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Self-reported illnesses in Thatta: Evidence from a rural and underdeveloped district in Sindh province, Pakistan
Introduction Self-reported illnesses (SRI) surveys are widely used as a low-cost substitute for weak Disease Surveillance Systems in low- and low-middle-income countries. In this paper, we report findings of a district-level disease prevalence survey of all types of illnesses including chronic, infectious, injuries and accidents, and maternal and child health in a rural district in Pakistan. Methods A district-level survey was conducted in Thatta in 2019 with a population-representative sample of all ages (n = 7811) a. Survey included questions on demographics and SRIs from the respondents. Prevalence was estimated for all SRIs categorized into six major and 16 minor illnesses. The influence of important socio-demographic covariates on the illnesses and multiple comorbidities was explored by estimating prevalence ratios with a Generalized Linear Model of the Poisson family and by Zero-Inflated Poison Distribution respectively. Findings 36.57% of the respondents to the survey reported at least one SRI. Prevalence of communicable illnesses was 20.7%, followed by non-communicable illnesses (4.8%), Gastrointestinal disorders (4.4%), and injuries/disabilities (1.9%). Urban inhabitants were more likely to have Chronic Obstructive Pulmonary Disorders (3.34%) and Diabetes (1.62%). Females were most likely to have injuries (1.20,), disabilities (1.59), and Musculoskeletal Disorders (1.25). Children aged < 1 year (0.80) and elderly >65 years (0.78) were more likely to have comorbidities. Discussion Our estimated prevalence of SRI is quite higher than the prevalence of unknown SRIs in national-level surveys in Pakistan. This research’s findings serve as an example of aiding evidence-based priority settings within the health sector. Our findings on gender, and young and old age as positive predictors of SRI are consistent with similar surveys in a few LMICs. Recommendation and conclusion We provide evidence of a complete disease profile of a district that is otherwise unavailable in the country. This study can reshape the existing health surveys and to aid evidence-based priority settings in the health sector. We, however, support strengthening the Disease Surveillance System as a reliable source of disease prevalence data.
Cryo-EM structure of the calcium-sensing receptor complexed with the kokumi substance γ-glutamyl-valyl-glycine
Abstract Taste is a key element for food palatability and is strongly influenced by the five basic tastes and other taste sensations, such as fatty orosensation, and koku perception, which indicates taste complexity, mouthfulness and lastingness. This study focuses on the taste modifier γ-glutamyl-valyl-glycine (γ-EVG), a potent kokumi substance that enhances taste and koku perception by modulating the calcium-sensing receptor (CaSR). We used cryo-electron microscopy to determine the structure of the CaSR/γ-EVG complex at a resolution of 3.55 Å. Structural analysis revealed important interactions between γ-EVG and the CaSR, involving key residues, such as Pro39, Phe42, Arg66, Ser147, and Glu297. Mutagenesis experiments demonstrated the importance of these residues in peptide binding. Each γ-EVG residue contributed to its binding to the orthosteric ligand binding site of the CaSR. These findings elucidate the molecular basis of kokumi peptide recognition by the CaSR and contribute to a better understanding of positive allosteric modulators of the CaSR. In addition, this research provides valuable insights into the functionality of class C G-protein-coupled receptors in taste perception, potentially informing the development of new taste modifiers and advancing the field of food science.
