Category: Nevin Manimala

Pediatr Pulmonol. 2023 Sep 13. doi: 10.1002/ppul.26676. Online ahead of print.

ABSTRACT

BACKGROUND: Sleep disordered breathing (SDB) may exacerbate asthma and is a treatable comorbidity.

OBJECTIVE: To design and implement a screening process for SDB in patients hospitalized for asthma exacerbation using quality improvement (QI) methods. We sought to improve screening for SDB from zero to 60% from July 2019 to December 2020.

DESIGN/METHODS: A multidisciplinary team used QI methods to screen for SDB using the Michigan pediatric sleep questionnaire (PSQ) in patients 2-18 years hospitalized for asthma exacerbation. Key interventions included: pairing the PSQ screen with another element of routine care (the asthma risk factor screen), educating staff and physicians, engaging respiratory therapists to complete the PSQ and document scores, and modifying the electronic medical record (asthma order set and flowsheet for PSQ score documentation). A run chart tracked progress and descriptive statistics were generated.

RESULTS: There were 2067 patients admitted for asthma exacerbation during this project. The PSQ was completed for 1531 patients (74%) overall. Of screened patients, 360 (24%) had a positive PSQ; the mean age was 8.6 years. Approximately 14 months after the project began, ~90% of children admitted for asthma were being screened; subsequently, >80% of patients were being screened until May 2022. Screening with the PSQ occurred approximately 90% of the time when routine asthma risk screens were completed.

CONCLUSION: A screening process for SDB was successfully implemented and appeared feasible and sustainable. The high proportion of positive screens reinforces the importance of evaluating for SDB in the high-risk population of children requiring hospitalization for asthma exacerbation.

PMID:37701984 | DOI:10.1002/ppul.26676

J Neurophysiol. 2023 Sep 13. doi: 10.1152/jn.00248.2023. Online ahead of print.

ABSTRACT

The dynamics and interaction of spinal and suparspinal centers during locomotor adaptation remain vaguely understood. In this work, we use Hoffmann reflex measurements to investigate changes of spinal reflex gains during split-belt locomotor adaptation. We show that spinal reflex gains are dynamically modulated during split-belt locomotor adaptation. During first exposure to split-belt transitions, modulation occurs mostly on the leg ipsilateral to the speed change, and constitutes rapid suppression or facilitation of the reflex gains, followed by slow recovery to baseline. Over repeated exposure, the modulation pattern washes out. We further show that reflex gain modulation strongly correlates with correction of leg asymmetry, and cannot be explained by speed modulation solely. We argue that reflex modulation is likely of supraspinal origins, and constitutes an integral part of the neural substrate underlying split-belt locomotor adaptation.

PMID:37701940 | DOI:10.1152/jn.00248.2023

World J Hepatol. 2023 Aug 27;15(8):1001-1012. doi: 10.4254/wjh.v15.i8.1001.

ABSTRACT

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has become a prevalent cause of chronic liver disease and ranks third among the causes of transplantation. In the United States alone, annual medical costs are approximately 100 billion dollars. Unfortunately, there is no Federal Drug Administration (FDA)-approved medication for its treatment. However, various clinical trials are investigating several therapeutic classes that could potentially treat NAFLD. It is valuable to have a compilation of the data available on their efficacy.

AIM: To assess the efficacy of cyclophilin inhibitors, fibroblast growth factor 21 analogs (FGF21), and dual and pan peroxisome proliferator-activated receptor (PPAR) agonists for treating NAFLD.

