Risk Stratification, Intention to fast and Outcomes of fast during Ramadan in people with diabetes presenting to tertiary care hospital.

OBJECTIVES: The objective of this study was to evaluate the stratification of people with diabetes mellitus (DM) based on the International Diabetes Federation Diabetes and Ramadan (IDF DAR) 2021 risk calculator into different risk categories, and to assess their intentions to fast and outcomes of fast during the holy month of Ramadan. RESEARCH DESIGN AND METHODS: This was a 3-month prospective study which was carried out from 9th February to 6th of May 2023 (6 weeks before Ramadan till 6 weeks after Ramadan) at a tertiary care hospital in Pakistan. Data regarding glycemic control, characteristics and complications of diabetes, comorbidities, and the various factors which influence fasting was gathered from patients of either gender aged 18 to 80 years with any type of diabetes. The IDF DAR 2021 risk calculation and recommendation were made accordingly for each patient. RESULTS: This study comprised of 460 participants with DM, with 174 (37.8%) males and 286 (62.2%) females. The risk categorization showed that 209 (45.4%), 107 (23.3%) and 144 (31.3%) of the participants were in low, moderate, and high-risk categories respectively. Out of the 144 high risk patients who fasted, 57.9% participants experienced hypoglycemia (p<0.0001). The recommendation of fasting showed statistically significant differences with risk categories, intention to fast, hypoglycemia, type of DM, duration of DM, level of glycemic control and days of fasting (p < 0.001). CONCLUSION: A statistically significant number of participants in the high-risk group who fasted experienced complications. This reiterates the importance of rigorous adherence to the medical recommendations.

High Prevalence of Antibiotic Resistance Bacteria Isolated From Bahir Dar City Municipal Solid Waste Dumpsite, North West Ethiopia.

The emergence and spread of antibiotic resistance (ABR) have been a public health challenge globally. The burden is even higher in low-income countries where there is a lack of appropriate healthcare systems, and inappropriate antibiotic disposal practices and utilization. Due to poor solid waste disposal practices in developing nations, municipal solid waste dumpsite (MSWDS) can be a reservoir for ABR bacteria. However, only a few studies demonstrated the prevalence of ABR in non-clinical environments such as MSWDS. This study assessed the prevalence of ABR bacteria at Bahir Dar City MSWDS, to understand the public health risks related to poor solid waste disposal systems. Nine soil samples were collected from the dumpsite. Bacteria were isolated, identified and tested for ABR. Seventy-one distinct colonies were isolated from all samples and identified into 10 bacterial genera based on morphological features and biochemical tests. For ABR tests, gentamicin (GN, 10 µg), streptomycin (ST, 30 µg), tetracycline (TE, 30 µg), ciprofloxacin (CIP, 5 µg), nalidixic acid (NAA, 30 µg), sulfonamide (SA, 250 µg), chloramphenicol (C, 30 µg), erythromycin (E, 15 µg), vancomycin (V, 30 µg), and amoxicillin (AMX, 25 µg) were used. The most frequently isolated bacteria were Staphylococcus (23%) followed by Escherichia species (17%). Ten isolates related to Bacillus spp. were excluded from the antibiotic sensitivity test as there is no standard regarding this genus in the Clinical and Laboratory Standards Institute. The overall antibiotic résistance rate was 95.08%, and most isolates were found to be resistant to amoxicillin (100%), nalidixic acid (75.5%), and vancomycin (75%). Substantial proportions of the isolates were also resistant to tetracycline (55.35%), streptomycin (54.5%), and sulfonamide (50%). The overall multidrug resistance (MDR) rate was 36.06%. This high level of ABR calls for urgent intervention in waste management systems and regular surveillance programs.

Synthesis and evaluation of antibody-drug conjugates with high drug-to-antibody ratio using dimaleimide-DM1 as a linker- payload.