Folic acid supplementation during preconception period in sub-Saharan African countries: A systematic review and meta-analysis
Introduction Neural tube defects (NTDs) are serious congenital anomalies of the central nervous system caused by disruptions in early embryonic development. The prevalence is about twice as common in low- and middle-income countries and more prevalent in sub-Saharan Africa. Folic acid deficiency is a major risk factor and common during pregnancy. However, limited research on preconception folic acid supplementation in this region highlights the need for systematic reviews and targeted interventions to improve maternal and fetal health. Methods We conducted a systematic literature search in EMBASE, MEDLINE, Scopus, CINAHL, Google Scholar, and Google for studies on the proportion of folic acid supplementation during the preconception period, covering publications up to January 2024. Study quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity was evaluated with Cochrane Q and I2 statistics, and small study effects were tested with Egger’s test at a 5% significance level. The certainty of evidence was assessed using the GRADE approach. A random-effects model was used to estimate the pooled proportion of FA supplementation during the preconception period in sub-Saharan African countries. Result This systematic review included 28 studies with a total of 12,562 participants. The highest (45.2%) and lowest (1.9%) proportion of folic acid supplementation during preconception period were recorded in the southern and Amhara regions of Ethiopia, respectively. The estimated pooled proportion of folic acid supplementation among women in Sub-Saharan Africa (SSA) during preconception period was (14.10%; 95% CI: 11.22–16.98) with significant heterogeneity between studies (I2 = 97.71%, p = 0.001). In sub-group analysis based on corresponding countries the highest estimated folic acid supplementation proportion during preconception period was found in studies conducted in Kenya ((22%; 95% CI: 19%-25%), I2 = 97.7%), followed by studies conducted in Ghana (20%; 95% CI: 7%-33%), I2 = 96.9%). The majority of the studies included in the analysis are of high quality, with quality scores ranging from 7 to 8. The certainty of evidence was assessed using the GRADE approach, resulting in a low overall rating. Conclusion The results of this systematic review and meta-analysis indicated that folic acid supplementation during preconception period is significantly low among mothers in sub-Saharan African countries, despite being one of the best approaches to improve birth outcomes. Therefore, healthcare organizations, governments, policymakers, and other stakeholders involved in folic acid supplementation must collaborate on developing strategies to improve its uptake during the preconception period.
Posttraumatic stress and growth in pulmonary patients recovered from COVID-19
Associations of heavy metals and urinary sodium excretion with obesity in adults: A cross-sectional study from Korean Health Examination and Nutritional Survey
Backgrounds Sodium and heavy metals are among the key elements to which humans are exposed due to environmental pollution and food consumption. Investigating the association between heavy metals, urinary sodium excretion, and obesity is of significant importance, given potential implications for public health. Therefore, this study aims to explore the relationship between heavy metals, urinary sodium excretion, and overweight and obesity in the Korean population. Methods Data from 6,609 participants in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2012 were analyzed. Associations between heavy metals (cadmium, mercury), urinary arsenic, sodium excretion levels, and overweight/obesity were assessed using polytomous logistic regression models, adjusting for confounders. Results Higher mercury (OR = 1.57, 95% CI = 1.31–1.88) and urinary sodium (OR = 2.21, 95% CI = 1.84–2.66) levels are associated with an increased risk of overweight and obesity. Notably, participants with elevated levels of both mercury and urinary sodium had the highest odds of being overweight and obesity (OR = 3.61, 95% CI = 2.61–5.00). In contrast, other heavy metals, such as serum cadmium and urinary arsenic, were not statistically significantly associated with the risk of overweight and obesity. Conclusions This finding highlights the intricate multiplicative effect between mercury and sodium on obesity, necessitating further research to validate and understand the connections. Heavy metals, particularly mercury, exert an influence on obesity, and the possibility of an enhanced impact on obesity, especially when acting in conjunction with salt, is indicated.
Separation of heavy metals using aqueous two-phase systems based on choline chloride/urea and betaine/urea deep eutectic solvents
Anticoagulants utilization in eight hospitals within the Luzhou region from 2019 to 2023
Background With the increasing utilization of anticoagulants, the selection of appropriate anticoagulants has emerged as a significant quandary. The objective of this study was to evaluate recent trend in the utilization and expenditure of anticoagulants within a specific region, aiming to provide valuable insights into the optimal choice of anticoagulants across other healthcare facilities. Methods The utilization of anticoagulants was retrospectively analyzed. The data on anticoagulant utilizations in tertiary-care hospitals within a district were collected from January 2019 to December 2023. The expenditure, defined daily doses (DDDs), and defined daily cost (DDC) were calculated. The trends in the utilization and expenditure of anticoagulants were examined using linear regression analysis. Results From 2019 to 2023, the DDDs of rivaroxaban demonstrated a significant annual increase in most hospitals (p < 0.05). Only a few hospitals exhibited a gradual rise in the consumption of low molecular weight heparin (LMWH) over the same period (p < 0.05). The trend of heparin sodium and warfarin varied across different hospitals. The implementation of the centralized procurement policy, however, resulted in a decline in the consumption of rivaroxaban and LMWH in 2021 and 2022 respectively. The DDC value of rivaroxaban experienced a substantial decrease over the past five years (p = 0.020), declining from 55.20 Chinese Yuan (CNY) in 2019 to 4.28 CNY in 2023. Conversely, there was a slight increase noted in the DDC of heparin sodium during this time frame (p = 0.042). Conclusion Over the past five years (2019–2023), there has been an increase in the utilization of rivaroxaban and LMWH. However, their expenditure has decreased. In addition, the utilization and expenditure of warfarin and heparin sodium remained relatively stable. The application prospects of rivaroxaban and LMWH are promising.
