The incidence of neonatal sepsis in India is the highest in the world. Evidence regarding its risk factors can guide clinical practice and prevention strategies.
To review, assess and synthesize the ...available literature from India on the risk factors of sepsis among neonates.
A systematic review was conducted. We searched PubMed, CINAHL, Scopus, Web of Science, Popline, IndMed, Indian Science Abstracts and Google Scholar from inception up to March 23, 2018 to identify observational analytical studies reporting on risk factors of laboratory-confirmed neonatal sepsis in India. Two authors independently screened studies (title, abstract and full-text stages), extracted data, and assessed quality. A random-effects meta-analysis was performed as substantial heterogeneity was anticipated. Subgroup and sensitivity analyses were additionally performed. Effect size in our review included odds ratio and standardized mean difference.
Fifteen studies were included from 11,009 records, of which nine were prospective in design. Birthweight and gestational age at delivery were the most frequently reported factors. On meta-analyses, it was found that male sex (OR: 1.3, 95% CI: 1.02, 1.68), out born neonates (OR: 5.5, 95% CI: 2.39, 12.49), need for artificial ventilation (OR: 5.61; 95% CI: 8.21, 41.18), gestational age <37 weeks (OR: 2.05; 95% CI:1.40, 2.99) and premature rupture of membranes (OR:11.14, 95% CI: 5.54, 22.38) emerged as risk factors for neonatal sepsis. Included studies scored lowest on exposure assessment and confounding adjustment, which limited comparability. Inadequacy and variation in definitions and methodology affected the quality of included studies and increased heterogeneity.
Male neonates, outborn admissions, need for artificial ventilation, gestational age <37 weeks and premature rupture of membranes are risk factors for sepsis among neonates in India. Robustly designed and reported research is urgently needed to confirm the role of other risk factors of neonatal sepsis in India.
In communications, unknown variables are usually modelled as random variables, and concepts such as independence, entropy and information are defined in terms of the underlying probability ...distributions. In contrast, control theory often treats uncertainties and disturbances as bounded unknowns having no statistical structure. The area of networked control combines both fields, raising the question of whether it is possible to construct meaningful analogues of stochastic concepts such as independence, Markovness, entropy and information without assuming a probability space. This paper introduces a framework for doing so, leading to the construction of a maximin information functional for nonstochastic variables. It is shown that the largest maximin information rate through a memoryless, error-prone channel in this framework coincides with the block-coding zero-error capacity of the channel. Maximin information is then used to derive tight conditions for uniformly estimating the state of a linear time-invariant system over such a channel, paralleling recent results of Matveev and Savkin.
Obesity in children is a major public health concern due to the increased risk of developing adverse health outcomes in their future, and disability in adulthood. The existing systematic reviews on ...the topic are limited in scope, focusing solely on high-income countries and children aged 4-12 years. Hence, we propose to conduct a systematic review and meta-analysis to understand, how exposure to authoritative feeding style versus authoritarian, indulgent, uninvolved compare in terms of its association with adiposity in children aged 6 months to 5 years. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines were followed for ensuring the completeness of the protocol. Case-control and cohort studies will be included. Searches will be done using electronic databases viz. PubMed, Ovid EMBASE, PsycINFO and Web of Science. Grey literature will be searched using OpenGrey and Grey Literature Report. We will only include quantitative studies using the developed search strategy. For categorical outcomes, relative risks, odds ratios, and hazard ratios with confidence intervals and for continuous outcomes mean difference with confidence intervals will be used. Risk of Bias In Non-randomized Studies- of Exposure (ROBINS-E) will be used for the evaluation of risk of bias in the individual observational studies. Considering the inherent variability in the observational studies, random effects meta-analysis will also be conducted. If between-study heterogeneity exists, a subgroup analysis based on low and middle-income countries vs. high income countries will be conducted. If the data is not suitable for combining quantitatively, a narrative synthesis will be undertaken. We propose to identify publication bias by using contour-enhanced funnel plots and "trim and fill" method. Outcome reporting bias will be ascertained by comparing the outcomes published in the protocol and the published report. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to understand the confidence we can have on the effect estimates. Registration: This protocol has been registered in International Prospective Register of Systematic Reviews (PROSPERO) on 13 March 2023 with registration number CRD42023356014.
Endophytes are microorganisms (bacteria or fungi or actinomycetes) that dwell within robust plant tissues by having a symbiotic association. They are ubiquitously associated with almost all plants ...studied till date. Some commonly found endophytes are those belonging to the genera Enterobacter sp., Colletotrichum sp., Phomopsis sp., Phyllosticta sp., Cladosporium sp., and so forth. Endophytic population is greatly affected by climatic conditions and location where the host plant grows. They produce a wide range of compounds useful for plants for their growth, protection to environmental conditions, and sustainability, in favour of a good dwelling place within the hosts. They protect plants from herbivory by producing certain compounds which will prevent animals from further grazing on the same plant and sometimes act as biocontrol agents. A large amount of bioactive compounds produced by them not only are useful for plants but also are of economical importance to humans. They serve as antibiotics, drugs or medicines, or the compounds of high relevance in research or as compounds useful to food industry. They are also found to have some important role in nutrient cycling, biodegradation, and bioremediation. In this review, we have tried to comprehend different roles of endophytes in plants and their significance and impacts on man and environment.