The notable characteristics of recently emerged Antibody-Drug Conjugates (ADCs) encompass the targeting of Human Epidermal growth factor Receptor 2 (HER2) through monoclonal antibodies (mAbs) and a high ratio of drug to antibody (DAR). The achievements of Kadcyla® (T-DM1) and Enhertu® (T-Dxd) have demonstrated that HER2-targeting antibodies, such as trastuzumab, have shown to be competitive in terms of efficacy and price for development. Furthermore, with the arrival of T-Dxd and Trodelvy®, high-DAR (7-8) ADCs, which differ from the moderate DAR (3-4) ADCs that were formerly regarded as conventional, are being acknowledged for their worth. Following this trend of drug development, we endeavored to develop a high-DAR ADC using a straightforward approach involving the utilization of DM1, a highly potent substance, in combination with the widely recognized trastuzumab. To achieve a high DAR, DM1 was conjugated to reduced cysteine through the simple design and synthesis of various dimaleimide linkers with differing lengths. Using LC and MS analysis, we have demonstrated that our synthesis methodology is uncomplicated and efficacious, yielding trastuzumab-based ADCs that exhibit a remarkable degree of uniformity. These ADCs have been experimentally substantiated to exert an inhibitory effect on cancer cells in vitro, thus affirming their value as noteworthy additions to the realm of ADCs.

Structural equation modeling approach for the analysis of ergonomics risk factors and occupational injuries among building construction workers in Bahir Dar City-Ethiopia.

Ergonomic risk factors are a prominent cause of fatality and severe injuries in building constructions. Hence, this study applies a Structural Equation Modeling (SEM) approach to analyze ergonomics risk factors and occupational injuries among building construction workers in Bahir Dar City, Ethiopia. The results indicate significant relationships between ergonomics risk factors and the prevalence of occupational injuries. This study's findings contribute to the understanding of occupational health and safety in the construction industry, highlighting the need for targeted interventions. A cross-sectional study has been carried out, where data was collected through direct observations and standardized pretested questionnaires. The study recruited 220 participants in the construction industry. The data was analyzed using AMOS to study the direct and indirect effects of the identified variable. SEM has shown that the magnitude of the prevalence of occupational injury was 65.2 %. The results also revealed that the mostly affected body parts were lower arm, lower leg, hand, toe, and knee. Carpenter & roofers, plasterer and daily labors & other helpers were highly injury subjected occupations in respective order. The six leading significant risk factors were, do not tie belt at scaffold, falling stairways & ladders, exposure hazardous substances, tools & machinery, electricity (electric power accidents), repetitive tasks, the layout didn't consider health & safety aspects in the site, and do not provide safety orientation for new workers engaging the job. Employees are mostly affected on their lower body parts which needs more focus to prevent it, especially carpenter & roofers, plasterer and daily labors. Also the findings show that 50 % of respondents agree that the higher priority for safety and health management practices should be given to finishing part of the construction followed by excavation and earth work, masonry, and electrical installations. Therefore, it is recommended that the contractors must focus more on the finishing phase.

The Evolution of Antibody-Drug Conjugates: Toward Accurate DAR and Multi-specificity.

Antibody-drug conjugates (ADCs) consist of antibodies, linkers and payloads. They offer targeted delivery of potent cytotoxic drugs to tumor cells, minimizing off-target effects. However, the therapeutic efficacy of ADCs is compromised by heterogeneity in the drug-to-antibody ratio (DAR), which impacts both cytotoxicity and pharmacokinetics (PK). Additionally, the emergence of drug resistance poses significant challenges to the clinical advancement of ADCs. To overcome these limitations, a variety of strategies have been developed, including the design of multi-specific drugs with accurate DAR. This review critically summarizes the current challenges faced by ADCs, categorizing key issues and evaluating various innovative solutions. We provide an in-depth analysis of the latest methodologies for achieving homogeneous DAR and explore design strategies for multi-specific drugs aimed at combating drug resistance. Our discussion offers a current perspective on the advancements made in refining ADC technologies, with an emphasis on enhancing therapeutic outcomes.

Risk factors associated with severe perineal tear at Public Hospitals in Bahir Dar town, Northwest Ethiopia.

