Concordance between modification of diet in renal disease,chronic kidney disease epidemiology collaboration and Cockcroft-Gault equations in patients with chronic kidney disease at St. Paul’s hospital millennium medical college,Addis Ababa,Ethiopia

Background

The most commonly used glomerular filtration rate estimating equations for drug dosing are Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. However there is still a concern about whether to use MDRD and CKD-EPI interchangeably with CG for drug dosage adjustment.

Methods

The study was initiated to determine the concordance between MDRD, CKD-EPI and CG equations and associated factors in patients with chronic kidney disease at Saint Paul’s Hospital Millennium Medical College (SPHMMC). This was a cross sectional study which involved patient chart review and physicians self-administered questionnaire. Serum creatinine level?≥?1.2 mg/dL was used as a cutoff point in pre-selection of patients. The correctness of the drug dose prescribed for the level of renal function were compared to the drug database (Lexi-Comp) available through Up-to-date version 21.2.

Results

Among the total of 422 patients, 249 (59%) were males. Mean age of patients was 46.09 years. The use of MDRD equation for drug dose adjustment by physicians working in the renal clinic of SPHMMC was six out of nine physicians. The Pearson correlation coefficient between the CG with MDRD and CKD-EPI equations was r?=?0.94, P?<?0.001 and r?=?0.95, P?<?0.001, respectively. The concordance between the CG with MDRD and CKD-EPI equations for FDA assigned kidney function categories was 73.7%, Kappa?=?0.644 and 74.9%, Kappa?=?0.659, respectively. Concordance between the CG with MDRD and CKD-EPI equations for the drug dosing recommendation was 89.6%, kappa?=?0.782 and 92%, kappa?=?0.834, respectively. Age?>?70 years was associated with discordance between CG and MDRD equations for drug dosing recommendation whereas serum creatinine 1.2–3.5 mg/dL, weight?<?61 Kg and age?>?70 years were associated with discordance between the CG with MDRD and CKD-EPI equations for FDA assigned kidney function categories. However, none of the factors associated with discordance between CG and CKD-EPI for drug dosing.

Conclusion

MDRD equation can be used interchangeably with CG equation for drug dosing recommended in all adult patients between the age of 18 and 70 years. CKD-EPI can be used interchangeably with CG in all adult Ethiopian patients with CKD.

     

The Cost of Suspected and Confirmed Bacterial Meningitis Cases Treated at Jimma University Medical Center,Ethiopia

BackgroundInfections of the central nervous system (CNS) such as meningitis or encephalitis can be caused by myriad of microorganisms and may be life-threatening. In Ethiopia, it is an important cause of premature death and disability, being the 9^th most common cause of years of life lost and loss of disability-adjusted life years.The objective of this study was to estimate the cost of suspected and confirmed bacterial meningitis among inpatient managed patients at JUMC.MethodsA facility-based cross-sectional study was conducted from July 28 to September 12, 2018. A semi-structured questionnaire was used in this study. Checklists were used to collect the types of laboratory tests performed and prescribed medications. This cost of illness study was conducted from the patient perspectives. We employed a micro-costing bottom-up approach to estimate the direct cost of meningitis. The human capital approach was used for estimating wages lost.ResultAmong total patients admitted and treated in JUMC, higher proportions (69.8%) were suspected bacterial meningitis but have been treated as confirmed cases. Total median costs for both suspected and confirmed bacterial meningitis patients were estimated to be ETB 98,812.32 (US $ 3,593.2; IQR 1,303.0 to 5,734.0). Total median direct cost was ETB 79,248.02 (US $ 2,881.75; IQR 890.7 to 3,576.7). Moreover, 45.3% of the patients reported that they were either admitted or given medication at JUMC or nearby health facility before their current admissions.ConclusionThese findings indicate that most cases of bacterial meningitis were treated only empirically, and the cost of the treatment was high, especially for resource-limited countries like Ethiopia. To minimize the burden of meningitis and avoid unnecessary hospitalizations, the availability of diagnostic techniques is vitally important.     

Experimental Investigation and Parametric Optimization of the Tungsten Inert Gas Welding Process Parameters of Dissimilar Metals

Special attention is required when joining two materials with distinct chemical, physical and thermal properties in order to make the joint bond robust and rigid. The goal of this study was to see how significantly different tungsten inert gas (TIG) welding process parameters (welding current, gas flow rate, root gap, and filler materials) affect mechanical properties (tensile, hardness, and flexural strength), as well as the bead width and microstructural properties, of dissimilar welds In comparison to SS 316 and AISI 1020 low-carbon steel. TIG welding parameters were optimized in this study using a Taguchi-based desirability function analysis (DFA). From the experimental results, it was observed that welded samples employing ER-309L filler wires had a microstructure consisting of a delta ferrite network in an austenite matrix. The tensile strength experimental results revealed that welding current, followed by GFR, was a highly influential parameter on tensile strength. Weld metals had higher hardness and flexural strength than stainless steel and carbon steel base metals. This was supported by the fact that the results of our tests had hardness ratings greater than a base for the FZ and HAZ, and that no crack was observed in the weld metal following U-shape flexural bending. Welding current has a significant impact on the bead width of welded specimens, followed by root gap. Furthermore, the dissimilar welded sample responses were optimized with a composite desirability percentage improvement of 22.90% by using a parametric setting of (A2B4C4D2). Finally, the validation of the experiment was validated by our confirmation test results, which agreed with the predictive optimum parameter settings.     