METHODS: A comprehensive literature search using keywords including cyclophilin inhibitor, FGF agonist, pan-PPAR agonists, dual-PPAR agonist, NAFLD, non-alcoholic steatohepatitis, and fatty liver was conducted on October 29, 2022, in PubMed, EMBASE, Cochrane Library, Scopus and Web of Science. Animal and human research, case reports, and published articles in English from all countries with patients aged 18 and above were included. Only articles with a National Institutes of Health (NIH) Quality Assessment score of five or higher out of eight points were included. Articles that were narrative or systematic reviews, abstracts, not in English, focused on patients under 18 years old, did not measure outcomes of interest, were inaccessible, or had a low NIH Quality Assessment score were excluded. Each article was screened by two independent researchers evaluating relevance and quality. Resources were scored based on the NIH Quality Assessment Score; then, pertinent data was extracted in a spreadsheet and descriptively analyzed.

RESULTS: Of the 681 records screened, 29 met the necessary criteria and were included in this review. These records included 12 human studies and 17 animal studies. Specifically, there were four studies on cyclophilin inhibitors, four on FGF agonists/analogs, eleven on pan-PPAR agonists, and ten on dual-PPAR agonists. Different investigational products were assessed: The most common cyclophilin inhibitor was NV556; FGF agonists and analogs was Efruxifermin; pan-PPAR agonists was Lanifibranor; and dual-PPAR agonists was Saroglitazar. All classes were found to be statistically efficacious for the treatment of NAFLD, with animal studies demonstrating improvement in steatosis and/or fibrosis on biopsy and human studies evidencing improvement in different metabolic parameters and/or steatosis and fibrosis on FibroScan (P < 0.05).

CONCLUSION: The data analyzed in this review showed clinically significant improvement in individual histological features of NAFLD in both animal and human trials for all four classes, as well as good safety profiles (P < 0.05). We believe this compilation of information will have positive clinical implications in obtaining an FDA-approved therapy for NAFLD.

PMID:37701920 | PMC:PMC10494562 | DOI:10.4254/wjh.v15.i8.1001

World J Hepatol. 2023 Aug 27;15(8):985-1000. doi: 10.4254/wjh.v15.i8.985.

ABSTRACT

BACKGROUND: Recently, a group of hepatologists proposed to rename non-alcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) with modified diagnostic criteria. It is important to note, however, that there are some differences between the diagnostic criteria used for NAFLD and MAFLD. Since the research on MAFLD is just beginning, however, evidence on its incidence and prevalence in the general population and in specific subpopulations remains limited.

AIM: To assess epidemiology of fatty liver in new definition and compare MAFLD with NAFLD. Exploring risk factors of MAFLD individuals.

METHODS: This was a retrospective, cross-sectional study. A total of 85242 adults were selected from the Chinese health management database in 2017-2022. The data of general information, laboratory indicators, lifestyle management and psychological status were obtained. MAFLD was diagnosed as ultrasound diagnosis of fatty liver and at least one between these three conditions: Overweight/obesity, type 2 diabetes mellitus (T2DM) or metabolic dysregulation. Metabolic factors were not considered in NAFLD diagnosis standard. The clinical characteristics of MAFLD and NAFLD were analysed using descriptive statistics. Continuous variables normally distributed were expressed as means ± SD. Categorical variables were expressed as frequencies and proportions. Binary logistic regression was used to determine risk factors of the MAFLD.

RESULTS: The prevalence of MAFLD and NAFLD was 40.5% and 31.0%, respectively. The MAFLD or NAFLD population is more likely to be older (M: 47.19 ± 10.82 vs 43.43 ± 11.96; N: 47.72 ± 11.17 vs 43.71 ± 11.66), male (M: 77.21% vs 44.43%; N: 67.90% vs 53.12%) and high body mass index (M: 26.79 ± 2.69 vs 22.44 ± 2.48; N: 26.29 ± 2.84 vs 23.29 ± 3.12) than the non-MAFLD or non-MAFLD population. In multivariate analysis, general information (e.g., ≥ 2 metabolic abnormalities OR = 3.38, (95%CI: 2.99-3.81), P < 0.001; diastolic blood pressure OR = 1.01, (95%CI: 1.00-1.01), P = 0.002), laboratory results [e.g.,total bilirubin (TBIL) OR = 0.98, (95%CI: 0.98-0.99), P < 0.001; serum uric acid(SUA) OR = 1.01, (95%CI: 1.01-1.01), P < 0.001], and lifestyle factors [e.g., drink beverage OR = 0.32, (95%CI: 0.17-0.63), P = 0.001] were influence factors for MAFLD. Our study results offer new insight into potential risk factors associated with fatty liver disease, including SUA, TBIL and creatinine, all of which are related to chronic renal disease (CKD).

