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Carbetocin versus oxytocin with or without tranexamic acid for preventing postpartum hemorrhage in cesarean delivery: a randomized controlled trial
No full textAbstract Background Postpartum hemorrhage (PPH) is a significant contributor to maternal morbidity, particularly following cesarean deliveries. Uterotonics, including oxytocin and carbetocin, are commonly used to prevent PPH. However, the comparative effectiveness of these agents when used in conjunction with tranexamic acid remains uncertain. Aims This study aims to evaluate the efficacy of carbetocin, oxytocin, and their combinations with tranexamic acid in mitigating intraoperative blood loss during cesarean deliveries. Methods In this randomized, double-blind, two-factorial trial, 200 women scheduled for cesarean sections were allocated into four groups (n = 50 each): carbetocin (100 µg), carbetocin combined with tranexamic acid, oxytocin (5 IU), and oxytocin combined with tranexamic acid. The interventions were administered intravenously immediately after delivery. The primary outcome was estimated intraoperative blood loss in the first 24 h, assessed through suction volume and gauze counts. Secondary outcomes included hematological parameters (hemoglobin, hematocrit) and hemodynamic changes (blood pressure, heart rate). Results The carbetocin group demonstrated significantly lower blood loss (629.0 ± 139.62 mL) compared to the oxytocin plus tranexamic acid group (712.7 ± 131.32 mL; p = 0.017). Post-hoc analysis revealed no significant difference in blood loss between the carbetocin and oxytocin-alone groups. Carbetocin also resulted in the smallest decreases in hematocrit (-2.01%) and hemoglobin (-0.99 g/dL), along with minimal changes in blood pressure (+ 1.60 mmHg systolic, + 3.42 mmHg diastolic). In contrast, the oxytocin groups exhibited greater hemodynamic fluctuations, characterized by significant reductions in blood pressure and increases in heart rate (p < 0.001). Significant differences in hematocrit, white blood cell count, and blood pressure changes were observed between the groups (p < 0.05). No significant differences in adverse effects were identified among the groups. Conclusion In this trial, carbetocin was associated with less blood loss than oxytocin combined with tranexamic acid and demonstrated a more favorable hemodynamic profile compared to oxytocin-based regimens. These findings suggest it may be considered a preferred uterotonic agent for the prevention of PPH in cesarean deliveries, though the role of tranexamic acid requires further clarification
Epidemiological characteristics of measles in children in Togo from 2020 to 2024: a cross-sectional study
No full textAbstract Introduction In Togo, despite efforts to achieve optimal vaccination coverage, measles continues to be prevalent in the country. The objective of this study was to describe the epidemiological, diagnostic, and preventive aspects of measles in children. Methods This was a cross-sectional study of measles data from 2020 to 2024 in Togo among children under 18 years of age. The measles database of the “Institut National d’Hygiène” was used for the study. It was a secondary analysis of national measles surveillance data. A time, place, and person analysis was performed. Results A total of 3,135 suspected cases were recorded. There were 1,251 confirmed cases. The confirmation rate was 39.9% (CI 38.2–41.6%) with 3 deaths among confirmed cases. The median age was 3.7 years (IQR 1.9–6.0) for confirmed cases. The sex-ratio was 1.03 among confirmed cases. A higher proportion of confirmed cases was observed among females compared to males (42.0% vs. 37.8%, p = 0.016). In rural areas 707 cases were confirmed, compared with 397 cases in urban areas. The number of confirmed cases was highest in the Maritime and the Plateaux regions, with 380 and 352 cases respectively (p < 0.001). Most confirmed cases were notified in the years 2022 and 2023 with 619 and 444 cases respectively (p < 0.001). The frequency of confirmed cases was lower among vaccinated suspected cases compared to unvaccinated suspected cases (p < 0.001). Conclusion Measles confirmed cases was highest in the Maritime and the Plateaux regions and the frequency of confirmed cases was lower among vaccinated suspected cases. Response measures and awareness campaigns to improve vaccination coverage are needed
Left pulmonary aplasia with left pulmonary artery agenesis in a child: case report from Nepal
No full textAbstract Background Unilateral pulmonary agenesis is a rare congenital anomaly with an incidence of 1:15,000, affecting both sides and sexes equally. It's classified by Schneider-Schwalbe (Types 1–3) and Boyden systems (Groups 1–3) based on developmental severity. Children commonly experience recurrent respiratory tract infections and breathing difficulties due to aberrant tracheal function and increased vulnerability from airway constriction. Case presentation A 9-year-old male presented with fever and nonproductive cough. Physical examination revealed severe malnutrition (weight and BMI < -3Z score) with tracheal deviation, decreased left chest movement, dullness to percussion, and diminished breath sounds on the left side. Chest X-ray showed complete left hemithorax opacification with mediastinal shift. High-resolution computed tomography revealed left lung aplasia with compensatory right lung hyperinflation. Computed tomography pulmonary angiogram (CTPA) confirmed left pulmonary artery agenesis. Bronchoscopy demonstrated hypoplastic left bronchial tree with blind-ending left main bronchus and tracheal bronchus supplying the right upper lobe. The patient was treated with antibiotics for secondary infection, chest physiotherapy, inhaled corticosteroids, and nutritional support. Conclusion This rare congenital anomaly highlights the importance of advanced imaging in diagnosing complex respiratory presentations in pediatric patients with recurrent respiratory infections
Development and evaluation of a mental health and suicide prevention student leadership training programme for secondary school students in Hong Kong
