Clinical Utility of Functional Near-Infrared Spectroscopy for Assessment and Prediction of Suicidality: A Systematic Review.

Introduction: Suicide is a pressing psychiatric concern worldwide with no established biomarker. While there is some evidence of the clinical utility of functional near-infrared spectroscopy (fNIRS) in assessing and predicting suicidality, no systematic review of such evidence has been conducted to date. Therefore, this review aimed to systematically review and gather evidence from existing studies that used fNIRS signals to assess suicidality and its associated changes in the brain, and those that examined how such signals correlated with suicide symptomatology. Methods: PubMed, EMBASE, and Cochrane Library databases were used in a systematic literature search for English-language articles published between 2000 and December 19, 2020 that focused on the utility of fNIRS for (i) assessing suicidality and its associated changes in the brain, and (ii) correlating with suicide symptomatology. Studies were included if they utilised fNIRS to evaluate variations in fNIRS-measured cerebral hemodynamic responses in patients with different mental disorders (e.g., major depressive disorder, schizophrenia), as well as in healthy controls, of any age group. Quality of evidence was assessed using the Newcastle-Ottawa quality assessment scale. Results: A total of 7 cross-sectional studies were included in this review, all of which had acceptable quality. Across all studies, fNIRS demonstrated reduced cerebral hemodynamic changes in suicidal individuals when compared to non-suicidal individuals. One study also demonstrated the potential of fNIRS signals in correlating with the severity of suicidality. Conclusions: This review provides a comprehensive, updated review of evidence supporting the clinical utility of fNIRS in the assessment and prediction of suicidality. Further studies involving larger sample sizes, standardised methodology, and longitudinal follow-ups are needed.

Influence of maternal adiposity, preterm birth and birth weight centiles on early childhood obesity in an Indigenous Australian pregnancy-through-to-early-childhood cohort study.

Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother-child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight (P=0.005) and GROW customized birth weight centiles (P=0.008). There was a significant association between maternal percentage body fat (P=0.02) and visceral fat area (P=0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term (P=0.03). GROW customized birth weight centiles was significantly associated with body weight (P=0.01), BMI (P=0.007) and abdominal circumference (P=0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.

The relationship between maternal obesity and diabetes during pregnancy on offspring kidney structure and function in humans: a systematic review.

Evidence from animal models indicates that exposure to an obesogenic or hyperglycemic intrauterine environment adversely impacts offspring kidney development and renal function. However, evidence from human studies has not been evaluated systematically. Therefore, the aim of this systematic review was to synthesize current research in humans that has examined the relationship between gestational obesity and/or diabetes and offspring kidney structure and function. Systematic electronic database searches were conducted of five relevant databases (CINAHL, Cochrane, EMBASE, MEDLINE and Scopus). Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed, and articles screened by two independent reviewers generated nine eligible papers for inclusion. Six studies were assessed as being of 'neutral' quality, two of 'negative' and one 'positive' quality. Observational studies suggest that offspring exposed to a hyperglycemic intrauterine environment are more likely to display markers of renal dysfunction and are at higher risk of end-stage renal disease. There was limited and inconsistent evidence for a link between exposure to an obesogenic intrauterine environment and offspring renal outcomes. Offspring renal outcome measures across studies were diverse, with a large variation in offspring age at follow-up, limiting comparability across studies. The collective current body of evidence suggests that intrauterine exposure to maternal obesity and/or diabetes adversely impacts renal programming in offspring, with an increased risk of kidney disease in adulthood. Further high-quality, longitudinal, prospective cohort studies that measure indicators of offspring renal development and function, including fetal kidney volume and albuminuria, at standardized follow-up time points, are warranted.

Disparities exist between the dietary intake of Indigenous Australian women during pregnancy and the Australian dietary guidelines: the Gomeroi gaaynggal study.

