a perspective on materials, synthesis methods and applications

The oxides of copper (CuxO) are fascinating materials due to their remarkable optical, electrical, thermal and magnetic properties. Nanostructuring of CuxO can further enhance the performance of this important functional material and provide it with unique properties that do not exist in its bulk form. Three distinctly different phases of CuxO, mainly CuO, Cu2O and Cu4O3, can be prepared by numerous synthesis techniques including, vapour deposition and liquid phase chemical methods. In this article, we present a review of nanostructured CuxO focusing on their material properties, methods of synthesis and an overview of various applications that have been associated with nanostructured CuxO

A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings: the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) multi-country prospective cohort study.

BACKGROUND: Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and middle- income countries (LMICs). We developed the miniPIERS risk prediction model to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications. METHODS AND FINDINGS: From 1 July 2008 to 31 March 2012, in five LMICs, data were collected prospectively on 2,081 women with any hypertensive disorder of pregnancy admitted to a participating centre. Candidate predictors collected within 24 hours of admission were entered into a step-wise backward elimination logistic regression model to predict a composite adverse maternal outcome within 48 hours of admission. Model internal validation was accomplished by bootstrapping and external validation was completed using data from 1,300 women in the Pre-eclampsia Integrated Estimate of RiSk (fullPIERS) dataset. Predictive performance was assessed for calibration, discrimination, and stratification capacity. The final miniPIERS model included: parity (nulliparous versus multiparous); gestational age on admission; headache/visual disturbances; chest pain/dyspnoea; vaginal bleeding with abdominal pain; systolic blood pressure; and dipstick proteinuria. The miniPIERS model was well-calibrated and had an area under the receiver operating characteristic curve (AUC ROC) of 0.768 (95% CI 0.735-0.801) with an average optimism of 0.037. External validation AUC ROC was 0.713 (95% CI 0.658-0.768). A predicted probability ≥25% to define a positive test classified women with 85.5% accuracy. Limitations of this study include the composite outcome and the broad inclusion criteria of any hypertensive disorder of pregnancy. This broad approach was used to optimize model generalizability. CONCLUSIONS: The miniPIERS model shows reasonable ability to identify women at increased risk of adverse maternal outcomes associated with the hypertensive disorders of pregnancy. It could be used in LMICs to identify women who would benefit most from interventions such as magnesium sulphate, antihypertensives, or transportation to a higher level of care

Misoprostol in addition to routine treatment of postpartum hemorrhage: A hospital-based randomized-controlled trial in Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment.</p> <p>Methods</p> <p>A randomized controlled trial was conducted in four Karachi hospitals from December 2005 – April 2007 to assess the benefit of a 600 mcg dose of misoprostol given sublingually in addition to standard oxytocics for postpartum hemorrhage treatment. Consenting women had their blood loss measured after normal vaginal delivery and were enrolled in the study after losing more than 500 ml of blood. Women were randomly assigned to receive either 600 mcg sublingual misoprostol or matching placebo in addition to standard PPH treatment with injectable oxytocics. Both women and providers were blinded to the treatment assignment. Blood loss was collected until active bleeding stopped and for a minimum of one hour after PPH diagnosis. Total blood loss, hemoglobin measures, and treatment outcomes were recorded for all participants.</p> <p>Results</p> <p>Due to a much lower rate of PPH than expected (1.2%), only sixty-one patients were diagnosed and treated for their PPH in this study, and we were therefore unable to measure statistical significance in any of the primary endpoints. The addition of 600 mcg sublingual misoprostol to standard PPH treatments does, however, suggest a trend in reduced postpartum blood loss, a smaller drop in postpartum hemoglobin, and need for fewer additional interventions. Women who bled less overall had a significantly smaller drop in hemoglobin and received fewer additional interventions. There were no hysterectomies or maternal deaths among study participants. The rate of transient shivering and fever was significantly higher among women receiving misoprostol</p> <p>Conclusion</p> <p>A 600 mcg dose of misoprostol given sublingually shows promise as an adjunct treatment for PPH and its use should continue to be explored for its life-saving potential in the care of women experiencing PPH.</p> <p>Trial Registration</p> <p>Clinical trials.gov, Registry No. NCT00116480</p

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Effect of 3 Days of Oral Azithromycin on Young Children With Acute Diarrhea in Low-Resource Settings A Randomized Clinical Trial

Importance: World Health Organization (WHO) guidelines do not recommend routine antibiotic use for children with acute watery diarrhea. However, recent studies suggest that a significant proportion of such episodes have a bacterial cause and are associated with mortality and growth impairment, especially among children at high risk of diarrhea-associated mortality. Expanding antibiotic use among dehydrated or undernourished children may reduce diarrhea-associated mortality and improve growth. Objective: To determine whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear growth. Design, Setting, and Participants: The Antibiotics for Children with Diarrhea (ABCD) trial was a multicountry, randomized, double-blind, clinical trial among 8266 high-risk children aged 2 to 23 months presenting with acute nonbloody diarrhea. Participants were recruited between July 1, 2017, and July 10, 2019, from 36 outpatient hospital departments or community health centers in a mixture of urban and rural settings in Bangladesh, India, Kenya, Malawi, Mali, Pakistan, and Tanzania. Each participant was followed up for 180 days. Primary analysis included all randomized participants by intention to treat. Interventions: Enrolled children were randomly assigned to receive either oral azithromycin, 10 mg/kg, or placebo once daily for 3 days in addition to standard WHO case management protocols for the management of acute watery diarrhea. Main Outcomes and Measures: Primary outcomes included all-cause mortality up to 180 days after enrollment and linear growth faltering 90 days after enrollment. Results: A total of 8266 children (4463 boys [54.0%]; mean [SD] age, 11.6 [5.3] months) were randomized. A total of 20 of 4133 children in the azithromycin group (0.5%) and 28 of 4135 children in the placebo group (0.7%) died (relative risk, 0.72; 95% CI, 0.40-1.27). The mean (SD) change in length-for-age z scores 90 days after enrollment was -0.16 (0.59) in the azithromycin group and -0.19 (0.60) in the placebo group (risk difference, 0.03; 95% CI, 0.01-0.06). Overall mortality was much lower than anticipated, and the trial was stopped for futility at the prespecified interim analysis. Conclusions and Relevance: The study did not detect a survival benefit for children from the addition of azithromycin to standard WHO case management of acute watery diarrhea in low-resource settings. There was a small reduction in linear growth faltering in the azithromycin group, although the magnitude of this effect was not likely to be clinically significant. In low-resource settings, expansion of antibiotic use is not warranted. Adherence to current WHO case management protocols for watery diarrhea remains appropriate and should be encouraged. Trial Registration: ClinicalTrials.gov Identifier: NCT03130114.publishedVersionPeer reviewe

