in Kenya

AIDS ◽

10.1097/qad.0000000000003124 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Jillian Neary ◽

Agnes Langat ◽

Benson Singa ◽

John Kinuthia ◽

Janet Itindi ◽

...

Keyword(s):

Poor Growth ◽

Growth Outcomes ◽

Hiv Exposed ◽

Exposed Uninfected

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Abstract 16587: More Than Five Years After FDA Approval, There Remains Very Limited Adoption of New Evidence-Based, Highly Effective Medications for the Treatment of Patients With Heart Failure, Especially Among Those on Medicare

Circulation ◽

10.1161/circ.142.suppl_3.16587 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Joseph B Muhlestein ◽

Heidi T May ◽

Tami L Bair ◽

Stacey Knight ◽

Kirk U Knowlton ◽

...

Keyword(s):

Heart Failure ◽

Cox Regression ◽

Sglt2 Inhibitor ◽

Clinical Effectiveness ◽

Major Adverse Cardiovascular Events ◽

Evidence Based ◽

Cox Regression Analysis ◽

Reduced Ejection Fraction ◽

Highly Effective ◽

Baseline Characteristics

Background: Over the past decade, the FDA has approved several new medications that are highly effective when added to existing standard therapy in the treatment of heart failure with reduced ejection fraction (HFrEF). It is possible that, despite the presence of substantial evidence regarding the clinical effectiveness of these new medications, their high cost and the complex medical reimbursement system in America may prevent their routine adoption. Methods: We analyzed 5,824 Intermountain Healthcare patients, age ≥18 years with a new clinical diagnosis of HFrEF (LVEF ≤35%), from 1/1/2015 onward, for the use of newly-approved sacubitril/valsartan or any sodium-glucose cotransporter-2 inhibitor (SGLT2-I). We collected baseline characteristics and medication utilization data. We followed the patients for 1.7±1.4 years for future major adverse cardiovascular events (MACE), including death, myocardial infarction (MI), stroke, and heart failure hospitalization (HFH). We identified differences between groups by multivariable Cox regression analysis. Results: Baseline characteristics and incidence of MACE, according to insurance status and the use of common HFrEF medications, are shown in the Table. Overall, only 344 (5.9%) and 169 (2.9%) of patients ever received a prescription for sacubitril/valsartan or an SGLT2 inhibitor, respectively. The figures show survival curves for MACE of patients receiving or not receiving the newly-approved medications. Conclusion: In this large, modern, real-world HFrEF population, the adoption of newly-approved evidence-based HFrEF medications is minimal in all patients and especially in Medicare patients. This lack of adoption is associated with a significant worsening in patient outcomes. These findings demonstrate a critical need to resolve our present healthcare financial crisis, which is almost certainly the reason for these findings.

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Serum and Saliva 25(OH)D Levels in Relation to Dental Caries in Young Children

Journal of Clinical Pediatric Dentistry ◽

10.17796/1053-4625-45.6.8 ◽

2021 ◽

Vol 45 (6) ◽

pp. 414-420

Author(s):

Alaa Sabah Hussein ◽

Manal Mohamed Almoudi ◽

Mohamed Ibrahim Abu-Hassan ◽

Robert J Schroth ◽

Bahruddin Saripudin ◽

...

Keyword(s):

Dental Caries ◽

Young Children ◽

Rank Correlation ◽

Enzyme Linked Immunosorbent Assay ◽

Healthy Children ◽

Spearman’S Rank Correlation ◽

Increased Risk ◽

Whole Saliva ◽

Dmft Index ◽

Unstimulated Whole Saliva

Objective: Several studies have reported that low levels of vitamin D (25(OH)D) are associated with an increased risk of dental caries and that optimal levels may offer protection This study aimed to assess the relationship between serum and saliva 25(OH)D levels and caries among young children. Study design: A total of 120 healthy children were recruited; 93 with caries and 27 caries-free. Dental caries status was evaluated using decayed, missing and filled in primary teeth (dmft) index. Blood and unstimulated whole saliva samples were collected. Laboratory analysis was performed using Enzyme-Linked Immunosorbent Assay Kit. Data were analyzed with descriptive statistics, bivariate and Spearman’s rank correlation analysis. Results: There were no significant associations between serum and saliva 25(OH)D levels and caries status (P > 0.05). Levels of 25(OH)D in serum were significantly higher than levels found in saliva (P < 0.05), and a correlation between serum and saliva 25(OH)D levels was observed (P < 0.05). Conclusions: The association between serum and saliva 25(OH)D and dental caries in young children was inconclusive. However, a positive and significant correlation was observed between serum and saliva 25(OH)D levels. Further studies are warranted to investigate the definite relation between 25(OH)D levels and dental caries and using saliva 25(OH)D as a non-invasive alternative method over blood samples.