Background: Birth-related perineal trauma is a public health issue that can lead to significant maternal morbidity in low-income countries like Ethiopia. Research on the proportion and underlying factors of birth-related severe perineal tears is rare, both in the study area and throughout Ethiopia. As a result, this study was intended to determine the proportion of birth-related severe perineal tears and associated factors at hospitals in Bahir Dar town, Ethiopia. Methods: A cross-sectional study was undertaken at government hospitals in Bahir Dar, Ethiopia. Five hundred fifteen study subjects were selected using a systematic sampling technique. The data was collected through chart reviews and interviews. Data was entered and analyzed using SPSS Version 23. A binary logistic regression was employed to identify factors, and an adjusted odds ratio and a 95% CI were used to estimate the strength of relationships. Statistical significance was declared at p-value < 0.05. Result: The prevalence of severe perineal tears was 7.4%. Previous history of a perineal tear (AOR = 3.06, 95% CI = 1.24-7.59), being nullipara (AOR = 4.03, 95% CI = 1.42-11.44), occipito-posterior position (AOR = 5.49, 95% CI = 2.27-13.28), duration of second stage of labor > 2 h (AOR = 5.42, 95% CI = 2.26-12.99), birth attendant's work experience <1 year (AOR = 5.98, 95% CI = 2.16-16.57) were found to be associated with birth-related severe perineal tear. Conclusion: The proportion of birth-related severe perineal tears was high at governmental hospitals in Bahir Dar town. Previous history of perineal tear, work experience of birth attendants, duration of the second stage of labor, being nullipara, and occipito-posterior position were the major determinants of severe perineal tear. This study suggests that strategies and regulations should be developed to shorten the second stage of labor.

A novel bispecific antibody drug conjugate targeting HER2 and HER3 with potent therapeutic efficacy against breast cancer.

Antibody drug conjugate (ADC) therapy has become one of the most promising approaches in cancer immunotherapy. Bispecific targeting could enhance the efficacy and safety of ADC by improving its specificity, affinity and internalization. In this study we constructed a HER2/HER3-targeting bispecific ADC (BsADC) and characterized its physiochemical properties, target specificity and internalization in vitro, and assessed its anti-tumor activities in breast cancer cell lines and in animal models. The HER2/HER3-targeting BsADC had a drug to antibody ratio (DAR) of 2.89, displayed a high selectivity against the target JIMT-1 breast cancer cells in vitro, as well as a slightly higher level of internalization than HER2- or HER3-monospecific ADCs. More importantly, the bispecific ADC potently inhibited the viability of MCF7, JIMT-1, BT474, BxPC-3 and SKOV-3 cancer cells in vitro. In JIMT-1 breast cancer xenograft mice, a single injection of bispecific ADC (3 mg/kg, i.v.) significantly inhibited the tumor growth with an efficacy comparable to that caused by combined injection of HER2 and HER3-monospecific ADCs (3 mg/kg for each). Our study demonstrates that the bispecific ADC concept can be applied to development of more potent new cancer therapeutics than the monospecific ADCs.

Availability of Dispensing and Storage Facilities at Public and Community Pharmacies at Bahir Dar and Gondar Towns.

Background: The availability of various facilities that aid in providing expected services is necessary for the practice of pharmacy, which aims to make the best use of medications and other healthcare products and services. Therefore, the aim of this study was to assess the availability of dispensing and storage facilities at public and community pharmacies in Bahir Dar and Gondar towns. Methods: In Gondar and Bahir Dar towns' public and private pharmacies, a facility-based cross-sectional study was conducted from July 2023 to September 2023. All pharmacy areas that were open during data collection were included in the study. The frequency and percentage were calculated using descriptive statistics. Results: From 239 pharmacies, 208 (87.0%) of them were open during data collection, and they are included in the study. The water supply and dispensing counter were available in the dispensing area in 79.3% and 60.1% of instances, respectively. They also had adequate room for storage (92.8%), dispensing (92.8%), and receiving (95.7%) of medicines. Additionally, about 98.1% of the facilities had shaded, ventilated, and dry areas. A therapeutic order was the most often used method (59.6%) for medication organization. Merely 1.9% of participants did not employ a strategy to arrange their medications. A refrigerator (88.0%), a refrigerator thermometer (91.3%), a spoon or spatula (81.3%), a separate storage facility (74.5%), a cold room (68.8%), a lockable cabinet (90.9%), a tablet counter (69.2%), and a fire extinguisher (safety device) (88%) were among the various storage equipment the majority of the pharmacies in the survey had. Nonetheless, air conditioning was absent from the majority (53.4%) of pharmacy facilities. Conclusion: Few pharmacies need to make improvements to their facilities in order to encourage convenient drug storage and dispensing practices, even though the majority of the pharmacies surveyed had all the necessary equipment and infrastructure. In addition to initiating the pharmacies to provide good practices of dispensing and storage, facility-focused initiation and regulation should be obtained to ensure full availability of the facilities.

