69832 research outputs found
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Improving the refractive outcomes of cataract surgery
Get PDFPoor refractive outcomes form one of the main reasons for cataract surgery failing to provide patients with the vision they need to function well.
Cataract is the leading cause of blindness worldwide, despite an effective cure having been available for several decades, in the form of cataract surgery
Introducing biometry during outreach: improving visual acuity outcomes in Karamoja subregion, Uganda
Get PDFContinuous monitoring and quality improvement improved outcomes and patient satisfaction, thereby increasing the uptake of cataract surgery
Systems leadership for sustainable change
Get PDFTo lead change in eye health, we must first understand the system we’re trying to change
Prevalence of colonisation with multi-drug-resistant Gram-negative organisms in pregnant and postpartum women and people in low- and middle-income countries: A protocol for a systematic review [version 1; peer review: 1 approved, 1 approved with reservations]
Get PDFBackground: Maternal infections are a significant cause of mortality and morbidity in LMICs, and the rise of antimicrobial resistance (AMR) poses a growing threat to global maternal health. Multi-drug resistant Gram negative bacteria (MDR-GNB), including extended-spectrum β-lactamase (ESBL) and carbapenemase-producing organisms, in particular, are critical threats due to limited treatment options, particularly in resource-constrained settings.
Objective: This systematic review will assess the prevalence of, and risk factors for, maternal colonisation with MDR-GNB in pregnant and postpartum women and people across LMICs. It also characterises resistance phenotypes and genotypes, assesses evidence of nosocomial acquisition, and evaluates the quality of data reporting.
Methods: PRISMA-P guidelines, we will search the following databases from 2000 onwards: PubMed/MEDLINE, Scopus, Web of Science, ProQuest, Global Health, CINAHL, and the WHO Global Index Medicus. Grey literature will be identified through Google Scholar, preprint servers and websites of ministries of health and international agencies. Eligible studies must report on MDR-GNB colonisation among pregnant or postpartum individuals in LMICs. Two reviewers will independently screen articles, extract data, and assess risk of bias using validated tools. Data synthesis will include descriptive and quantitative analyses, including meta-analysis if appropriate. The certainty of evidence will be evaluated using the GRADE framework.
Expected outcomes: This review will synthesise current knowledge on maternal colonisation with MDR-GNB in LMICs, identify gaps in the literature, and support efforts to strengthen microbiological surveillance, inform clinical guidance, and reduce AMR-related maternal mortality.
Registration CRD420250639803
Available at https://www.crd.york.ac.uk/PROSPERO/view/CRD42025063980
A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia.
Get PDFBACKGROUND: Adjunctive glucocorticoids may reduce mortality among patients with severe community-acquired pneumonia (CAP) in well-resourced settings. Whether these drugs are beneficial in low-resource settings with limited diagnostic and treatment facilities is unclear. METHODS: In this pragmatic, open-label, randomized, controlled trial conducted in 18 public hospitals in Kenya, we assigned adult patients who had received a diagnosis of CAP and who did not have a clear indication for glucocorticoids to receive either standard care for CAP or oral low-dose glucocorticoids for 10 days in addition to standard care. The primary outcome was death from any cause at 30 days after enrollment. RESULTS: A total of 2180 patients underwent randomization (1089 assigned to the glucocorticoid group and 1091 to the standard-care group). The median age of the patients was 53 years (interquartile range, 38 to 72); 46% were women. At day 30, deaths were reported in 530 patients (24.3%): 246 patients (22.6%) in the glucocorticoid group and 284 patients (26.0%) in the standard-care group (hazard ratio, 0.84; 95% confidence interval, 0.73 to 0.97; P = 0.02). The frequencies of adverse events and serious adverse events were similar in the two trial groups. Serious adverse events that were considered to be related to glucocorticoid administration occurred in 5 patients (0.5%). CONCLUSIONS: In patients with CAP in a low-resource setting, adjunctive glucocorticoid therapy was associated with a lower risk of death than standard care. (Funded by Wellcome Trust and others; SONIA PACTR number, PACTR202111481740832; ISRCTN number, ISRCTN36138594.)
A Rapid Method for Purifying Intact Trypanosoma cruzi Amastigotes from Host Cells, In Vitro and In Vivo, for Downstream 'Omic Analysis.
Get PDFAmastigotes are the replicative intracellular life cycle stage of the protozoan parasite Trypanosoma cruzi, the causative agent of Chagas disease. They have the ability to proliferate in any nucleated mammalian cell. A greater understanding of amastigote biology would greatly aid drug development since this life cycle stage is the principal target of chemotherapy. Reports have linked recrudescence following drug treatment with the possible existence of a quiescent amastigote phenotype. However, the lack of a rapid and straightforward method for isolating amastigotes from infected host cells has limited research progress in this area. This is particularly the case with omics technology, where the current complex fractionation and purification procedures can act to perturb RNA and protein expression. Here, we outline a methodology that largely overcomes these problems. Our protocol exploits MP Bio-Lysing Matrix M tubes to promote the differential lysis of host cells and the release of intact amastigotes in a 1-min time frame. Immediate treatment of the lysate with CellCover reagent then maintains RNA and protein in their native states. Amastigotes stabilized in this way can undergo further manipulations, such as cell sorting, without modification of their proteome or transcriptome profiles. This methodology, which is flexible and widely applicable, should greatly benefit research into the intracellular life cycle of T. cruzi
Reassessing the link between adiposity and head and neck cancer: a Mendelian randomization study.