The clinical role of blood coagulation and platelet receptors gene allelic variants in development of Wilson’s disease

Aim of investigation. To estimate the effect of carriage of various allelic variants of blood coagulation system and platelet receptors genes on Wilson’s disease (WD) clinical presentation features. Material and methods. Original study included 85 patients with a Wilson’s disease who were divided into two groups: without neurological symptoms (abdominal form; n=51) and with neurologic symptomatology (mixed form; n=34). Genetic polymorphism testing was carried out by real-time polymerase chain reaction with melting curve analysis. Results. Alleles A of hemostasis genes FII 20210 G/A, FV 1691G/A were more frequent in the group with neurologic symptomatology as compared to the group of patients with abdominal form of WD at the level of trend. Frequency of 5G allele of plasminogen activator inhibitor gene PAI-675 5G/4G in the group with neurologic symptoms was lower (41.17%), than in the group without symptoms of central nervous system (CNS) involvement (49.02%) (odds ratio - OR: 1.374; 95% confidence interval - CI: 0.739-2.553). In the group of patients with neurological symptoms 4G4G genotype of PAI-675 5G/4G gene was more common (47.06%), than in patients without those symptoms (23.53%) (OR: 2.889; 95%-CI: 1.135-7.350). The allele T of platelet receptor gene ITGA2 807 C/T was more common in patients with CNS involvement than in the group of patients without neurological symptoms (р =0.018; OR: 2.172. 95%-CI: 1.163-4.058). Integrated genotype CT+TT was significantly more common in patients with neurological symptoms (82.35%) as compared to patients without those (54.90%) (р =0.010; OR: 3,833; 95%-CI: 1.355-10.846). Conclusion. Carriage of mutant genotypes FII 20210 G/A, FV 1691G/A, PAI-675 5G/4G, ITGA2 807 C/T is the factor associated to the presence of neurological symptoms at Wilson's disease

The clinical role of blood coagulation and platelet receptors gene allelic variants in development of Wilson’s disease

Aim of investigation. To estimate the effect of carriage of various allelic variants of blood coagulation system and platelet receptors genes on Wilson’s disease (WD) clinical presentation features. Material and methods. Original study included 85 patients with a Wilson’s disease who were divided into two groups: without neurological symptoms (abdominal form; n=51) and with neurologic symptomatology (mixed form; n=34). Genetic polymorphism testing was carried out by real-time polymerase chain reaction with melting curve analysis. Results. Alleles A of hemostasis genes FII 20210 G/A, FV 1691G/A were more frequent in the group with neurologic symptomatology as compared to the group of patients with abdominal form of WD at the level of trend. Frequency of 5G allele of plasminogen activator inhibitor gene PAI-675 5G/4G in the group with neurologic symptoms was lower (41.17%), than in the group without symptoms of central nervous system (CNS) involvement (49.02%) (odds ratio - OR: 1.374; 95% confidence interval - CI: 0.739-2.553). In the group of patients with neurological symptoms 4G4G genotype of PAI-675 5G/4G gene was more common (47.06%), than in patients without those symptoms (23.53%) (OR: 2.889; 95%-CI: 1.135-7.350). The allele T of platelet receptor gene ITGA2 807 C/T was more common in patients with CNS involvement than in the group of patients without neurological symptoms (р =0.018; OR: 2.172. 95%-CI: 1.163-4.058). Integrated genotype CT+TT was significantly more common in patients with neurological symptoms (82.35%) as compared to patients without those (54.90%) (р =0.010; OR: 3,833; 95%-CI: 1.355-10.846). Conclusion. Carriage of mutant genotypes FII 20210 G/A, FV 1691G/A, PAI-675 5G/4G, ITGA2 807 C/T is the factor associated to the presence of neurological symptoms at Wilson's disease

Nanostructured copper oxide semiconductors : a perspective on materials, synthesis methods and applications

The oxides of copper (CuxO) are fascinating materials due to their remarkable optical, electrical, thermal and magnetic properties. Nanostructuring of CuxO can further enhance the performance of this important functional material and provide it with unique properties that do not exist in its bulk form. Three distinctly different phases of CuxO, mainly CuO, Cu2O and Cu4O3, can be prepared by numerous synthesis techniques including, vapour deposition and liquid phase chemical methods. In this article, we present a review of nanostructured CuxO focusing on their material properties, methods of synthesis and an overview of various applications that have been associated with nanostructured CuxO