CONCLUSION: MAFLD is more prevalent than NAFLD, with two-fifths of individuals meeting the diagnosis criteria. MAFLD and NAFLD populations have different clinical characteristics. CKD may be related with MAFLD.

PMID:37701916 | PMC:PMC10494565 | DOI:10.4254/wjh.v15.i8.985

Parasite Epidemiol Control. 2023 Sep 7;23:e00324. doi: 10.1016/j.parepi.2023.e00324. eCollection 2023 Nov.

ABSTRACT

Livestock, mainly goats, are crucial for animal protein, household income, economic security, and wealth creation in the pastoral areas of eastern Ethiopia. However, gastrointestinal parasitosis poses a substantial challenge in this sector. A cross-sectional study was conducted in the Gursum district of the Somali region, Ethiopia, to investigate the prevalence and intensity of gastrointestinal nematodes in goats and their associated risk factors. A total of 384 goat fecal samples were collected and examined using flotation and McMaster egg counting techniques for GIT nematodes. Coprological cultures have also been conducted for nematode identification. Fecal samples showed an overall parasite prevalence of 54.17%, with identified nematodes including Haemonchus (24%), Strongyloides (10.4%), Trichostrongles (6.5%), Nematodirus (6%), Oesophagostomum (5.5%) and Trichuris (1.87%). Older and poor body condition animals had higher chances of hosting nematodes than younger (OR = 0.245; CI = 0.144-0.417) and good body condition animals (OR = 0.069; CI = 0.030-0.157), according to multivariate logistic regression analysis. Quantitative examination of eggs revealed light 75(36.06%), moderate 99(47.60%), and heavy infection (n = 34, 16.35%). Analysis of the different study variables indicated that the age and body condition of the animals and the season of the year had a statistically significant association with the prevalence of GIT nematode infections (P-value <0.05). The high prevalence and intensity of GIT nematodiasis in goats from the study area warrants immediate attention and the implementation of strategic control and prevention measures.

PMID:37701882 | PMC:PMC10493581 | DOI:10.1016/j.parepi.2023.e00324

Open Access Emerg Med. 2023 Sep 6;15:277-287. doi: 10.2147/OAEM.S424814. eCollection 2023.

ABSTRACT

BACKGROUND: Medical emergencies require quick field interventions and stabilization before transport, while rapid transportation to definitive healthcare with fewer field interventions improves trauma outcomes. Poor prehospital healthcare practices negatively impact patients’ health, and limited studies exist on providers’ practices in resource-limited areas like Ethiopia. This study aimed to assess the practice of pre-hospital emergency care and associated factors at pre-hospital health facilities in Addis Ababa, Ethiopia.

METHODS: A facility-based cross-sectional study was conducted 191 pre-hospital healthcare providers, of which 20 randomly selected participants were participated in the observational study from October 2021 to February 2022 in Addis Ababa Ethiopia. Data was collected using a checklist and self-administered questionnaire. Data was cleaned, entered into Epi data version 4.4, and exported to SPSS software for analysis. Binary and multivariable logistic regression analyses were performed, with a P-value of 0.05 considered statistically significant.

RESULTS: The study found that 43% (82) of pre-hospital healthcare providers in Addis Ababa, Ethiopia, had good practice in pre-hospital emergency care. The identified factors that increased the odds of good practice in pre-hospital emergency care were: being able to provide advanced life support (AOR = 88.99; 95% CI: 27.143-291.603); adequate monitoring and defibrillators (AOR = 5.829; 95% CI: 1.430-23.765); having work experience of 4-5 years (AOR = 5.86; 95% CI: 1.424-24.109); and having the opportunity to continue education (AOR = 31.953; 95% 6.479-157.591).