BACKGROUND: Little is known about the adequacy of nutrient intakes and the overall diet quality of Indigenous Australian pregnant women. The aim of this cross-sectional study was to assess nutrient sufficiency and diet quality, as measured using the Australian Recommended Food Score (ARFS), in pregnant women from the Gomeroi gaaynggal cohort (n = 58). METHODS: Maternal dietary intake during pregnancy was assessed using the Australian Eating Survey Food Frequency Questionnaire, which was self-administered in the third trimester. Diet quality was determined using the ARFS. Food group servings and nutrient intakes were compared to the Australian Guide to Health Eating (AGHE) and Australian Nutrient Reference Values (NRVs). The current analysis examined the adequacy of usual intakes from food sources only, excluding supplements. RESULTS: None of the women met all AGHE daily food group serving recommendations. The highest alignment rates were for dairy (33%), meat/alternatives (31%) and vegetables (29.3%). Almost 93% of participants exceeded the recommended intake of energy-dense, nutrient-poor foods and percentage energy from saturated fat was high (15%). Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the NRVs were zinc (77.6%) and folate (68.9%), whereas iron was the lowest. Only one person achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. The median ARFS was 28 points (maximum of 73). CONCLUSIONS: Although the small cohort limits the generalisability of the findings of the present study, the data obtained indicate that the diets of these Indigenous pregnant women are inadequate. Therefore, strategies aiming to optimise nutrient intakes of Indigenous pregnant women are needed urgently.

Validation of a chloroquine-induced cell death mechanism for clinical use against malaria.

An alternative antimalarial pathway of an 'outdated' drug, chloroquine (CQ), may facilitate its return to the shrinking list of effective antimalarials. Conventionally, CQ is believed to interfere with hemozoin formation at nanomolar concentrations, but resistant parasites are able to efflux this drug from the digestive vacuole (DV). However, we show that the DV membrane of both resistant and sensitive laboratory and field parasites is compromised after exposure to micromolar concentrations of CQ, leading to an extrusion of DV proteases. Furthermore, only a short period of exposure is required to compromise the viability of late-stage parasites. To study the feasibility of this strategy, mice malaria models were used to demonstrate that high doses of CQ also triggered DV permeabilization in vivo and reduced reinvasion efficiency. We suggest that a time-release oral formulation of CQ may sustain elevated blood CQ levels sufficiently to clear even CQ-resistant parasites.

Bacteriology of deep neck abscesses: a retrospective review of 96 consecutive cases.

INTRODUCTION: This study aimed to review the microbiology of deep neck abscesses and identify the factors that influence their occurrence. METHODS: A retrospective chart review was done of patients diagnosed with deep neck abscesses at the Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore between 2004 and 2009. The data of 131 deep neck abscess patients were reviewed, and those with positive pus culture were included in the study. Logistic regression was applied to analyse and compare the incidence of common organisms in various conditions (age, gender, aetiology and effects of diabetes mellitus). RESULTS: Of the 96 patients recruited, 18 had polymicrobial cultures. The leading pathogens cultured were Klebsiella (K.) pneumoniae (27.1 percent), Streptococcus milleri group (SMG) bacteria (21.9 percent) and anaerobic bacteria-not otherwise specified (NOS) (20.8 percent). K. pneumoniae (50.0 percent) was over-represented in the diabetic group. SMG bacteria (68.8 percent) and anaerobic bacteria-NOS (43.8 percent) were most commonly isolated in patients with odontogenic infections. K. pneumoniae was found more commonly among female patients (39.3 percent). The distribution of the three leading pathogens between patients aged below 50 years and those 50 years and above was comparable. K. pneumoniae was the commonest organism cultured in parapharyngeal space abscesses, while the submandibular space and parotid space most commonly isolated SMG bacteria and Staphylococcus aureus, respectively. CONCLUSION: Broad-spectrum antibiotics are recommended for treating deep neck abscesses. Empirical antibiotic coverage against K. pneumoniae infection in diabetic patients, and SMG and anaerobic bacteria in patients with an odontogenic infection, is advocated. Routine antibiotic coverage against Gram-negative bacteria is not paramount.