No full textAbstract Background Contributing to the growing need for adolescent school-based mental health interventions in Hong Kong, the “Suicide Help Intervention through Education and Leadership Development for Students” (S.H.I.E.L.D.S.) programme was developed to train secondary school students to become gatekeepers and lay leaders in mental health for their school communities. It involved both education – through mental health and suicide prevention training – and leadership development – through the design and implementation of student-led projects to encourage help-seeking behaviours and promote mental wellbeing to their peers. Methods Using a mixed-methods approach, we examined the impact of two rounds of S.H.I.E.L.D.S. that ran between June 2022 and June 2023 on three groups of participants across eight participating schools: 89 student leaders (M age = 15.2) who underwent training, 33 staff advisors who supported the student leaders, and 423 general students (M age = 14.3) who participated in student-led project activities. Questionnaires were disseminated to each group of participants before and after relevant programme activities, while interviews were conducted after the conclusion of all programme activities. Results Quantitative analyses demonstrated that there were no significant changes in both student leaders’ and general students’ knowledge of and attitudes towards mental health. However, qualitative feedback revealed that leaders did feel that their mental health-related knowledge and ability to help their peers improved. This was supported by the staff advisors, who also developed a greater appreciation for the role of students’ input in co-creating school-based mental health promotion initiatives. General students similarly appreciated the peer-led nature of project activities. General observations on the impact of S.H.I.E.L.D.S. on the schools’ mental health culture are also discussed. Conclusions This study highlights the importance of recognising student perspectives and integrating new mental health programmes with existing school efforts, which were instrumental in the successful implementation of S.H.I.E.L.D.S. in the intervention schools. Future implications for the continuity and scaling-up of S.H.I.E.L.D.S. and similar school-based mental health promotion initiatives are also given. Trial registration Not applicable
Multi-stage task allocation strategy for UAV clusterin multi-object tracking
No full textAbstract Multi-unarmed aerial vehicle (UAV) collaborative mission planning is a key technology for the intelligent development of UAV clusters at this stage, where mission assignment under multiple constraints is a core part of UAV mission planning technology. The poor planning ability of an UAV swarm often leads to resource waste and revenue reduction during mission execution, while the adoption of task allocation in the multi-target tracking of UAV clusters guarantees the highest profit. Algorithms of traditional pigeon-inspired optimization(PIO) and contract network protocol reflect defects of low timeliness and high time costs, respectively. Compared with these methods, the multilevel PIO algorithm maximizes the efficiency and profitability of the overall tracking task. A staged UAV cluster task allocation architecture was constructed to complete the global optimal initialization before tracking, and then a parallel auction contract network was employed to further perform the local optimal redistribution of each UAV. The simulation results suggest that this scheme not only guides cluster allocation in stages but also decreases the negotiatory time of a UAV cluster to in-crease the integral profitability under multiple constraints, such as prohibited areas
An integrated methodology for intrusion detection and mitigation to optimize cloud security
No full textAbstract The quick adoption of the cloud computing technology has created new security challenges and they require new approaches to security intrusion monitoring and control. This paper will offer a two-layered AI-based security architecture incorporating AI-based Anomaly Detection (AAD) and Extended Zero Trust (EZT) model to bolster the security of the cloud infrastructure. The given methodology will be based on the most advanced AI models such as deep learning algorithms and machine learning models to identify anomalies and potential threats in dynamic, sophisticated, and real-time cloud environments. The framework was tried on CIC-IDS2018, TONIoT and later on current data including UNSW-NB15 and CICIoT2023 to reflect the increase in attack vectors such as Kubernetes exploits and container escapes. Role-Based Access Control (RBAC) and Multi-Factor Authentication (MFA) and micro-segmentation have been introduced in the implementation of EZT to enforce dynamic policies in the real time scenarios. Experimental performance of 98.6% accuracy in detection with low FPR (False Positive Rate) and 1.3 low-cost computation in the multi-tenant cloud environment was achieved. Adversarial resilience was analyzed and demonstrated 93.4 percent of resilience in poisons and evasion attacks and a statistical validation with 95 percent confidence intervals and mean rate in multiple runs confirmed stability
Aegis: a transformer-based deep learning framework for the accurate identification of anticancer peptides