Molecular detection and antibiogram of Shiga toxin-producing Escherichia coli (STEC) from raw milk in and around Bahir Dar town dairy farms, Ethiopia.

Illnesses associated with consuming infected milk and milk products are a widespread problem in low and middle-income countries. Shiga toxin-producing Escherichia coli (STEC) is a bacterium commonly found in raw milk and causes foodborne diseases ranging from mild diarrhea to severe hemorrhagic colitis and hemolytic uremic syndrome. This study aimed to investigate the virulence gene and antimicrobial resistance profiles of Shiga toxin-producing E. coli strains isolated from raw milk in dairy farms in and around Bahir Dar town. Raw milk samples (n = 128) collected from December 2021 to July 2022 were cultured, and E. coli strains were isolated using standard methods. Shiga toxin-producing E. coli strains were identified genotypically by the presence of the virulence markers using a single-plex polymerase chain reaction. The antibiotic susceptibility testing of Shiga toxin-producing E. coli isolates was done by the agar disk diffusion method. In total, 32 E. coli isolates were recovered from milk samples from lactating animals. PCR screening of these isolates resulted in 19 (59.3%) positives for Shiga toxin-producing E. coli. The stx2 gene was detected in 53% of cases, followed by stx1 (31%) and eae (16%. The STEC isolates were highly sensitive to ciprofloxacin (94.7%) and kanamycin (89.5%), while exhibiting significant resistance to amoxicillin (89.5%) and streptomycin (73.7%). The present study points out the occurrence of virulent and antibiotic-resistant Shiga toxin-producing E. coli strains in raw milk that could pose a potential risk to public health. Further analysis by whole genome sequencing is necessary for an in-depth assessment and understanding of their virulence and resistance factors. Moreover, large-scale studies are needed to identify the prevalence and potential risk factors and to prevent the spread of antibiotic-resistant STEC strains in the milk production chain.

Double burden of malnutrition and associated factors among mother-child pairs at household level in Bahir Dar City, Northwest Ethiopia: community based cross-sectional study design.

Introduction: The double burden of malnutrition refers to the simultaneous presence of under nutrition and overweight, obesity, or diet-related non-communicable diseases which might occur at the population, household, and individual level. The simultaneous presence of overweight/obese mothers with undernourished children in the same household, as well as overweight children with underweight mothers, holds particular significance. This phenomenon primarily impacts low-income and middle-income countries. The prevalence of double-burden malnutrition at the household level has increased significantly in sub-Saharan African countries. However, there is limited knowledge regarding the extent and factors associated with the double burden of malnutrition among mother-child pairs in Ethiopia. Consequently, the objective of this study was to assess the prevalence and determinants of the double burden of malnutrition among mother-child pairs at the household level in Bahir Dar City, Ethiopia. Method: In the year 2021, a community-based cross-sectional study design was employed among 702 mother-child pairs in Bahir Dar City from February 28 to March 23. A multistage sampling technique was used to identify study participants who were interviewed using an interviewer-administered questionnaire. The nutritional status of children was evaluated using WHO Anthro Software. To determine the strength of the association, multivariable logistic regression analysis was performed, and adjusted odds ratios with their respective 95% confidence intervals were computed. Results: The prevalence of the double burden of malnutrition among mother-child pairs was 14.5% (95% CI: 12.8, 15.7%}. Participants who were in the richest wealth index were 2.72 {AOR = 2.72, 95% CI 2.01, 5.63} times more odds of double burden of malnutrition than the poorest. The odds of the double burden of malnutrition among children who had high dietary diversity decreased by 63% {AOR = 0.37, 95% CI 0.22, 0.61} than low dietary diversity. Food secure households were 1.96 {AOR = 1.96, 95% CI 1.13, 3.39} times more likely to have the double burden of malnutrition than food insecure households. The odds of the double burden of malnutrition among mothers who completed college and above decreased by 74% {AOR = 0.26 95% CI 0.121, 0.549} than those unable to read and write. Conclusions and recommendation: The magnitude of the double burden of malnutrition was lower than the Ethiopian Demographic and Health Survey. Wealth index, dietary diversity, food security, and educational status were significantly associated with the double burden of malnutrition. Therefore, it is recommended to implement public health interventions that target the identified associated factors in order to reduce the burden of double malnutrition.

