Showing papers by "Medical Research Council published in 2022"

Evaluation of the impact of maternal training on knowledge of danger signs in sick newborns and health seeking behaviors among mothers in Enugu, South-East Nigeria: A pre-and-post interventional study

Abstract: The signs/symptoms of serious illness can be subtle in the first few weeks of life, so close monitoring is essential. The World Health Organization has identified nine “danger signs” that are closely associated with morbidity and mortality if not identified early and treated appropriately. This project was undertaken to assess mothers’ knowledge of these danger signs as well as their health seeking behavior before and after newborn danger sign training. From March to September 2021, this community-based interventional study was conducted among women in two rural communities in Enugu State. An interviewer administered questionnaire was used to assess participants’ knowledge of danger signs and care seeking behaviors before and after training on the danger signs of newborns using videos from the Integrated Management of Childhood Illnesses (IMCI). Three months apart, pre- and post-training data were collected for analysis and comparison using SPSS version 20.0 (Chicago IL). The study enrolled a total of 197 women. Only the number of newborns nursed in the past significantly predicted knowledge of danger signs in the sick newborn (p=0.032) among the socio-demographic indices examined. Prior to training, 47% of respondents could not recall any danger signs offhand, compared to 1.5% after training (p=0.001). Knowledge of up to three danger signs significantly increased after training (p=0.001), as did participants who admitted seeking medical help within 24 hours of noticing any danger signs in their newborn (p=0.043). Our study found that training mothers had a significant impact on their knowledge of danger signs in sick newborns as well as their healthcare seeking behavior. As a result, training and retraining of mothers and/or caregivers may aid in improving newborn care and lowering overall infant mortality.

Risk of seizure recurrence in people with single seizures and early epilepsy - Model development and external validation.

Abstract: Purpose Following a single seizure, or recent epilepsy diagnosis, it is difficult to balance risk of medication side effects with the potential to prevent seizure recurrence. A prediction model was developed and validated enabling risk stratification which in turn informs treatment decisions and individualises counselling. Methods Data from a randomised controlled trial was used to develop a prediction model for risk of seizure recurrence following a first seizure or diagnosis of epilepsy. Time-to-event data was modelled via Cox's proportional hazards regression. Model validity was assessed via discrimination and calibration using the original dataset and also using three external datasets - National General Practice Survey of Epilepsy (NGPSE), Western Australian first seizure database (WA) and FIRST (Italian dataset of people with first tonic-clonic seizures). Results People with neurological deficit, focal seizures, abnormal EEG, not indicated for CT/MRI scan, or not immediately treated have a significantly higher risk of seizure recurrence. Discrimination was fair and consistent across the datasets (c-statistics: 0.555 (NGPSE); 0.558 (WA); 0.597 (FIRST)). Calibration plots showed good agreement between observed and predicted probabilities in NGPSE at one and three years. Plots for WA and FIRST showed poorer agreement with the model underpredicting risk in WA, and over-predicting in FIRST. This was resolved following model recalibration. Conclusion The model performs well in independent data especially when recalibrated. It should now be used in clinical practice as it can improve the lives of people with single seizures and early epilepsy by enabling targeted treatment choices and more informed patient counselling.

Malassezia sympodialis Mala s 1 allergen is a potential KELCH protein that cross reacts with human skin

Abstract: Malassezia yeast species are the dominant commensal fungal species of the human skin microbiota, but are also associated with inflammatory skin diseases, such as seborrheic dermatitis and atopic eczema (AE). Mala s 1, a β-propeller protein, is an allergen identified in Malassezia sympodialis inducing both IgE and T-cell reactivity in the majority of patients with AE. In this study, we aimed to elucidate the role of Mala s 1 allergen in skin disease. An anti-Mala s 1 antibody was used to investigate the cellular localisation of Mala s 1, the potential of Mala s 1 as a therapeutic target and examine cross-reactivity of the anti-Mala s 1 antibody with human skin. We demonstrate by high pressure freezing electron microscopy and immune-staining that Mala s 1 is located in the cell wall of M. sympodialis yeast cells. Despite the ability of the anti-Mala s 1 antibody to bind to yeast cells, it did not inhibit M. sympodialis growth suggesting Mala s 1 may not be an attractive antifungal target. The Mala s 1 predicted protein sequence was analysed in silico and was found to contain a motif indicative of a KELCH protein, a group of β-propeller proteins. Humans express a large number of KELCH proteins including some that are localised in the skin. To test the hypothesis that antibodies against Mala s 1 cross react with human skin proteins we examined the binding of anti-Mala s 1 antibody to human skin explant samples. Reactivity with the antibody was visualised in the epidermal layer of skin. To further characterise putative human targets recognised by the anti-Mala s 1 antibody, proteins were extracted from immunoblot gel bands and proteomic analysis performed. Several candidate human proteins were identified. To conclude, we propose that Mala s 1 is a KELCH-like β-propeller protein with similarity to human skin proteins and Mala s 1 recognition may trigger the production of cross-reactive responses that contribute to skin diseases associated with M. sympodialis.

The psychosocial responses of patients in cancer clinical trials: are they a barrier to participation?

Abstract: Abstract Introduction: This paper aims to discuss the psychosocial concomitants with involvement in oncology clinical trials, focusing on barriers that can impact upon participation. It will conclude with some recommendations for strategies to address potential psychosocial barriers with the aim of increasing trial participation rates. Materials and methods: A literature search was carried out using CINAHL, PubMed and EMCare databases with the following keywords for filtering: psychological distress, clinical trials, participation and oncology. The final selection of papers that met the inclusion criteria for this review was manually subjected to Critical Appraisal Skills Programme tool for relevance. Results: Thirteen papers were included in the review. The dominant theme within the literature is psychosocial obstacles to oncology clinical trial participation. Five key barriers were identified: anxiety and fear; ethnicity and social background; tensions between scientific objectives and personal motivations to participation; tensions between personal benefits versus altruism; carer perspectives. Conclusions: The key barriers discussed led to the identification of a set of strategies to help mediate conflicting tensions and motivations of trial enrolment with a view to increasing participation rates. Further prospective research garnering primary data investigating both the psychological and psychosocial factors influencing cancer clinical trial participation for patients needs to be undertaken.

Reviewer response for version 1

Abstract: Introduction:  Rhizopus homothallicus is a new emerging pathogen causing Mucormycosis.Case Presentation: We report a case of pneumonia caused by Rhizopus homothallicus in a 54 year old type 2 diabetic patient. The organism was isolated from bronchoalveolar lavage fluid and preliminary identified by fungal morphology and finally by sequencing of the internal transcribed spacer region.Conclusion: Mucormycosis may be associated with cavitary lung lesions in the backdrop of poorly controlled diabetes or other immunosuppressed states. Pulmonary mucormycosis may have variable clinical and radiological presentations. Therefore, strong clinical suspicion and prompt management can prevent high fatality associated with the disease.