While numerous methods have been proposed to produce semiconducting graphene, a significant band gap has never been demonstrated. The reason is that, regardless of the theoretical gap formation ...mechanism, subnanometer disorder prevents the required symmetry breaking necessary to make graphene semiconducting. In this work, we show for the first time that semiconducting graphene can be made by epitaxial growth. Using improved growth methods, we show by direct band measurements that a band gap greater than 0.5 eV can be produced in the first graphene layer grown on the SiC(0001) surface. This work demonstrates that order, a property that remains lacking in other graphene systems, is key to producing electronically viable semiconducting graphene.
In the present communication, we propose a quantile‐based measure for the divergence between two survival functions. This can also be used in a dynamic way where the divergence between survival ...functions varies with time. Several new properties of the proposed measure are investigated with suitable examples. The behavior of the measure for various reliability models is also investigated. A real data analysis is employed to compare the relative efficacy of two treatment groups using the proposed divergence measure.
Background
Congenital bleeding disorders can cause obstetric haemorrhage during pregnancy, labour and following delivery. Desmopressin acetate (DDAVP) is found to be an effective drug which can ...reduce the risk of haemorrhage and can also stop bleeding in certain congenital bleeding disorders. Its use in pregnancy has been controversial. Hence beneficial and adverse effects of DDAVP in these groups of pregnant women should be evaluated.
This is an update of a Cochrane Review first published in 2013 and updated in 2015.
Objectives
To evaluate the efficacy and safety of DDAVP in preventing and treating acute bleeding in pregnant women with bleeding disorders.
Search methods
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coaguopathies Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant and books of conferences proceedings. We also searched several clinical trial registries and grey literature (27 August 2017).
Date of most recent search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coaguopathies Trials Register: 01 October 2018.
Selection criteria
Randomised and quasi‐randomised controlled trials investigating the efficacy of DDAVP versus tranexamic acid or factor VIII or rFactor VII or fresh frozen plasma in preventing and treating congenital bleeding disorders during pregnancy were eligible.
Data collection and analysis
No trials matching the selection criteria were eligible for inclusion.
Main results
No trials matching the selection criteria were eligible for inclusion.
Authors' conclusions
No randomised controlled trials were identified investigating the relative effectiveness of DDAVP for bleeding during pregnancy in women with congenital bleeding disorders. In the absence of high‐quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials) to decide whether or not to treat women with congenital bleeding disorders with DDAVP.
Given the ethical considerations, future randomised controlled trials are unlikely. However, other high‐quality controlled studies (such as risk allocation designs, sequential design, parallel cohort design) to investigate the risks and benefits of using DDAVP in this population are needed.
Given that there are unlikely to be any trials published in this area, this review will no longer be regularly updated.
Apical periodontitis is a chronic inflammatory disorder of periradicular tissues caused by aetiological agents of endodontic origin. Persistent apical periodontitis occurs when root canal treatment ...of apical periodontitis has not adequately eliminated intraradicular infection. Problems that lead to persistent apical periodontitis include: inadequate aseptic control, poor access cavity design, missed canals, inadequate instrumentation, debridement and leaking temporary or permanent restorations. Even when the most stringent procedures are followed, apical periodontitis may still persist as asymptomatic radiolucencies, because of the complexity of the root canal system formed by the main and accessory canals, their ramifications and anastomoses where residual infection can persist. Further, there are extraradicular factors – located within the inflamed periapical tissue – that can interfere with post‐treatment healing of apical periodontitis. The causes of apical periodontitis persisting after root canal treatment have not been well characterized. During the 1990s, a series of investigations have shown that there are six biological factors that lead to asymptomatic radiolucencies persisting after root canal treatment. These are: (i) intraradicular infection persisting in the complex apical root canal system; (ii) extraradicular infection, generally in the form of periapical actinomycosis; (iii) extruded root canal filling or other exogenous materials that cause a foreign body reaction; (iv) accumulation of endogenous cholesterol crystals that irritate periapical tissues; (v) true cystic lesions, and (vi) scar tissue healing of the lesion. This article provides a comprehensive overview of the causative factors of non‐resolving periapical lesions that are seen as asymptomatic radiolucencies post‐treatment.
Background
Rice fortification with vitamins and minerals has the potential to increase the nutrition in rice‐consuming countries where micronutrient deficiencies exist. Globally, 490 million metric ...tonnes of rice are consumed annually. It is the dominant staple food crop of around three billion people.
Objectives
To determine the benefits and harms of rice fortification with vitamins and minerals (iron, vitamin A, zinc or folic acid) on micronutrient status and health‐related outcomes in the general population.