Tetracycline and sulphonamide residues in farmed fish in Dar es Salaam, Tanzania and human health risk implications.

In Africa, antibiotic residue investigations in animal food have primarily been focused on meat, neglecting farmed fish. This cross-sectional study conducted in Dar es Salaam, Tanzania, aimed to assess sulphonamide and tetracycline residues in farmed fish, comparing levels with Codex Alimentarius Commission's acceptable daily intake (ADI) and maximum residue limits (MRLs). A total of 84 farmed fish were sampled and analysed in the presence of tetracycline and sulphonamide residues. All samples were positive for sulphonamide residues (100%; n = 84), and 2.4% (n = 2) were positive for tetracycline and consequently also positive for both compounds. Tetracycline levels were below ADI and MRL, 28.5% (n = 24) surpassed the ADI, and 6% (n = 5) of the samples exceeded the MRL for sulphonamide. Regular monitoring of antibiotic residues in aquaculture products is crucial to mitigate health risks and expanding assessments to include other commonly used compounds is warranted.

Application of geospatial techniques and binary logistic regression model for analyzing driving factors of urban growth in Bahir Dar city, Ethiopia.

Understanding the drivers of urban growth and spatiotemporal land use change is important for rational land use and sustainable urban development. Based on the land use data, GIS data of explanatory variables, experts' knowledge and field observation, the study used a binary logistic regression model (BLRM) to analyze factors that drive rapid urban growth in Bahir Dar city, Ethiopia, using the LOGISTICREG module in IDRISI Selva software. Nine factors were used to reflect the influence of proximity and physical factors on urban growth from 1984 to 2019. This model helped in quantifying and identifying the factors of urban growth, which includes topography (slope, elevation and aspect) and accessibility (Dis. to the main road, Dis. to international airport, Dis. to CBD, Dis. to existing built-up area, Dis. to forest land and Dis. to water body). Furthermore, urban growth probability maps were created based on LRM results, revealing that the biggest urban growth would occur around existing built-up areas along the main roads and near Bahir Dar international airport. The Relative Operating Characteristic (ROC) values of 0.85, 0.90 and 0.93 and PCP values of 96.72 %, 98.46 % and 98.51 % indicate the urban growth probability maps are valid and BLRM had an ideal ability to predict urban growth. So, the study highlighted the relation between urban growth and its drivers in Bahir Dar, giving a decision making framework for better land use management and resource allocation.

A Retrospective Cohort Study to Evaluate the Outcomes of HIV-Associated High-Grade B-Cell Non-Hodgkin Lymphoma (NHL) Treated with Dose Adjusted EPOCH (+/-R) Regimen.

High-grade B-cell NHL's are more common in seropositive patients. They are biologically different from their seronegative counterparts. We report our analysis on our cohort of patients who were treated with DA-EPOCH(+/-R). We retrospectively analyzed treatment-naïve HIV-associated High-grade B-cell NHL patients (aged ≥ 18) treated with DA-EPOCH(+/-R) regimen from 2011 to 2015. Descriptive statistics were summarized with median and range; survival outcomes were analyzed with Kaplan-Meier method. The cohort comprised of 40 patients [DLBCL(19), Burkitt's Lymphoma(16), High-grade B-Cell Lymphoma-Unclassifiable(09), and Plasmablastic Lymphoma(01)] and the median CD4 + T cell count was 202/mm3. CNS prophylaxis was administered with intrathecal methotrexate to 90% of patients. With a median follow-up of 72 months, an estimated 5-year OS was 82.5%, and 5-PFS was 77.5%. There were 9 deaths, and 9 patients had progression. At least 4 cycles of chemotherapy were administered to 35 (93%) patients, with 28 (70%) receiving 6 cycles. Grade 3-4 toxicities were seen in 33 (83%) patients- febrile neutropenia (65%) being the most common followed by mucositis (25%) and peripheral neuropathy (13%). There was no difference in survival based on IPI, CD 4 + T cell count, CDI, or duration of HIV. DA-EPOCH(+/-R) is a highly effective regimen in seropositive high-grade B-cell lymphoma, even in the presence of adverse features. Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-023-01652-3.

Post-abortion contraceptive utilization and associated factors among women who attended abortion services: A health facility cross-sectional study.