A scoping review of distributed ledger technology in genomics: thematic analysis and directions for future research

ObjectiveRising interests in distributed ledger technology (DLT) and genomics have sparked various interdisciplinary research streams with a proliferating number of scattered publications investigating the application of DLT in genomics. This review aims to uncover the current state of research on DLT in genomics, in terms of focal research themes and directions for future research.Materials and MethodsWe conducted a scoping review and thematic analysis. To identify the 60 relevant papers, we queried Scopus, Web of Science, PubMed, ACM Digital Library, IEEE Xplore, arXiv, and BiorXiv.ResultsOur analysis resulted in 7 focal themes on DLT in genomics discussed in literature, namely: (1) Data economy and sharing; (2) Data management; (3) Data protection; (4) Data storage; (5) Decentralized data analysis; (6) Proof of useful work; and (7) Ethical, legal, and social implications.DiscussionBased on the identified themes, we present 7 future research directions: (1) Investigate opportunities for the application of DLT concepts other than Blockchain; (2) Explore people’s attitudes and behaviors regarding the commodification of genetic data through DLT-based genetic data markets; (3) Examine opportunities for joint consent management via DLT; (4) Investigate and evaluate data storage models appropriate for DLT; (5) Research the regulation-compliant use of DLT in healthcare information systems; (6) Investigate alternative consensus mechanisms based on Proof of Useful Work; and (7) Explore DLT-enabled approaches for the protection of genetic data ensuring user privacy.ConclusionWhile research on DLT in genomics is currently growing, there are many unresolved problems. This literature review outlines extant research and provides future directions for researchers and practitioners.     

Changes in physiological and behavioural pain indicators over time in preterm and term infants at risk for neurologic impairment

Background

Approximately 10% of infants admitted to a Neonatal Intensive Care Unit (NICU) are at risk for Neurological Impairment (NI). While we have limited knowledge on the influence of NI risk on pain responses, we have no knowledge of how these responses change over time.

Objective

To compare physiological and behavioural pain responses of infants at three levels of NI risk during the NICU neonatal period (Session 1) and at 6 months of age (Session 2).

Design/methods

Prospective observational design with 149 preterm and term infants at high (Cohort A, n = 54), moderate (Cohort B, n = 45) and mild (Cohort C, n = 50) risks for NI from 3 Canadian tertiary level NICUs. Infants were observed in the NICU during 3 standardized phases of a heel lance: baseline, stick and return-to-baseline. At 6 months, infants were observed during the same three phases during an intramuscular immunization injection. Physiological (heart rate, oxygen saturation) and behavioural (9 facial actions, cry) responses were continuously recorded.

Results

A significant interaction of Phase by Session was found with less total facial activity observed during Session 2 (all p values < 0.04). A significant interaction for Session by Cohort was found, showing that infants in Cohort A had significantly more change from baseline-to-stick phase for brow bulge, eye squeeze, nasolabial furrow and open lips between sessions with less facial actions demonstrated at Session 2 (all p < 0.02). There were significantly lower mean and minimum heart rate (all p < 0.02) and higher minimum and maximum oxygen saturation (p < 0.04) at Session 2. Significantly higher mean and minimum fundamental cry frequencies (pitch) in Cohort B (p < 0.04) were found in Session 1. Cohort A had significantly longer cry durations, but no significant differences in cry dysphonation.

Conclusions

Behavioural and physiological infant pain responses were generally diminished at 6 months of age compared to those in the neonatal period with some differences between NI risk groups in cry responses. Future exploration into the explanation for these differences between sessions and cohorts is warranted.     

Postasphyxial hypoxic-ischemic encephalopathy in neonates: outcome prediction rule within 4 hours of birth

OBJECTIVES: To construct and validate a model and derive a simple rule that is usable in any birth location for the prediction of outcome of term infants with severe asphyxia. DESIGN: Retrospective cohort study. SETTING: Regional outborn neonatal intensive care unit. PARTICIPANTS: Infants with postintrapartum asphyxial hypoxic-ischemic encephalopathy (n = 375). MAIN EXPOSURES: Clinical and laboratory predictors available at age 4 hours. MAIN OUTCOME MEASURES: A logistic regression model was developed and internally validated (with random sampling and based on the year of birth) for severe adverse outcome, which was defined as death or severe disability (severe cerebral palsy, severe developmental delay, sensorineural deafness, or cortical blindness singly or in combination). A simple prediction rule was derived from 3 variables. RESULTS: Complete data were available for 302 (92%) of the 345 infants with known outcomes (204 infants with severe adverse outcome). Six independent predictors of outcomes were identified. Using the 3 most significant predictors (chest compressions, age at onset of respiration, and base deficit), severe adverse outcome rates were 46% (95% confidence interval, 33%-58%) with none of the 3 predictors, 64% (95% confidence interval, 54%-73%) with any 1 predictor, 76% (95% confidence interval, 66%-85%) with any 2 predictors, and 93% (95% confidence interval, 81%-99%) with all of the 3 predictors present. The internal validations revealed a robust model. CONCLUSIONS: This predictive model for neonatal hypoxic-ischemic encephalopathy provides a sliding scale of probabilities that could be used for prognostication and to design eligibility criteria for decision making including neuroprotective therapy.     