No full textAbstract Background Anticancer peptides (ACPs) are promising therapeutic agents with selective cytotoxicity toward cancer cells and minimal toxicity toward normal cells. However, the experimental identification and characterization of ACPs are often costly, time-consuming, and inefficient. Computational approaches provide promising alternatives for the rapid and accurate prediction of ACPs. Results Here, we introduce Aegis, a novel transformer-based deep learning framework designed for precise ACP identification. We systematically evaluated various machine learning and deep learning models via multiple feature extraction methods, including the composition of k-spaced amino acid pairs (CKSAAP), CTD composition (CTDC), CTD transition (CTDT), CTD distribution (CTDD), and pseudo amino acid composition (PAAC) methods. Comprehensive feature importance analyses via analysis of variance (ANOVA), ReliefF, and SHapley Additive exPlanations (SHAP) methods were performed, followed by incremental feature selection (IFS) to determine the optimal subset of discriminative features. Using the 103 optimal features identified via SHAP, Aegis achieves state-of-the-art (SOTA) performance on an independent testing dataset, outperforming existing ACP prediction models. Furthermore, compositional analysis revealed that ACP sequences are significantly enriched in positively charged and hydrophobic residues. Conclusions Overall, our study demonstrates the exceptional potential of transformer-based deep learning for ACP identification, laying a foundation for future computational screening and the clinical development of novel ACPs
Synonymous codon usage defines functional gene families
No full textAbstract Background The degeneracy of the genetic code is increasingly recognized for roles in regulating translation rate, protein folding, and cell response. However, the functional genomics of codon usage patterns remains poorly defined. We previously showed that prokaryotic and eukaryotic cells respond to individual stresses by uniquely reprogramming the tRNA pool and the dozens of tRNA modifications comprising the tRNA epitranscriptome to cause selective translation of mRNAs from codon-biased stress response genes. Here, we tested the hypothesis that functional gene families have distinct values of codon bias in the Saccharomyces cerevisiae genome by modeling isoacceptor codon distributions using a new approach—analysis of synonymous codon signatures (ASCS). Results Application of ASCS to the S. cerevisiae genome revealed linear relationships between patterns of codon bias and gene function using canonical correlation analysis. By mapping codon-biased open reading frames (ORFs) onto a functional network of gene ontology (GO) categories, we identified 91 gene families distinguished by unique codon usage signatures. The codon usage patterns were found to strongly predict functional clusters of genes, such as translational machinery, transcription, and metabolic processes. Conclusions The ASCS-derived model of codon usage patterns in S. cerevisiae reveals functional codon bias signatures and captures more biologically meaningful information when compared to other codon analytical approaches
Advances in genetic and pharmacological therapeutic strategies for fibrodysplasia ossificans progressiva
No full textAbstract A very rare, severe genetic condition known as fibrodysplasia ossificans progressiva (FOP) is characterized by progressive heterotopic ossification of soft tissues caused on by mutations in the ACVR1 gene, particularly R206H, which results in abnormal BMP signalling. This condition causes severe mobility limitations and life-threatening complications. The goal of this review is to thoroughly examine current developments in stem cell, pharmacologic, and genetic therapy for FOP and assess their potential for translation in clinical settings. Current understanding highlights that mutant ACVR1 receptors respond abnormally to Activin A, triggering pathological ossification. Innovations such as CRISPR-Cas9 gene editing, antisense oligonucleotides, and RNA interference show promise in correcting or silencing these mutations. Several Pharmacological advances include saracatinib (evaluated in Phase II studies), garetosmab (anti-Activin A antibody with early clinical data), and palovarotene which received FDA approval in August 2023 for reducing HO in FOP. Though post-marketing data highlight ongoing concerns regarding growth-plate toxicity and long-term skeletal safety. However, significant translational challenges persist, including limited long-term safety data, heterogeneous patient responses, and gaps between preclinical success and clinical efficacy. Stem cell therapies using MSCs and iPSCs offer regenerative potential and personalized modeling platforms. Smart drug delivery devices and precision medicine techniques guided by biomarkers improve therapy targeting and monitoring. Although there are still issues with delivery, safety, and long-term effectiveness, a mix of targeted medications, gene-based treatments, and cutting-edge technology is opening the door to precision and combination therapies, which provide patients with FOP fresh hope for better results. Graphical Abstrac
Narratives unveil knowledge and awareness-related issue, reinforcing patients’ self-identity in sickle cell disease
No full textAbstract Background Sickle cell disease (SCD) increasingly requires a holistic approach. Narratives have been used to complement clinical and observational findings related to quality of life (QoL). The “Sickle Cell Anemia Narrations” project aimed to help frame the illness burden and QoL of the multi-ethnic population with SCD in Italy via a narrative approach. Results Twenty-one adult patients with SCD and 10 informal caregivers from seven SCD centers and two Patient Associations volunteered for this project. Researchers collected anonymous narratives and independently analyzed them through content analysis. Lack of SCD knowledge on multiple levels was found to strongly impact the illness experience independent of ethnicity. Fear of stigma at school, the challenging management of vaso-occlusive crises, and a lack of SCD knowledge at the workplace were reported. Fifty-five percent of participants reported a lack of SCD knowledge among healthcare professionals working outside the expert centers and 33% reported misdiagnosis. Caregivers highlighted the lack of coordination among territorial healthcare facilities. Conclusions Our findings confirm that SCD represents a critical burden for patients and caregivers and indicate that lack of SCD knowledge may bolster the barriers to care, thus revealing the urgent need to enhance awareness to foster inclusion and quality of care
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