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Role of ctDNA to predict risk of recurrence following potentially curative resection of biliary tract and pancreatic malignancies.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.336 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 336-336

Author(s):

Angela Lamarca ◽

Mairead Geraldine McNamara ◽

Richard Hubner ◽

Juan W. Valle

Keyword(s):

Relapse Rate ◽

Curative Resection ◽

Cox Regression ◽

Statistical Significance ◽

Molecular Profiling ◽

P Value ◽

Relapse Risk ◽

Baseline Characteristics

336 Background: The potential role of ctDNA to identify residual disease after potentially curative resection has been suggested in some malignancies; its role in resected pancreatico(P)-biliary(B) malignancies is unknown. Methods: Patients diagnosed with PB malignancies underwent molecular profiling (ctDNA) using FoundationMedicine Liquid (72 cancer-related genes) following potentially curative resection. Baseline patient characteristics and molecular profiling outcomes, including mutant allele frequency (MAF) for pathological alterations were extracted. Primary objective: prevalence of ctDNA identification and its correlation with recurrence (relapse-free survival (RFS) and relapse rate). Results: Total of 11 individuals had ctDNA analysed following potentially curative resection for PB malignancies: 8 B (4 extra-hepatic cholangiocarcinoma (eCCA), 2 ampulla, 1 intrahepatic cholangiocarcinoma (iCCA), 1 gallbladder cancer (GBC)) and 3 P. Baseline characteristics: 6 female (54.55%), median age 71.59 years (range 39.98-81.19). Most were pT2 (45.45%), pN0 (54.55%) and R0 (63.64%). Following surgery, 6 patients were started on adjuvant chemotherapy; at the end of follow-up (data cut-off 25/6/2020; median follow-up 11.15 months (range 5.45-13.52); 5 relapsed (45.45%) and 2 died (18.18%). Estimated median RFS was 11.43 months (95% CI 2.28-not reached); median overall survival was not reached. No sample failed ctDNA analysis; presence of ctDNA was identified in 3/11 (27.27%) of the samples; 2 and 1 samples had 2 and 1 pathological alterations identified, respectively: ALK fusion (1 sample; GBC), TP53 mutation (2 samples; eCCA and GBC), CHEK2 mutation (1 sample; pancreas), IDH2 mutation (1 sample; eCCA). Mean maximum MAF was 1.47 (2 in biliary; 0.43 in pancreas). Variants of unknown significance were identified in 72.73% of the samples (87.5% in B; 33.33% in P; p-value 0.152). None of the baseline characteristics explored correlated with presence of ctDNA. There was a trend towards increased relapse risk in the patients with ctDNA present following potentially curative surgery; Cox regression for RFS [HR 2.64 (95% CI 0.36-19.31); median RFS 11.44 months (95% CI 2.28-not reached) vs 10.87 (95% CI 2.21-not reached)]; relapse rate 37.5% (ctDNA absent) vs 66.67% (ctDNA present); statistical significance was not reached (p-value 0.340 and p-value 0.545, respectively). Conclusions: This pilot study demonstrates the feasibility of testing for ctDNA following potentially curative resection in PB malignancies. Presence of ctDNA may be associated with increased relapse risk; further studies are required to increase sample size and assess clinical implications.