CONCLUSIONS AND RECOMMENDATIONS: The study found high levels of poor practice among pre-hospital healthcare providers in Addis Ababa, Ethiopia. Factors contributing to good practice include being trained in advanced Life Support, adequate monitoring, defibrillators, work experience, and having the opportunity to continue education. Therefore, policymakers and health planners should establish teaching and training centres based on Ministry of Health and Education guidelines.

PMID:37701880 | PMC:PMC10493197 | DOI:10.2147/OAEM.S424814

J Econom. 2023 Aug;235(2):444-453. doi: 10.1016/j.jeconom.2022.05.004. Epub 2022 Jun 18.

ABSTRACT

Differential privacy is becoming one gold standard for protecting the privacy of publicly shared data. It has been widely used in social science, data science, public health, information technology, and the U.S. decennial census. Nevertheless, to guarantee differential privacy, existing methods may unavoidably alter the conclusion of original data analysis, as privatization often changes the sample distribution. This phenomenon is known as the trade-off between privacy protection and statistical accuracy. In this work, we mitigate this trade-off by developing a distribution-invariant privatization (DIP) method to reconcile both high statistical accuracy and strict differential privacy. As a result, any downstream statistical or machine learning task yields essentially the same conclusion as if one used the original data. Numerically, under the same strictness of privacy protection, DIP achieves superior statistical accuracy in a wide range of simulation studies and real-world benchmarks.

PMID:37701878 | PMC:PMC10495082 | DOI:10.1016/j.jeconom.2022.05.004

Front Psychol. 2023 Aug 28;14:1221697. doi: 10.3389/fpsyg.2023.1221697. eCollection 2023.

ABSTRACT

INTRODUCTION: Divorce is a contributor to family instability within sub-Saharan Africa, and specifically within Namibia, an increasing number of children are exposed to its impact. However, not all children react uniformly to the impact of parental divorce, and many children may be resilient. Understanding what promotes resilience in children post-divorce in African contexts is vital, given the unique socio-cultural context. Therefore, this study aimed to understand how some children are capable of resilience despite exposure to parental divorce in Namibia.

METHODS: A multiple case study design was employed to assess the lived experiences of children aged 9-12 post-parental divorce in Windhoek. Using the Child and Youth Resilience Measurement (CYRM-12) scale, 24 children exposed to parental divorce were screened for resiliency. The Q-Methodology, with visual material, was utilized with a sub-sample of 12 children who scored high on the CYRM (50% girls, mean age = 11) to eliminate some of the challenges associated with gathering qualitative data from younger children. The PQ Method 2.35 software program was used for data analysis.

RESULTS: By-person factor analysis identified four statistically significant profiles. A third (33%) of participants loaded on a factor emphasizing “quality parent-child relationships” and a further 33% emphasizing “effective parent conflict resolution.” The final two factors emphasized “healthy school attachment” (17%) and “strong community attachment” (17%). All children emphasized a stable, loving familial environment, and frequent visitation with the non-custodial father.

DISCUSSION: Our findings suggest that multiple social ecologies nurture resilience in children exposed to parental divorce in Namibia. Support should be extended beyond the perimeters of the nuclear family, and relationships with extended family members, peer groups, school, and the wider community can play an important role in children’s adjustment. The study highlights the importance of contextually grounded resilience as some factors that are emphasized for children from more Western communities do not reflect as strongly in the results of this study. Other factors, including a stronger reliance on community and factors such as the school, peers, and extended family members, may play a bigger role in child resilience post-divorce in Namibia.

PMID:37701873 | PMC:PMC10493287 | DOI:10.3389/fpsyg.2023.1221697

Clinicoecon Outcomes Res. 2023 Sep 7;15:659-671. doi: 10.2147/CEOR.S415711. eCollection 2023.