From the Cover: Integrative geochronology calibrates the Middle and Late Stone Ages of Ethiopia’s Afar Rift

The Halibee member of the Upper Dawaitoli Formation of Ethiopia’s Middle Awash study area features a wealth of Middle and Later Stone Age (MSA and LSA) paleoanthropological resources in a succession of Pleistocene sediments. We introduce these artifacts and fossils, and determine their chronostratigraphic placement via a combination of established radioisotopic methods and a recently developed dating method applied to ostrich eggshell (OES). We apply the recently developed ²³⁰Th/U burial dating of OES to bridge the temporal gap between radiocarbon (¹⁴C) and ⁴⁰Ar/³⁹Ar ages for the MSA and provide ¹⁴C ages to constrain the younger LSA archaeology and fauna to ∼24 to 21.4 ka. Paired ¹⁴C and ²³⁰Th/U burial ages of OES agree at ∼31 ka for an older LSA locality, validating the newer method, and in turn supporting its application to stratigraphically underlying MSA occurrences previously constrained only by a maximum ⁴⁰Ar/³⁹Ar age. Associated fauna, flora, and Homo sapiens fossils are thereby now fixed between 106 ± 20 ka and 96.4 ± 1.6 ka (all errors 2σ). Additional ⁴⁰Ar/³⁹ results on an underlying tuff refine its age to 158.1 ± 11.0 ka, providing a more precise minimum age for MSA lithic artifacts, fauna, and H. sapiens fossils recovered ∼9 m below it. These results demonstrate how chronological control can be obtained in tectonically active and stratigraphically complex settings to precisely calibrate crucial evidence of technological, environmental, and evolutionary changes during the African Middle and Late Pleistocene.

Accurately dating the emergence of Homo sapiens and associated technologies in Africa is an enduring challenge in geochronology and a persistent source of frustration for paleoanthropologists (1–3). Most of Africa’s Middle Stone Age (MSA) lies beyond the ∼50-ka range of ¹⁴C dating, and even Later Stone Age (LSA) occurrences often lack associated charcoal or bone suitable for this technique. Furthermore, crucial Eurasian finds originally dated by ¹⁴C have recently required large revisions, highlighting the importance of improved sample preparation even for well-established dating methods (4–6). The ⁴⁰Ar/³⁹Ar dating of potassium-rich Pleistocene volcanic minerals has yielded solid calibrations based on association and correlation (7–12). However, even when present, many such rocks are contaminated by detrital minerals or lack datable fractions, further limiting application of the technique.Efforts to overcome these geochronological barriers have often led to adoption of less-reliable techniques such as electron spin resonance, thermoluminescence, or other trapped-charge techniques to obtain varying age estimates for important fossils of emergent H. sapiens (refs. 1 and 2, ref. 13 contra ref. 14; ref. 15 contra ref. 16). Such approaches, often pursued when more tested and cross-validated methods are unavailable, require in situ measurements, may involve questionable assumptions, and/or yield less-precise ages than many radioisotopic decay-based methods (1, 17). Even for more established techniques, methodological developments continue to require revision of earlier chronologies (e.g., ref. 18).Here we integrate the results of detailed stratigraphic and geomorphological field studies with satellite imagery, tephra chemistry, and multiple radioisotopic chronometers including the recently developed ²³⁰Th/U burial dating of ostrich eggshell (OES) (19) to calibrate a suite of stratigraphically superimposed fossil and artifact assemblages from the Middle Awash study area, Afar Rift, Ethiopia. This provides the temporal scale against which ongoing and future studies of key fossils and artifacts will be measured and provides a model approach for other occurrences with similar geochronological challenges and resources. We predict that further applications of this integrated, basinal-to-submeter geological approach employing multiple geochronological methods will meet ongoing challenges (20) of calibrating and understanding Pleistocene climate change, tectonic processes, environments, technologies, and biological evolution.The chronostratigraphic framework presented here is foundational to ongoing paleoanthropological studies on a spatially and stratigraphically extensive set of MSA and LSA occurrences in the Dawaitoli Formation of the Middle Awash. We first sketch the history of earlier work and outline our broader stratigraphic findings. We then describe four paleoanthropologically important Halibee member beds. We describe this succession in chronological order, oldest first, summarizing geological and geochronological results and introducing the paleoanthropological content of each. The broader implications of this research are then considered.