Background: Post-abortion contraceptive utilization prevents unintended pregnancies, reduces the number of abortions, and lowers the morbidity and mortality related to obstetric complications. It plays a central role in improving maternal health and reducing child mortality. However, many women are suffering from unintended pregnancy and its complications after abortion care. Hence, the main objective of this study was to determine the magnitude of post-abortion contraceptive utilization and its associated factors in Bahir Dar City. Methods: Health-facility-based cross-sectional study was conducted in Bahir Dar city health facilities from April 1 to May 30, 2018. A systematic random sampling technique was used to select 354 eligible study participants. A pre-tested semi-structured questionnaire was used to collect the data. Data entry was done using Epi Data version 3.7 software and analyzed by SPSS v23 software. Descriptive statistics were done based on the nature of the data. A simple logistic regression model was used to identify the association and strength of exploratory variables and the outcome variables. Associations were announced at a 95% confidence interval and p-value <0.05 with adjusted odds ratio. Model fitness was checked by the Hosmer-Lemeshow goodness of fit test for logistic regression. Results: In this study, 348 aborted participants were involved with a mean age of 24.37 (±5.73) years. About 40% of the participants were not currently married and 12.9% were unable to read and write. The magnitude of post-abortion contraceptive utilization was 65.8%. The number of alive children (adjusted odds ratio: 7.0, 95% confidence interval: 1.54, 31.95), lower income (adjusted odds ratio: 0.14, 95% confidence interval: 0.03, 0.60), and (adjusted odds ratio: 0.11, 95% confidence interval: 0.02, 0.46), primary school education (adjusted odds ratio: 0.18, 95% confidence interval: 0.03, 0.97), and currently unemployed (adjusted odds ratio: 0.23, 95% confidence interval: 0.06, 0.85) were significantly associated with the post-abortion contraceptive utilization. Conclusion: The level of post-abortion contraceptive utilization is low as per the national plan. The number of alive children, lower income, lower education, and currently unemployed were the identified factors affecting post-abortion contraceptive utilization. Therefore, a collaborative effort is needed among stakeholders to increase the utilization and avoid factors that prevent the utilization of post-abortion contraceptive utilization.

Validity of the International Diabetes Federation risk stratification score of Ramadan fasting in individuals with diabetes mellitus.

OBJECTIVES: To assess the validity of the new International Diabetes Federation-Diabetes and Ramadan International Alliance (IDF-DAR) risk stratification tool for Ramadan fasting in predicting diabetic patients' ability to fast safely. METHODS: A prospective observational study was carried out during Ramadan 2022 at the Diabetes Center, King Fahad Hospital, Al-Madinah Al-Munawarah, Saudi Arabia. The IDF-DAR risk stratification tool was used to calculate fasting risk for diabetic patients pre-Ramadan. The patients were allocated into 3 categories: high, moderate, and low risk. Fasting was left up to the patients and their healthcare providers. Participants filled out a log-sheet each day of Ramadan showing whether they completed the fast. A final interview was carried out after Ramadan to assess patients' fasting experiences. RESULTS: We included 466 patients with diabetes: 79.4% with T2DM and 20.6% with T1DM. Based on the IDF-DAR score, 265 (56.9%) patients were classified as high risk, 115 (24.7%) as moderate risk, and 86 (18.4%) as low risk. Non-fasting the whole month of Ramadan was statistically relevant to the IDF-DAR risk stratification score. High-risk individuals were more likely to experience hypoglycemia and hyperglycemia than those with a moderate or low risk. But overall, 70.4% of people at moderate risk and 53.2% of the ones at high risk observed Ramadan's complete fast. CONCLUSION: The IDF-DAR has proven to be reliable and valid for predicting the risk of adverse events associated with fasting in diabetic patients. Nonetheless, it might overestimate the risk of fasting for some patients.

Spatial and temporal variations of microclimate and outdoor thermal comfort in informal settlements of warm humid Dar es Salaam, Tanzania.