ABSTRACT

PURPOSE: The objective of the present study was to evaluate the efficiency of lorlatinib compared to alectinib and brigatinib for the treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC) previously not treated, in Spain.

METHODS: A partitioned survival model comprised progression free, non-intracranial progression, intracranial progression, and death health states was constructed to estimate the total costs, life-years gained (LYG) and quality-adjusted life years (QALYs) accumulated in a lifetime horizon. Overall survival (OS) and progression-free survival (PFS) for lorlatinib were obtained from the CROWN study. For alectinib and brigatinib, a network meta-analysis of randomized controlled trials was conducted to estimate OS and PFS hazard ratios versus crizotinib. Utilities were estimated based on EQ-5D-5L data derived from the CROWN (lorlatinib), ALEX (alectinib) and ALTA-1L (brigatinib) studies. According to the Spanish National Health Service perspective the total costs (expressed in euros using a 2021 cost year) included drug acquisition and the administration’s subsequent treatment, ALK+ advanced NSCLC management and adverse-event management, and palliative care. Unitary costs were obtained from local cost databases and literature. Costs, LYGs and QALYs were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses were used to test the model’s robustness.

RESULTS: Lorlatinib provided higher health outcomes (+0.70 LYG/patient, +1.42 QALYs/patient) and lower costs (-€9239/patient) than alectinib. Lorlatinib yielded higher LYG (+1.74) and QALYs (+2.30) versus brigatinib but higher costs/patient (+€36,627), resulting in an incremental-cost-effectiveness-ratio of €15,912/QALY gained.

CONCLUSION: The results of this study suggest that lorlatinib may be a dominant treatment option versus alectinib. Considering a willingness-to-pay threshold of €25,000/QALY, lorlatinib may be an efficient option compared to brigatinib.

PMID:37701861 | PMC:PMC10494862 | DOI:10.2147/CEOR.S415711

Clinicoecon Outcomes Res. 2023 Sep 7;15:645-658. doi: 10.2147/CEOR.S416562. eCollection 2023.

ABSTRACT

BACKGROUND: Pregnant women face high costs for health-care services despite being advertised as free. These costs include non-medical expenses, lost productivity, difficulties caring for family members, and long-term financial impact from complications. Limited research has been done on the cost burden of maternal services and complications, despite numerous studies on maternal health service provision. This is notable considering the government’s claim of providing free maternal health-care services.

METHODS: A cross-sectional study was conducted in July (1-30) 2022 among 425 randomly selected mothers in Harari and Dire Dawa City, Eastern Ethiopia. Data were collected through structured questionnaires and medical record reviews. The collected data was entered into Epi-Data version 3.02 and analyzed using STATA version 14.0 after data cleaning. Descriptive statistics and linear regression analysis were used to examine the data, ensuring assumptions of linearity, independence, homoscedasticity, and normality were met. The correlation coefficient was used to assess the strength of the association.

RESULTS: The median cost of maternal complications was around 4250 ETB (81.3 USD; IQR = 2900-5833.3), factors that predicted cost were monthly family income of ≥3001 birr (β=1.13; 95% CI: 1.00, 1.26), distance from hospital (β=0.73; 95% CI = 0.64-0.83), being admitted for less than 4 days (β=0.60; 95% CI = 0.53-0.69), accompanied by relatives besides their husbands (β=1.93; 95% CI = 1.52-2.46), caesarian sections delivery (β=1.17; 95% CI = 1.04-1.31), and giving birth to a normal baby (β=0.86; 95% CI = 0.77-0.97).

CONCLUSION: Maternal complications incur significant costs, with factors such as family income, travel time, hospital stay, caregiver presence, mode of delivery, and neonatal outcome predicting these costs. The Ethiopian health system should address the additional expenses faced by mothers with complications and their caregivers.

PMID:37701860 | PMC:PMC10494998 | DOI:10.2147/CEOR.S416562