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Background: There has been a significant increase in the incidence of recurrent, resistant, and extensive dermatophyte infections worldwide recently. This menace has spurred the need for more well-designed randomized controlled trials to optimize the treatment of dermatophyte skin infections. One of the limitations in designing such studies is the limited availability of standard and validated score, to measure the severity of dermatophyte infections. Aims: To create a severity score for the evaluation of dermatophyte infections. Materials and Methods: A Delphi consensus model was used to frame a severity scoring tool for superficial dermatophyte skin infections. Fourteen experts participated in the first round and twelve experts participated in the second round. Results: Based on the expert consensus, a final scoring system proposed was: Final Severity Score (FSS) = Sum total of Body Surface Area (BSA) in hand units for each patch multiplied by the sum of the scores for pruritis (P), lichenification (L), and actively raised borders (A) for each patch (FSS = BSA in hand units x (P + E + L + A) of patch 1 + BSA in hand units x (P + E + A) of patch 2 …etc.). For measuring hand units more accurately fractional values of 0.25 can be used (0.25 corresponding to an approximate 1/4[sup.th] of a hand unit). A score of +1 will be added in case of the following - 1) Close contact/family member affected, 2) History of at least one recurrence in the previous 6 months after a course of oral antifungals, 3) History of immunosuppression (on immunosuppressive medication or having underlying immunosuppressive disease). The scores will be valid only if the patient has not used any treatment topical or systemic, for at least 2 weeks before enrolment. Conclusion: The proposed Dermatophytosis Area and Severity Index (DeASI) score will help the physicians and researchers standardize the treatment protocol for dermatophytosis, henceforth, assessing the response to therapy. This will also help to standardize the parameters of effectiveness while designing any clinical trial. Keywords: Delphi, dermatophyte infections, severity score, Author(s): Feroze Kaliyadan [1]; Anupam Das (corresponding author) [2]; Karalikkattil T. Ashique [3]; Puravoor Jayasree [4]; Maitreyee Panda [5]; Saumya Panda [6]; Manas Chatterjee [7]; Mahdi Al Dhafiri [8]; Preethy [...]

Stunting currently affects 37% (1.1 million) of Malawian children and causing unfavorable impact for both children and their households. Identifying risk factors to stunting would go a long way in developing appropriate interventions. The objective of this study was to identify the risk factors of stunting among children aged below 60 months from Balaka, Dedza and Mzimba districts in Malawi. A matched cross-sectional case-control study was conducted among 913 (446 controls; 467 cases) children aged below 60 months from three regions of Malawi. Household demographic, anthropometric measurements, dietary intake, food security, and morbidity information were collected. Case-Control Stepwise multiple logistic regression models are used to determine risk factors of stunting. The following were identified as risk factors for stunting including; age of child (AOR= 6.3; 95% CI: 2.9, 8.9), polygamy (AOR= 8.9; 95%, CI: 3.3, 13.03), maternal education (AOR= 9.9; 95%, CI: 2.8, 20.1), access to markets (AOR= 1.3; 95%, CI: 0.2, 2.4), childhood infections (AOR= 2.11; 95%, CI: 1.4, 4.2) and presence of oedema (AOR= 2.5; 95%, CI: 1.3, 4.1). Also, lack of food any month (AOR= 1.31; 95%, CI: 1.01, 4.9), purchasing food on credit (AOR= 1.48; 95%, CI: 1.4, 1.7), begging for food (AOR= 1.55; 95%, CI: 1.2, 2.1), mothers or caregivers consuming less than 5 food groups (MDD-W) (AOR = 4.83; 95% CI: 1.9, 16.4), exclusive breastfeeding (AOR= 5.45; 95%, CI: 4.33, 7.61) children weaned on plain water (AOR= 1.6; 95%, CI: 1.6, 2.41), powdered milk (AOR= 0.63; 95%, CI: 0.4, 1.32), juices (AOR= 0.44; 95%, CI: 0.12, 0.96) and children fed on sugary food (AOR= 0.66; 95%, CI: 0.4, 0.99) were significantly related to stunting. Stunting is associated with increasing age of children, boys, polygamous households, lack of education by mothers or caregivers, inaccessible markets, childhood infections and presence of oedema, food insecurity, breastfeeding and complementary feeding among children and dietary diversity of mothers or caregivers. These results suggest that interventions against childhood stunting should be designed according to the factors that significantly affect stunting. Key words: child growth, Malawi, stunting and complementary feeding, Regression, Food Security and Health, INTRODUCTION Childhood stunting is one of the most serious health problems faced by most sub-Saharan African countries, including Malawi. Globally, Africa is the only region, where the number of stunted [...]