In developing countries, urbanization is dominated by the growth of informal settlements which represents 40-80% of major cities. The challenges brought up by the growth of informal settlements spans from social-economic to environmental. Previously, upgrading of the informal settlements focused on social-economic aspects such as provision of necessary services for the residents, whereas the quality of the outdoor thermal environment has not received much attention. This paper entails to investigate the potential of upgrading the outdoor thermal environment in informal settlements in the warm humid city of Dar es Salaam, Tanzania through examining the influence of addition of trees with different Leaf Area Index (LAI) and incremental increase of buildings heights. The study uses simulation as a method for analysis of the warm season and calculates the Physiological Equivalent Temperature (PET) as a thermal index. Results show substantial improvement of both microclimate and outdoor thermal comfort. Incremental increase of buildings heights in a street canyon to 12, 18, and 24 m leads to the reduction of PET by 2.5, 2.8, and 3.8 °C respectively at 2:00 p.m. Similarly, applying LAI's of 2, 4, and 6 m2/m2 leads to reduction of the mean radiant temperature by 7.9, 10.1, and 12.2 °C; while PET was reduced by 3.9, 4.7, and 5.6 °C respectively at 2:00 p.m. Nonetheless, upgrading of informal settlements shows marginal influence on the reduction of air temperature. Despite the noted thermal improvement in the studied area, the thermal comfort limits of the warm season were difficult to reach. The findings suggest that addition of vegetation is the economically most effective way for upgrading thermal conditions in informal urban fabric areas.

Incidence and determinants of perinatal mortality in five urban hospitals in Dar es Salaam, Tanzania: a cohort study with an embedded case-control analysis.

INTRODUCTION: Tanzania has one of the highest burdens of perinatal mortality, with a higher risk among urban versus rural women. To understand the characteristics of perinatal mortality in urban health facilities, study objectives were: I. To assess the incidence of perinatal deaths in public health facilities in Dar es Salaam and classify these into a) pre-facility stillbirths (absence of fetal heart tones on admission to the study health facilities) and b) intra-facility perinatal deaths before discharge; and II. To identify determinants of perinatal deaths by comparing each of the two groups of perinatal deaths with healthy newborns. METHODS: This was a retrospective cohort study among women who gave birth in five urban, public health facilities in Dar es Salaam. I. Incidence of perinatal death in the year 2020 was calculated based on routinely collected health facility records and the Perinatal Problem Identification Database. II. An embedded case-control study was conducted within a sub-population of singletons with birthweight ≥ 2000 g (excluding newborns with congenital malformations); pre-facility stillbirths and intra-facility perinatal deaths were compared with 'healthy newborns' (Apgar score ≥ 8 at one and ≥ 9 at five minutes and discharged home alive). Descriptive and logistic regression analyses were performed to explore the determinants of deaths. RESULTS: A total of 37,787 births were recorded in 2020. The pre-discharge perinatal death rate was 38.3 per 1,000 total births: a stillbirth rate of 27.7 per 1,000 total births and an intra-facility neonatal death rate of 10.9 per 1,000 live births. Pre-facility stillbirths accounted for 88.4% of the stillbirths. The case-control study included 2,224 women (452 pre-facility stillbirths; 287 intra-facility perinatal deaths and 1,485 controls), 99% of whom attended antenatal clinic (75% with more than three visits). Pre-facility stillbirths were associated with low birth weight (cOR 4.40; (95% CI: 3.13-6.18) and with maternal hypertension (cOR 4.72; 95% CI: 3.30-6.76). Intra-facility perinatal deaths were associated with breech presentation (aOR 40.3; 95% CI: 8.75-185.61), complications in the second stage (aOR 20.04; 95% CI: 12.02-33.41), low birth weight (aOR 5.57; 95% CI: 2.62-11.84), cervical dilation crossing the partograph's action line (aOR 4.16; 95% CI:2.29-7.56), and hypertension during intrapartum care (aOR 2.9; 95% CI 1.03-8.14), among other factors.  CONCLUSION: The perinatal death rate in the five urban hospitals was linked to gaps in the quality of antenatal and intrapartum care, in the study health facilities and in lower-level referral clinics. Urgent action is required to implement context-specific interventions and conduct implementation research to strengthen the urban referral system across the entire continuum of care from pregnancy onset to postpartum. The role of hypertensive disorders in pregnancy as a crucial determinant of perinatal deaths emphasizes the complexities of maternal-perinatal health within urban settings.

The anthropometric determinants of peak expiratory flow rate among children in Dar Es Salaam, Tanzania.