Get PDFBACKGROUND: Adiposity has been associated with an increased risk of head and neck cancer (HNC). Although body mass index (BMI) has been inversely associated with HNC risk among smokers, this is likely due to confounding. Previous Mendelian randomization (MR) studies could not fully discount causality between adiposity and HNC. Hence, we aimed to revisit this using the largest genome-wide association study (GWAS) of HNC available, which has more granular data on HNC subsites.
METHODS: We assessed the genetically predicted effects of BMI (N=806,834), waist-to-hip ratio (WHR; N=697,734) and waist circumference (N=462,166) on the risk of HNC (N=12,264 cases) and its subsites using a two-sample MR framework. We used inverse variance weighted (IVW) MR and multiple sensitivity analyses, including multivariable MR (MVMR), to explore the direct effects of the adiposity measures on HNC, while accounting for smoking behaviour (a well-known HNC risk factor).
RESULTS: In univariable MR, higher genetically predicted BMI increased the risk of overall HNC (IVW OR = 1.17 per 1-SD higher BMI, 95% CI 1.02-1.34). However, the IVW effect was attenuated when smoking was included in the MVMR model (OR accounting for comprehensive smoking index = 0.96 per 1-SD higher BMI, 95% CI 0.80-1.15). Furthermore, we did not find a link between genetically predicted WHR (IVW OR = 1.05 per 1-SD higher WHR, 95% CI 0.89-1.24) or waist circumference and HNC risk (IVW OR = 1.01 per 1-SD higher waist circumference, 95% CI 0.85-1.21).
CONCLUSIONS: Our findings suggest that adiposity does not play a major role in HNC risk
Stressors, mental health and coping amongst forcibly displaced youth since the advent of COVID-19: A systematic review
Get PDFMental health is a key issue for forcibly displaced youth. The evidence base on the mental health of youth forcibly displaced since the start of the pandemic is undefined, as well as sources of stressors and coping approaches. This systematic review aims to identify literature on the mental health of forcibly displaced youth in low- and middle-income settings, with focus on displacement since the advent of the COVID-19 pandemic. Objectives are to examine (1) sources of stress, (2) prevalence and covariates of common mental disorders (CMDs) and (3) coping approaches. Six databases were searched in February 2023. Search terms focused on CMDs, stress and forcibly displaced populations. Articles based on data collected after the onset of the COVID-19 pandemic focused on forcibly displaced persons aged 10-29 were included. Quantitative observation and intervention studies reporting CMD prevalences and related concepts were included, as were qualitative studies about stressors and/or coping approaches. Prevalences of CMDs and covariates were tabulated. Inductive thematic coding was conducted on qualitative data on stressors and coping. Interpretation of coping data was guided by a taxonomy including problem solving, support seeking, distraction/avoidance and positive cognitive restructuring. Twenty-one articles were included. Economic issues were the most prominent source of stress and led to subsequent stressors. Depression and anxiety symptom prevalence ranged from 6.2% to 77.4% and 17.2%–32.8% respectively. Problem-solving and support seeking were the most common coping approaches. Supporting the mental health and coping approaches of this marginalised group is critical to recovery in the post-COVID era
High-content high-resolution microscopy and deep learning-assisted analysis reveals host and bacterial heterogeneity during Shigella infection
Get PDFShigella flexneri is a Gram-negative bacterial pathogen and causative agent of bacillary dysentery. S. flexneri is closely related to Escherichia coli but harbours a virulence plasmid that encodes a type III secretion system (T3SS) required for host cell invasion. Widely recognised as a paradigm for research in cellular microbiology, S. flexneri has emerged as important to study mechanisms of cell-autonomous immunity, including septin cage entrapment. Here, we use high-content high-resolution microscopy to monitor the dynamic and heterogeneous S. flexneri infection process by assessing multiple host and bacterial parameters (DNA replication, protein translation, T3SS activity). In the case of infected host cells, we report a reduction in DNA and protein synthesis together with morphological changes that suggest S. flexneri can induce cell-cycle arrest. We developed an artificial intelligence image analysis approach using convolutional neural networks to reliably quantify, in an automated and unbiased manner, the recruitment of SEPT7 to intracellular bacteria. We discover that heterogeneous SEPT7 assemblies are recruited to bacteria with increased T3SS activation. Our automated microscopy workflow is useful to illuminate diverse host and bacterial interactions at the single-cell and population level, and to fully characterise the intracellular microenvironment controlling the S. flexneri infection process
Inclusion of climate change and planetary health in masters of public health curricula in the UK.
Get PDFDue to the many health impacts of climate change, it is imperative to equip public health professionals with the skills and knowledge to work on climate mitigation and adaptation. However, it is unclear to what extent Masters of Public Health (MPH) include climate change and related subjects in their curricula. A survey was sent to MPH directors in the UK with questions about inclusion of climate change and related subjects in the curriculum. Russell group universities and those commissioned by NHS England Workforce, Training and Education were invited to take part. A total of 27 MPH courses were included (100% response rate). Climate change and related subjects were included in optional or core modules on other subjects, with health protection and health improvement being the most common. Two MPHs had only one lecture/seminar on climate change and one MPH did not cover these topics in the syllabus. The most common subject included in curricula was climate change (24, 89%). Most MPH directors wanted to increase the inclusion of climate change and planetary health in the curriculum (12, 55%) but could not do so due to lack of space within an already overloaded curriculum (10, 37%). Despite the recognition of the importance of climate change and health education by MPH course directors, the inclusion of those subjects in curricula remains variable and not as thorough as required given the importance of the topic. Addressing barriers is warranted to enable public health professionals to gain the required skills in climate mitigation and adaptation