Purpose Lower respiratory tract infections (LRTI) are the most frequent infectious complication in patients admitted to the intensive care unit (ICU). We aim to report the clinical characteristics of ICU-admitted patients due to nosocomial LRTI and to describe their microbiology and clinical outcomes. Methods A prospective observational study was conducted in 13 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), ICU hospital-acquired pneumonia (ICU-HAP), HAP that required invasive ventilation (VHAP), and HAP in patients transferred to the ICU without invasive mechanical ventilation were collected. The clinical diagnosis and treatments were per clinical practice and not per protocol. Descriptive statistics were used to compare the study groups. Results 1060 patients with LRTI (72.5% male sex, median age 64 [50-74] years) were included in the study; 160 (15.1%) developed VAT, 556 (52.5%) VAP, 98 (9.2%) ICU-HAP, 152 (14.3%) HAP, and 94 (8.9%) VHAP. Patients with VHAP had higher serum procalcitonin (PCT) and Sequential Organ Failure Assessment (SOFA) scores. Patients with VAP or VHAP developed acute kidney injury, acute respiratory distress syndrome, multiple organ failure, or septic shock more often. One thousand eight patients had microbiological samples, and 711 (70.5%) had etiological microbiology identified. The most common microorganisms were Pseudomonas aeruginosa (18.4%) and Klebsiella spp (14.4%). In 382 patients (36%), the causative pathogen shows some antimicrobial resistance pattern. ICU, hospital and 28-day mortality were 30.8%, 37.5% and 27.5%, respectively. Patients with VHAP had the highest ICU, in-hospital and 28-day mortality rates. Conclusion VHAP patients presented the highest mortality among those admitted to the ICU. Multidrug-resistant pathogens frequently cause nosocomial LRTI in this multinational cohort study., Author(s): Ignacio Martin-Loeches [sup.1] [sup.37], Luis Felipe Reyes [sup.2] [sup.3] [sup.4], Saad Nseir [sup.5], Otavio Ranzani [sup.6], Pedro Povoa [sup.7], Emili Diaz [sup.8], Marcus J. Schultz [sup.9] [sup.10] [sup.40], Alejandro [...]

BACKGROUND. Severe, early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, thus preventing accurate patient counseling. We investigated the use of maternal serum protein and ultrasound measurements at diagnosis to predict fetal or neonatal death and 3 secondary outcomes: fetal death or delivery at or before 28+0 weeks, development of abnormal umbilical artery (UmA) Doppler velocimetry, and slow fetal growth. METHODS. Women with singleton pregnancies (n = 142, estimated fetal weights [EFWs] below the third centile, less than 600 g, 20+0 to 26+6 weeks of gestation, no known chromosomal, genetic, or major structural abnormalities) were recruited from 4 European centers. Maternal serum from the discovery set (n = 63) was analyzed for 7 proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease, and 5 proteins identified through pooled liquid chromatography and tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n = 60), with final models calculated from combined data. RESULTS. The most discriminative model for fetal or neonatal death included the EFW z score (Hadlock 3 formula/Marsal chart), gestational age, and UmA Doppler category (AUC, 0.91; 95% CI, 0.86-0.97) but was less well calibrated than the model containing only the EFW z score (Hadlock 3/Marsal). The most discriminative model for fetal death or delivery at or before 28+0 weeks included maternal serum placental growth factor (PlGF) concentration and UmA Doppler category (AUC, 0.89; 95% CI, 0.83-0.94). CONCLUSION. Ultrasound measurements and maternal serum PlGF concentration at diagnosis of severe, early-onset FGR predicted pregnancy outcomes of importance to patients and clinicians. TRIAL REGISTRATION. ClinicalTrials.gov NCT02097667. FUNDING. The European Union, Rosetrees Trust, Mitchell Charitable Trust., Introduction The survival and growth of a fetus depends on placental provision of nutrients and waste exchange with the mother. When this system is impaired by inadequate transformation of the [...]