Systematic study on the evaluation method of surface antibacterial activity based on the fluorescent observation of bacterial growth
Peptidoglycan recognition protein PGRP-5 is involved in immune defence and neuro-behavioral disorders in zebrafish embryos
Peptidoglycan recognition proteins (PGRPs) are the evolutionarily highly conserved class of pattern recognition receptors, however, their functions on the innate immune system and neuro-inflammatory response in aquatic organism are still poorly understood. In this study, we systematically investigated the molecular functions of PGRPs in zebrafish embryos. Firstly, we identified three PGRPs in zebrafish and phylogenetic analysis suggested that DrPGRP-5 was a novel member of the PGRP superfamily in evolution. Secondly, the endogenous mRNA levels of DrPGRP-5 were highly expressed in brain and muscle while significantly down-regulated in liver and egg at 72 hpf in zebrafish embryos. Thirdly, the mRNA levels of DrPGRP-5 were greatly elevated after 6 h of E. coli infection but reached its highest value at 24 h after M. luteus stimulation. Moreover, knock-down DrPGRP-5 could significantly reduce the pro-inflammatory cytokines such as TNF-α, IL-1β and IL-6, but increased the expression of anti-inflammatory cytokine TGF-β. On the other hand, the locomotor behavior abilities and the antioxidant enzyme activities such as CAT and SOD were obviously decreased under the DrPGRP-5 KD conditions. Finally, incubation of zebrafish embryos with anti-inflammatory and neuroprotective agents (10 μM Minocycline) can partially rescue the DrPGRP5-regulated locomotor behavior. Taken together, our data suggested that zebrafish PGRP-5 is involved in the innate immune defenses and regulated the neurobehavior and neuro-inflammation, which may provide new strategies for the treatment of neuro-inflammatory diseases in the aquatic organisms.
First true blood pressure measurement with micropulse detection of arterial opening achieved
Abstract There is a well-accepted need for a new more accurate solution to automatic blood pressure measurement, in spite of clinical convenience continuing to encourage the adoption of oscillometric devices with their known poor accuracy throughout healthcare. Our solution avoids estimates, mathematical modelling, oscillometric algorithms, and inadequate calibration against numerous private clinical data sets. Here we show that our new technique detects, from an arm cuff, micropulses associated with arterial opening between systolic and diastolic pressures; hence detecting systole at the first micropulse and diastole at the last, during cuff deflation. Our technique has equivalent accuracy to the gold standard auscultatory method, and is significantly better than the requirements of the current international standard for blood pressure devices. Our results provide scientific evidence for the effectiveness of our technique, and demonstrate significant clinically important improvements. We anticipate that our technique can be automated easily and economically. We acknowledge that this early study is an initial manual evaluation, but expect this new technique to be an automated universal solution for true blood pressure measurement, and a vital step change in an important clinical measurement in healthcare of the worldwide population.
