Socioeconomic and bio-demographic determinants of infant mortality in Egypt

Background: This study examines the socioeconomic and biodemographic determinants of infant, neonatal and post neonatal mortality in Egypt. It also tries to reach better understanding on the relative importance of these factors. Methods: Population-based cross-sectional secondary data analysis of the 2005 Egypt Demographic and Health Survey (EDHS). Cox’s proportional hazard models have been fitted to select the significant determinants of infant and post neonatal mortality, while logistic regression models were adopted for the neonatal period. Results: 13,851 live births were analyzed with 463 deaths before the first birthday; the total follow up time is 144,835 babymonths, giving an IMR of 32 per 10,000 baby-months. After adjusting for all socioeconomic and biodemographic factors, the analyses reveal strong association between infant mortality and biodemographic factors, while the only significant socioeconomic determinant is the mother’s education. Also it has been shown that mother’s education, child’s sex and place of delivery are time dependent covariates. Analyses of neonatal period indicate no association with any socioeconomic factor, while child’s sex and place of delivery are significant predictors. Exclusion of neonatal deaths shows that the risk of post neonatal mortality is inversely related to mother’s education, and not determined by sex of the child nor place of delivery. The risk of infant, neonatal and post neonatal death is consistently related to birth interval and birth size. Conclusions: Biodemographic characteristics represent the most substantial impacts on infant mortality. The only significant socioeconomic predictor (maternal education) has a modest impact, at best, on infant mortality, which appears at later stages of infancy period (namely post neonatal period); since the later proved to be a time varying covariate. Unlike neonatal period, analysis indicates lack of association between post neonatal mortality and child’s sex contradicting the biological knowledge, and supporting the hypothesis of gender discrimination and male sex preference

Neutrophils From Children With Systemic Juvenile Idiopathic Arthritis Exhibit Persistent Proinflammatory Activation Despite Long-Standing Clinically Inactive Disease

Background: Systemic juvenile idiopathic arthritis (SJIA) is a chronic childhood arthropathy with features of autoinflammation. Early inflammatory SJIA is associated with expansion and activation of neutrophils with a sepsis-like phenotype, but neutrophil phenotypes present in longstanding and clinically inactive disease (CID) are unknown. The objective of this study was to examine activated neutrophil subsets, S100 alarmin release, and gene expression signatures in children with a spectrum of SJIA disease activity.Methods: Highly-purified neutrophils were isolated using a two-step procedure of density-gradient centrifugation followed by magnetic-bead based negative selection prior to flow cytometry or cell culture to quantify S100 protein release. Whole transcriptome gene expression profiles were compared in neutrophils from children with both active SJIA and CID.Results: Patients with SJIA and active systemic features demonstrated a higher proportion of CD16+CD62Llo neutrophil population compared to controls. This neutrophil subset was not seen in patients with CID or patients with active arthritis not exhibiting systemic features. Using imaging flow cytometry, CD16+CD62Llo neutrophils from patients with active SJIA and features of macrophage activation syndrome (MAS) had increased nuclear hypersegmentation compared to CD16+CD62L+ neutrophils. Serum levels of S100A8/A9 and S100A12 were strongly correlated with peripheral blood neutrophil counts. Neutrophils from active SJIA patients did not show enhanced resting S100 protein release; however, regardless of disease activity, neutrophils from SJIA patients did show enhanced S100A8/A9 release upon PMA stimulation compared to control neutrophils. Furthermore, whole transcriptome analysis of highly purified neutrophils from children with active SJIA identified 214 differentially expressed genes (DEG) compared to neutrophils from healthy controls. The most significantly upregulated gene pathway was Immune System Process, including AIM2, IL18RAP, and NLRC4. Interestingly, this gene set showed intermediate levels of expression in neutrophils from patients with long-standing CID yet persistent serum IL-18 elevation. Indeed, all patient samples regardless of disease activity demonstrated elevated inflammatory gene expression, including inflammasome components and S100A8.Conclusion: We identify features of neutrophil activation in SJIA patients with both active disease and CID, including a proinflammatory gene expression signature, reflecting persistent innate immune activation. Taken together, these studies expand understanding of neutrophil function in chronic autoinflammatory disorders such as SJIA

Recent advances in electrospun fibrous membranes for effective chromium (VI) removal from water

The accumulation of heavy metals in aquatic environments is a significant environmental threat. Among the available methods for their removal, adsorption using nanofiber has been proven to be the most effective approach. The unique architecture of nanofibers provides them with intriguing features, such as high specific surface area and pore density, which makes them capable of removing harmful metals and a potential solution for various applications, including water treatment. This new generation of highly porous membranes is expected to have a promising future in separation applications due to its unique properties, including 90% porosity and 3D interconnected pore structure. Electrospinning is a well-regarded technique for creating such unique porous membranes. Among the various metal ions, chromium (Cr(VI)) removal has been extensively researched, and electrospun nanofiber membranes have proven to be an effective adsorbent. The objective of this review is to provide up-to-date information on the most common ways that electrospun nanofiber membranes are utilized for the removal of Cr(VI) ions from water. The findings indicate that electrospun fibrous materials are effective in eliminating Cr(VI) and establish their suitability for decontaminating polluted water. However, further attention is required to enhance the stability, mechanical strength, and reusability of these fibrous membranes

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

IL-18 as a biomarker linking systemic juvenile idiopathic arthritis and macrophage activation syndrome

Systemic juvenile idiopathic arthritis (sJIA) is a childhood arthritis with features of autoinflammation and high risk of macrophage activation syndrome (MAS). IL-18 has been shown to have key roles in sJIA and MAS. We aimed to examine IL-18 levels in sJIA in relation to disease activity and history of MAS and other disease biomarkers namely S100 proteins and CXCL9

Feasibility of Conducting Comparative Effectiveness Research and Validation of a Clinical Disease Activity Score for Chronic Nonbacterial Osteomyelitis.

ObjectiveProspective comparative effectiveness research (CER) in chronic nonbacterial osteomyelitis (CNO) is lacking. Our objectives were to (1) determine the use and safety of each consensus treatment plan (CTP) regimen for CNO, (2) assess the feasibility of using the Chronic Nonbacterial Osteomyelitis International Registry (CHOIR) data for CER, and (3) develop and validate a CNO clinical disease activity score (CDAS) using CHOIR.MethodsConsenting children or young adults with CNO were enrolled into CHOIR. Demographic, clinical, and imaging data were prospectively collected. The CNO CDAS was developed through a Delphi survey and nominal group technique. External validation surveys were administered to CHOIR participants.ResultsOne hundred forty (78.2%) CHOIR participants enrolled between August 2018 and September 2020 received at least 1 CTP regimen. Baseline characteristics from different CTP groups were well matched. Patient pain, patient global assessment, and clinical CNO lesion count were key variables included in the CNO CDAS. The CDAS showed a strong correlation with patient/parent report of difficulty using a limb, back, or jaw and patient/parent report of disease severity, but a weak correlation with patient/parent report of fatigue, sadness, and worry. The change in CDAS was significant in patients reporting disease worsening or improvement (P P = 0.002). Although second-line treatments were well tolerated, psoriasis was the most common adverse event.ConclusionThe CNO CDAS was developed and validated for disease monitoring and assessment of treatment effectiveness. CHOIR provided a comprehensive framework for future CER