* Context.--Recent genome-wide sequencing studies have identified a subset of pancreatic ductal adenocarcinomas (PDACs) harboring significant alterations in epigenetic regulation genes, including the COMPASS-like complex genes. Whether this subset of PDACs has specific histologic characteristics or carries prognostic or therapeutic implications is unknown. Objective.--To determine the specific clinicopathologic and molecular features of PDACs carrying mutations in COMPASS-like complex genes. Design.--We analyzed a series of 103 primary and metastatic PDACs with comprehensive molecular profiling, including 13 PDACs carrying loss-of-function COMPASS-like complex gene alterations (study cohort). Another 45 patients carrying PDACs with wild-type COMPASS-like complex genes were used as the control group. Results.--PDACs within the study cohort were smaller, harboring frequent areas of poor differentiation and concurrent alterations in KRAS, TP53, SMAD4, and CDKN2A. A subset of metastatic PDACs from the study cohort showed squamous differentiation. There was a trend toward decreased survival in the study group. We further interrogated 2 public data sets and found that PDACs with COMPASS-like complex gene alterations have increased rates of TP53 mutation, body-tail location, poor differentiation or undifferentiated histology, and a higher death rate. Conclusions.--COMPASS-like complex gene alterations likely represent a subset of more aggressive PDACs with poor or squamous differentiation histologically and increased concurrent TP53 mutations. These findings may have potential prognostic and therapeutic implications., Pancreatic ductal adenocarcinoma (PDAC) remains a leading cause of cancer-related morbidity and mortality, with an estimated 5-year survival rate of just 9%-10%, (1,2) and accounts for a significant portion of [...]

Purpose Community-acquired pneumonia (CAP) is a leading cause of adult mortality worldwide and poses a significant global burden. Previous studies have indicated a tendency for viral pneumonia, particularly severe influenza virus pneumonia, to be complicated by Aspergillus superinfection. However, the clinical features and prognostic implications of Aspergillus detection in early-onset viral CAP remain unclear. Methods We conducted a prospective multicenter observational cohort study in China involving CAP patients. Adult patients with CAP from six hospitals were enrolled between January 2017 and October 2018. Within 72 h of admission, lower respiratory tract specimens, including sputum and alveolar lavage fluid, were collected. Comprehensive pathogenic testing, utilizing molecular biology techniques, was performed on the collected specimens, encompassing bacteria, atypical pathogens, viruses, and fungi. Patient clinical data were collected through a unified electronic medical record website system. Results A total of 382 adult CAP patients were included in the study. The viral detection rate was 38% (145/382), with Aspergillus identified in 11.0% (16/145) of viral CAP cases. Mortality among Aspergillus-positive patients was significantly higher (25%, 4/16) compared to Aspergillus-negative patients (5.4%, 7/129) in viral CAP (P = 0.021). Multivariable logistic regression models demonstrated that the presence of Aspergillus at admission might increase the mortality risk in viral CAP [OR (95%CI) = 7.34 (0.92-58.65), P = 0.06]. Furthermore, Aspergillus-positive patients exhibited a significantly lower lymphocyte count than Aspergillus-negative patients (P = 0.047). Conclusion Positive detection of Aspergillus in lower respiratory tract specimens might be associated with higher mortality in early-onset viral CAP. Trial Registration ClinicalTrials.gov, NCT03093220. Registered retrospectively on 28 March 2017., Author(s): Lu Yin [sup.1], Ying Zhang [sup.1], Yali Zheng [sup.2], Qiongzhen Luo [sup.3], Lili Zhao [sup.1], Wentao Ni [sup.1], Yu Xu [sup.4], Zhancheng Gao [sup.1] Author Affiliations: (1) grid.411634.5, 0000 [...]