Practice patterns on the management of secondary hyperparathyroidism in the United States: Results from a modified Delphi panel
Background Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD). Many recommendations in the Kidney Disease Improving Global Outcomes (KDIGO) CKD-mineral and bone disorder guidelines are supported by modest evidence and predate the approval of newer agents. Therefore, an expert panel defined consensus SHPT practice patterns in the United States with real-world context from the nephrology community. Methods Ten US healthcare providers and one patient participated in a modified Delphi method comprising three phases. Consensus was determined via iterative responses to a questionnaire based on the 2009 and 2017 KDIGO guidelines and published literature on the identification, evaluation, monitoring, and interventional strategies for patients with SHPT. The threshold for consensus was 66% agreement. Results Panelists generally agreed with KDIGO recommendations, with some differences. Consensus was reached on 42/105 (40%), 95/105 (90.5%), and 105/105 (100%) questions after phases 1, 2, and 3, respectively. Panelists unanimously agreed that SHPT treatment is often started late. There was a preference for serum phosphate level <4.6 mg/dL, and consensus to maintain serum calcium levels <9.5 mg/dL. There was unanimous agreement for vitamin D analogues as first-line options in patients not on dialysis with severe, progressive SHPT and unanimous preference for intravenous calcimimetic, etelcalcetide, in appropriate in-center dialysis patients. Factors such as formularies, dialysis center protocols, and insurance were recognized to influence therapeutic strategies. Conclusions Expert consensus was reached on SHPT management, further defining therapeutic strategies and medication use and emphasizing need for treatment early. Despite evidence-based treatment preferences supported by clinical experience, factors other than scientific evidence influence decision making, particularly with medications.
Plasma galectin-3 can be considered as a non-invasive marker to predict the prognosis of ACLF patients with new typing
Determining application rates of FYM and pressmud to improve soil health properties in salt degraded soils
Improving food grain production by enhancing plant nutrient availability is critical for meeting future production. In this line, degraded soils may have the potential to meet the food demand of future population. However, the key challenge is excessive concentration of salts. It adversely mediates the soil fertility parameters, physical properties and soil enzymatic activities. Addition of organic substances, such as farm yard manure (FYM) and pressmud (PM), may improve soil health parameters. An incubation experiment was conducted with graded application of FYM (0, 2.5, 5 and 10 t/ha) and PM (0, 2.5, 5 and 10 t/ha) to monitor the nutrient release pattern of FYM and PM; and its effect on soil physico-chemical properties and soil enzymatic activities. The results showed that soil pH and EC were reduced after the one year incubation period. It was also observed that available plant nutrients like N, P, K, S and soil enzymatic activities reported highest in treatment FYM and PM (each applied 10 t/ha) over control. The findings of this study suggested that organic amendments can improve soil fertility, mitigate salt ion toxicity, and enhance food production potential, particularly in arid and semi-arid soils.
Association of oxidative balance scores with cardiovascular and all cause mortality in patients with asthma
Understanding how intermediaries connect adults to community-based physical activity: A qualitative study
Intermediaries facilitate connections to community-based services and supports, including physical activity and exercise groups, and are an emerging method to promote physical activity participation. However, their processes when establishing connections to community-based physical activities are unclear. The aim of this study was to explore the processes, practices, and procedures of Irish intermediaries when connecting people to community-based physical activity. This was a qualitative descriptive design study. Semi-structured interviews were carried out with n = 27 intermediaries from a variety of sectors—Health Promotion and Improvement [HPO], Local Sports Partnerships [LSO] and Social Prescribing [SP]. Four themes were identified using qualitative content analysis; 1) the processes of connecting to an intermediary, 2) connecting individuals to physical activity, 3) exiting from the intermediary service and 4) working in the local context. Intermediaries reported that they received referrals for individuals with physical, mental, and social health needs, but that referrals to improve physical activity specifically were low. They used a person-centred approach throughout their process, often addressing barriers to physical activity. However, only LSO and SP facilitated connections to physical activity, as HPO mainly focused on delivering smoking cessation support and services. Levels of support given and length of follow-up varied between LSO and SP, with the latter providing more intensive support. To facilitate their work, they developed extensive local knowledge and networks of partners, which enabled connections to a variety of community-based physical activities. Intermediaries may be an under-utilized resource to promote physical activity. Understanding the processes used in their interventions can inform future research, which is needed to investigate the effectiveness of intermediaries in improving physical activity levels and to inform future referral pathways.