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Abstract 17277: Apixaban Use in Patients With Atrial Fibrillation With Bioprosthetic Valves: Insights From ARISTOTLE

Circulation ◽

10.1161/circ.132.suppl_3.17277 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Sean D Pokorney ◽

Meena P Rao ◽

Daniel M Wojdyla ◽

Bernard J Gersh ◽

Renato D Lopes ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

Package Insert ◽

Categorical Variables ◽

Published Data ◽

Continuous Variables ◽

Number Of Patients ◽

History Of ◽

Baseline Characteristics ◽

Bioprosthetic Valves

Background: The package insert for apixaban recommends against its use for stroke prevention in patients with atrial fibrillation (AF) with prosthetic heart valves. There are no published data on the use of apixaban in patients with AF with bioprosthetic valves. This analysis provides preliminary exploratory data on the safety and efficacy of apixaban in these patients. Methods: The ARISTOTLE trial randomized patients with AF to apixaban versus warfarin, and patients with a history of bioprosthetic valve replacement were eligible for inclusion in the trial. In this secondary analysis, baseline characteristics of patients with bioprosthetic valves were compared between apixaban and warfarin patients using Wilcoxon tests for continuous variables and chi-square tests for categorical variables. Unadjusted endpoints were compared between randomized treatments using a Cox regression model. With data collection on these valve patients ongoing, this interim report represents 82 of 260 patients with a history of valve surgery from ARISTOTLE. Results: Among 82 patients with bioprosthetic valves, 41 patients each were in the apixaban and warfarin arms. The patients had a median age of 78 years (vs. 70 years in overall trial), 18% had prior stroke (vs. 19% in overall trial), and 41% had concomitant aspirin use (vs. 31% in overall trial). Other than a higher rate of hypertension in the warfarin arm (98% vs. 81%, p=0.03), there were no statistically significant differences in baseline characteristics between the two groups. There were few events in patients with bioprosthetic valves. There were 2 stroke events, and there were no statistically significant differences between the apixaban and warfarin groups for major bleeding, stroke/systemic embolism, all-cause death, or cardiovascular death (Table). Conclusions: Among the small number of patients in ARISTOTLE with bioprosthetic valves, there were few events with similar event rates in both the apixaban and warfarin groups.

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The Predictive Value of Growth Differentiation Factor-15 in Recurrence of Atrial Fibrillation after Catheter Ablation

Mediators of Inflammation ◽

10.1155/2020/8360936 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Ying Wei ◽

Shuwang Liu ◽

Haiyi Yu ◽

Yuan Zhang ◽

Wei Gao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Recurrent Events ◽

Cox Regression ◽

Enzyme Linked Immunosorbent Assay ◽

Atrial Remodeling ◽

Baseline Serum ◽

Growth Differentiation Factor 15 ◽

Differentiation Factor ◽

Af Recurrence

The mechanisms underlying the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) are not well concerned. The study sought to explore the association between growth differentiation factor-15 (GDF-15) and the incidence of recurrent events among AF patients after the ablation procedure. We prospectively included 150 consecutive AF patients who underwent RFCA. Clinical information about the patients was collected. Blood samples on the second morning of hospital admission and three months after RFCA were collected, and enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of GDF-15. All participants were followed up at specific times (1st/3rd/6th/12th/18th/24th months) after RFCA to record recurrences events. During a median follow-up of 14.0 months, AF recurrence occurred in 37(24.7%) patients. Baseline serum GDF-15 level in the persistent AF group was significantly higher than the paroxysmal AF group [1140(854~1701)ng/L vs. 1062(651~1374)ng/L, P=0.039]. Baseline serum GDF-15 level in the recurrence group was significantly higher than the nonrecurrence group [1287(889~1768) ng/L vs. 1062(694~1373)ng/L, P=0.022]. Serum GDF-15 level at three months after RFCA was significantly lower than the baseline [870 (579~1270) ng/L vs. 1155 (735~1632)ng/L, P<0.001]. The baseline GDF-15 correlated significantly with LAP (r=0.296, P<0.001) and LAAV(r=−0.235, P=0.003). Kaplan-Meier analysis showed a significantly lower event-free survival time in the high baseline GDF-15 (≥1287.3 ng/L) group than the low baseline GDF-15 (<1287.3 ng/L) group (17.1 months vs. 20.4 months, Log Rank P=0.017). In the multivariate Cox regression, baseline GDF-15(HR 1.053, 95% CI 1.007-1.100, P=0.022) and LAD (HR 1.124, 95% CI 1.011-1.250, P=0.030) were independent predictors of AF recurrence after RFCA. Our study indicated increased preprocedural GDF-15 is associated with left atrial remodeling and acts as a predictor of AF recurrence after ablation.

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