BACKGROUND: Peak expiratory flow rate (PEFR) is an important tool for assessing lung function, which can be affected by environmental and physical factors such as altitude, nutrition, genetics, age, height, and weight. Conducting a study to assess the correlation between peak expiratory flow rate and anthropometric measurements in Tanzanian schoolchildren is crucial to derive a population-specific prediction formula and further simplify respiratory health assessment. METHODS: This cross-sectional study was conducted in a single center private primary and secondary school in Dar es Salaam, Tanzania using data from an asthma screening camp. Variables of interest were height, weight, Body Mass Index (BMI) and PEFR. Independent t-test was performed to identify any differences in mean flow rate values between different ethnicities and genders. Correlation coefficients (r) were used to observe the relationship between PEFR and anthropometric measurements. A prediction equation by gender was generated using linear regression analysis. Statistical significance was set at the 5% level. All statistical data was analyzed using SPSS version 25.0. RESULTS: The study involved 260 participants with a mean age of 9.5 years. Males were 51.2% and 65% of participants were of Asian ethnicity. PEFR was not observed to differ across the different ethnic groups and genders. Height was found to have the strongest correlation coefficient of 0.745, while BMI had the weakest correlation coefficient of 0.366. The strongest correlation was found with height for females (r = 0.787), while the weakest was with body mass index for boys (r = 0.203). The derived prediction equation for males was PEFR = 279.169 (Height of Student in meters) -134.12, while the predictive equation for females was PEFR = 318.32 (Height of Student in meters) -195.69. CONCLUSION: This study found a strong correlation between PEFR and anthropometric characteristics in school children from Dar es Salaam, Tanzania. A prediction equation by gender for PEFR was developed based on anthropometric characteristics. This equation may be applied in population-based studies or situations where peak flow meters are not readily available. Further research is needed to explore how well this prediction formula performs in other Tanzanian settings and to determine other factors that may affect lung function in this population.

An overview of site-specific methods for achieving antibody drug conjugates with homogenous drug to antibody ratio.

INTRODUCTION: Antibody drug conjugates (ADCs) have emerged as a potent tool in cancer treatment, where cytotoxic drugs are linked to antibodies targeting specific antigens. While conventional ADC synthesis methods have seen success as commercials therapeutics, there is a growing interest in next-generation ADCs, looking at homogeneity of the drug-to-antibody ratio. AREAS COVERED: The article provides a high-level overview for achieving said homogeneity by site-directed conjugations via encompassing engineered amino acids, enzyme-mediated strategies, peptide sequences, affinity peptides, and beyond. As the field rapidly evolves with multiple ADCs in clinical trials and the advent of biosimilars, the article explores the benefits and challenges in both conventional and non-platform ADC technologies. EXPERT OPINION: The choice of site selection approach must be based on multiple criteria as discussed in this report. Two ADCs made from conjugation to engineered cysteines have been approved by regulatory agencies which have contributed to the excitement in this space. For the others, though successful as proof-of-concept, the true test of merit will be determined as these technologies advance into the clinic. The promise of improving the therapeutics index and decreasing toxicities will continue to drive progress in this area.

A joint evaluation method of dynamic spectrum extraction methods for non-invasive blood component measurement based on stability coefficient, data point adoption rate, and smoothness of the spectrum.

BACKGROUND AND OBJECTIVE: Dynamic spectrum (DS) theory is a new non-invasive detection method of human blood components that can theoretically eliminate individual differences in static tissues and the influence of other measurement conditions to achieve blood component analysis with high precision. In order to obtain a high signal-to-noise ratio dynamic spectrum, researchers have proposed various dynamic spectrum extraction methods. METHODS: In this article, we propose three indexes: stability coefficient (SC), data point adoption rate (DAR), and smoothness of spectrum (SS). These solve the difficulty in evaluating different dynamic spectrum extraction methods without establishing mathematical models. RESULTS: In this study, DS is extracted using different dynamic spectrum extraction methods from the experimental data of 677 volunteers. Then three indexes, SC, DAR, and SS, are calculated. The trends in the scatter plot of the relationship between the three indexes and modeling results of hemoglobin, red blood cell count, and white blood cell count and the related coefficients demonstrate that SC, DAR, and SS are feasible and effective for evaluation. The results show that the root mean square extraction performs best, while the peak-to-peak value and the fast Fourier transform extraction are the worst. CONCLUSIONS: This study proposes feasible and effective indexes for evaluating dynamic spectrum extraction methods, providing a possibility for further research on high-precision dynamic spectrum extraction methods.