Search methods
We searched CENTRAL, MEDLINE, Embase, CINAHL, and 16 other databases all up to 10 December 2018. We searched ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (ICTRP) on 10 December 2018.
Selection criteria
We included randomised and quasi‐randomised trials (with either individual or cluster randomisation) and controlled before‐and‐after studies. Participants were populations older than two years of age (including pregnant women) from any country. The intervention was rice fortified with at least one micronutrient or a combination of several micronutrients (iron, folic acid, zinc, vitamin A or other vitamins and minerals) compared with unfortified rice or no intervention.
Data collection and analysis
We used standard methodological procedures expected by Cochrane. Two review authors independently screened studies and extracted data.
Main results
We included 17 studies (10,483 participants) and identified two ongoing studies. Twelve included studies were randomised‐controlled trials (RCTs), with 2238 participants after adjusting for clustering in two cluster‐RCTs, and five were non‐randomised studies (NRS) with four controlled before‐and‐after studies and one cross‐sectional study with a control (8245 participants). Four studies were conducted in India, three in Thailand, two in the Philippines, two in Brazil, one each in Bangladesh, Burundi, Cambodia, Indonesia, Mexico and the USA. Two studies involved non‐pregnant, non‐lactating women and 10 involved pre‐school or school‐age children.
All 17 studies reported fortification with iron. Of these, six studies fortified rice with iron only; 11 studies had other micronutrients added (iron, zinc and vitamin A, and folic acid). One study had one arm each with vitamin A alone and carotenoid alone. Elemental iron content ranged from 0.2 to 112.8 mg/100 g uncooked rice given for a period varying from two weeks to 48 months.
Thirteen studies did not clearly describe either sequence generation or allocation concealment. Eleven studies had a low attrition rate. There was no indication of selective reporting in the studies. We considered two RCTs at low overall risk of bias and 10 at high overall risk of bias. One RCT was at high or unclear risk of bias for most of the domains. All controlled before‐and‐after studies had a high risk or unclear risk of bias in most domains. The included studies were funded by Government, private and non‐governmental organisations, along with other academic institutions. The source of funding does not appear to have altered the results. We used the NRS in the qualitative synthesis but we excluded them from the quantitative analysis and review conclusions since they provided mostly contextual information and limited quantitative information.
Rice fortified with iron alone or in combination with other micronutrients versus unfortified rice (no micronutrients added)
Fortification of rice with iron (alone or in combination with other micronutrients) may make little or no difference in the risk of having anaemia (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.54 to 0.97; I2 = 74%; 7 studies, 1634 participants; low‐certainty evidence) and may reduce the risk of iron deficiency (RR 0.66, 95% CI 0.51 to 0.84; 8 studies, 1733 participants; low‐certainty evidence). Rice fortification may increase mean haemoglobin (mean difference (MD) 1.83, 95% CI 0.66 to 3.00; I2 = 54%; 11 studies, 2163 participants; low‐certainty evidence) and it may make little or no difference to vitamin A deficiency (with vitamin A as one of the micronutrients in the fortification arm) (RR 0.68, 95% CI 0.36 to 1.29; I2 = 37%; 4 studies, 927 participants; low‐certainty evidence). One study reported that fortification of rice (with folic acid as one of the micronutrients) may improve serum or plasma folate (nmol/L) (MD 4.30, 95% CI 2.00 to 6.60; 215 participants; low‐certainty evidence). One study reported that fortification of rice with iron alone or with other micronutrients may slightly increase hookworm infection (RR 1.78, 95% CI 1.18 to 2.70; 785 participants; low‐certainty evidence). We are uncertain about the effect of fortified rice on diarrhoea (RR 3.52, 95% CI 0.18 to 67.39; 1 study, 258 participants; very low‐certainty evidence).
Rice fortified with vitamin A alone or in combination with other micronutrients versus unfortified rice (no micronutrients added)
One study had one arm providing fortified rice with vitamin A only versus unfortified rice. Fortification of rice with vitamin A (in combination with other micronutrients) may increase mean haemoglobin (MD 10.00, 95% CI 8.79 to 11.21; 1 study, 74 participants; low‐certainty evidence). Rice fortified with vitamin A may slightly improve serum retinol concentration (MD 0.17, 95% CI 0.13 to 0.21; 1 study, 74 participants; low‐certainty evidence).
No studies contributed data to the comparisons of rice fortification versus no intervention. The studies involving folic acid and zinc also involved iron in the fortification arms and hence we reported them as part of the first comparison.
Authors' conclusions
Fortification of rice with iron alone or in combination with other micronutrients may make little or no difference in the risk of having anaemia or presenting iron deficiency and we are uncertain about an increase in mean haemoglobin concentrations in the general population older than 2 years of age. Fortification of rice with iron and other micronutrients such as vitamin A or folic acid may make little or no difference in the risk of having vitamin A deficiency or on the serum folate concentration. There is limited evidence on any adverse effects of rice fortification.
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