Background: Minimal literature exists on outcomes for Canadian patients with gastroesophageal adenocarcinoma (GEA). The objective of our study was to establish a prospective clinical database to evaluate demographic characteristics, presentation and outcomes of patients with GEA. Methods: Patients diagnosed with GEA were recruited from Jan. 30, 2017, to Aug. 30, 2020. Data collected included demographic characteristics, presentation, treatment and survival. A multivariable model for overall survival in patients treated with curative intent was created using sex, lymph node status, resection margin status, age and tumour location as variables. Results: A total of 122 patients with adenocarcinoma of the stomach or gastroesophageal junction were included. Median age was 65 years (interquartile range [IQR] 59-74), 70% of patients were male and 26% were born outside of Canada. Median follow-up time was 14.5 (IQR 8.0-31.0) months. Following staging computed tomography scanning, 88% of patients were deemed to have potentially resectable disease. Eighty-one (76%) received staging laparoscopy and 74 (61%) were treated with curativeintent surgery. Forty-six (62%) patients had nodal metastases. The median number of nodes harvested was 22 (IQR 18-30). The R0 resection margin rate was 82%. The 3-year overall survival for patients who received curative-intent treatment was 63% and 38% for all patients. On multivariable analysis, female sex (hazard ratio [HR] 3.88, p = 0.01), positive nodal status (HR 3.58, p = 0.02), positive margins (HR 3.11, p = 0.03) and tumour location (HR 3.00, p = 0.03) were associated with decreased overall survival. Conclusion: Many of the patients with GEA in this study presented with advanced disease, and only 61% were offered curative-intent surgery. A prospective multicentre national GEA database is now being established. Contexte : Presque rien n'a été publié sur les issues des patients canadiens atteints d'un adénocarcinome gastro-oesophagien. Notre étude avait pour objectif d'établir une base de données prospectives cliniques pour évaluer les caractéristiques démographiques, la présentation et les issues associées à cette population de patients. Méthodes : Le recrutement de patients ayant reçu un diagnostic d'adénocarcinome gastro-oesophagien s'est fait du 30 janvier 2017 au 30 août 2020. Les données recueillies portaient sur les caractéristiques sociodémographiques, la présentation, le traitement et la survie. Nous avons ensuite créé un modèle multivarié de la survie globale des patients ayant reçu un traitement à visée curative, qui inclut comme variables le sexe, l'atteinte des noeuds lymphatiques, le statut des marges de la résection, l'âge et la position de la tumeur. Résultats : Au total, 122 patients atteints d'un adénocarcinome de l'estomac ou de la jonction gastro-oesophagienne ont été retenus. L'âge médian était de 65 ans (écart interquartile [ÉI] 59-74 ans), 70% étaient de sexe masculin, et 26% étaient nés à l'extérieur du Canada. La durée médiane de suivi était de 14,5 mois (ÉI 8,0-31,0 mo). Après la stadification par tomodensitométrie, il a été conclu que les tumeurs de 88% des patients étaient potentiellement résécables. Parmi ces patients, 81 (76%) ont subi une chirurgie de stadification par laparoscopie, et 74 (61%) ont subi une opération à visée curative. Quarante-six patients (62%) avaient des métastases nodales. Le nombre médian de noeuds excisés était de 22 (ÉI 18-30). Le taux de résection R0 était de 82%. Le taux de survie globale à 3 ans des patients ayant subi un traitement à visée curative était de 63%, et de 38% pour tous les patients. Selon l'analyse multivariée, le sexe féminin (rapport de risque [RR] 3,88, p = 0,01), la présence d'une atteinte nodale (RR 3,58, p = 0,02), les marges positives (RR 3,11, p = 0,03) et la position de la tumeur (RR 3,00, p = 0,03) étaient associés à une baisse de la survie globale. Conclusion : Beaucoup des patients atteints d'un adénocarcinome gastro-oesophagien ayant participé à l'étude avaient une maladie avancée, et seuls 61% d'entre eux se sont fait proposer une opération à visée curative. Une base de données prospectives nationale multicentrique sur ce type de cancer est en cours de création., Gastroesophageal adenocarcinoma (GEA) is a common cancer worldwide and a major cause of cancer-related deaths. (1) Previous literature clearly demonstrates differences in the presentations and disease pathology seen across Asian [...]

Context: After the gas tragedy on the night of December 2/3, 1984, at Bhopal, the Indian Council of Medical Research (ICMR) started following up on four population cohorts with different levels of post-disaster mortality from December 3-6, 1984. Aims: The present study was undertaken to estimate the survival time of the cohort, and investigate the risk of mortality based on exposure, gender, and median age. Settings and Design: Survival analysis is generally used to evaluate factors associated with the time to an event of failure or death among any covered population. Methods and Materials: To know the cause of death and mortality rate, a retrospective cohort analysis was conducted on the outcomes of 92,320 individuals with an exposed and non-exposed group from 1985 to 2015 in Bhopal, India. Statistical Analysis Used: Basic survival analysis method, Kaplan-Meier method, and Cox proportional hazard regression model were used to analyze the mortality risk. Results: During the past 30 years, the survivability was 87.25%, and the mortality rate was 7.2% for the cohort population of Bhopal gas survivors. Cox regression analysis showed that exposed, males, and individuals above 21 years (at the time of the disaster) were at higher risk of mortality from 1985 to 2015. Conclusions: During the initial two phases, the mortality was higher in the exposed group, but over time, their survival turned out to be the same in both groups. Keywords: BGD victims, cohort, survival analysis, Author(s): Sushil Singh [1]; Dharma Raj (corresponding author) [1]; Yogesh Sabde [2]; Madhanraj Kalyanasundaram [3]; Rajnarayan Ramshankar Tiwari [2] INTRODUCTION Toxic gases mainly containing methyl-isocyanate (MIC) leaked on the intervening [...]