Safety and efficacy of oral administrated cepharanthine in non-hospitalized, asymptomatic or mild COVID-19 patients: a Double-blind, randomized, placebo-controlled trial
Abstract Cepharanthine (CEP) is a natural remedy that potently inhibits SARS-CoV-2 activity both in vitro and in vivo. To evaluate the efficacy and safety of CEP compared with placebo in adults with asymptomatic or mild coronavirus disease 2019 (COVID-19), we conducted a proof-of-concept, double-blind, randomized, placebo-controlled trial. Patients were randomized to receive 120 mg/day of CEP, 60 mg/day CEP or placebo for 5 days. Main outcome was the time from randomization to negative nasopharyngeal swab and safety. Among 262 randomized participants, 188 completed the trial among group of 120 mg/day CEP ( n = 65), 60 mg/day CEP ( n = 68) and placebo ( n = 55). Neither 120 mg/day or 60 mg/day CEP shortened the time to negative significantly compared with placebo. However, 60 mg/day CEP showed a slight trend (difference=-0.77 days, hazard ratio (HR) = 1.40, 95% CI 0.97–2.01, p = 0.072). In analysis of participants with good medication compliance, 60 mg/day CEP significantly shortened the time to negative (difference=-0.87 days, HR = 1.56, 95% CI 1.03–2.37, p = 0.035). Adverse events were not different among the three groups, and no serious adverse events occurred. In conclusion, treatment of asymptomatic or mild Covid-19 with 120 mg/day or 60 mg/day did not shorten the time to negative significantly. However, 60 mg/day CEP showed a slight trend which needs future confirmatory trials to validate. (NCT05398705).
Young Adults Rehabilitation experiences and Needs following Stroke (YARNS): A scoping review of the rehabilitation care experiences and outcomes of young adults post-stroke
Background Stroke is one of the leading disabling conditions in the United Kingdom. While an increasing focus on the rehabilitation care for stroke survivors has been noted, practice guidelines, targets and services tend to be tailored for the elderly population rather than young adults. Objectives This scoping review aimed to map the existing literature on the rehabilitation care experiences and outcomes of young adults post-stroke aged between 18 and 45 years within acute and social care settings. Methods and analysis A scoping review was conducted to identify existing practice and published academic and evidence-based literature related to the topic. Arksey and O’Malley’s framework guided the review and reporting followed the PRISMA-ScR checklist. Electronic databases and grey literature were searched to capture the potentially recent and relevant literature available in English from year 2000–2022. The databases included CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, AMED, PEDro, Cochrane Library and Web of Science. Grey literature was searched from the following sources: Google Scholar, websites of networks, organisations and charities related to stroke. Hand searches were performed on the reference lists of the included articles and grey literature to find relevant references. Data were extracted on young adults’ experiences of stroke and rehabilitation care and their outcomes and experiences of a particular stroke rehabilitation programme in acute and social care settings. Results Eighty-five articles were included in this review. In most instances, stroke was reported to negatively impact young adults, although positive consequences were also documented. The focus and the outcomes of stroke rehabilitation were predominantly physical especially in the areas of movement, communication and memory. Young adults experienced a lack of age-adapted stroke rehabilitation in acute and social care settings. Conclusion Our results highlight the unmet needs of young adults in their stroke recovery journey. Effective rehabilitation programmes and interventions should be developed to support young adults following stroke and meet their age-specific needs.
Association of glucose to lymphocyte ratio with the risk of death in patients with atherosclerotic cardiovascular disease
On the estimation of inverse-probability-of-censoring weights for the evaluation of survival prediction error
Inverse probability weighting (IPW) is a popular method for making inferences regarding unobserved or unobservable data of a target population based on observed data. This paper considers IPW applied to right-censored time-to-event data. We investigate the behavior of the inverse-probability-of-censoring weighted (IPCW) Brier score, which is frequently used to assess the predictive performance of time-to-event models. A key requirement of the IPCW Brier score is the estimation of the censoring distribution, which is needed to compute the weights. The established paradigm of splitting a dataset into a training and a test set for model fitting and evaluation raises the question which of these datasets to use in order to fit the censoring model. There seems to be considerable disagreement between authors with regards to this issue, and no standard has been established so far. To shed light on this important question, we conducted a comprehensive experimental study exploring various data scenarios and estimation schemes. We found that it is generally of little importance which dataset is used to model the censoring distribution. However, in some circumstances, such as in the case of a covariate-dependent censoring process, a small sample size, or when dealing with noisy data, it may be advisable to use the test set instead of the training set to model the censoring distribution. A detailed set of practical recommendations concludes our paper.