Nevin Manimala

East Mediterr Health J. 2024 Jul 17;30(6):430-439. doi: 10.26719/2024.30.6.430.

ABSTRACT

BACKGROUND: Health systems research and publication are vital for improving healthcare at all levels of care. They provide evidence for policy and for better service outcomes.

AIMS: To assess published health systems research in Pakistan from 2011 to 2020 and to model and forecast the publication trend.

METHODS: This cross-sectional study searched health systems research publications database for Pakistan in Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Tables and graphs were created using Microsoft Excel, visualization was produced on VoS Viewer, and SPSS version 29.1.0 was used for analysis, while R software was used to plot the time series data.

RESULTS: A total of 697 articles with an average of 16.6 citations were published between 2011 and 2020. The highest number of publications (240) per single institution was from Aga Khan University (including Aga Khan University Hospital), Karachi. There was a significant difference between the number of publications before and after the midpoint (2015) of the bibliometric analysis (t = -3.08, P = 0.015, 95% CI -87.78–12.61). We observed a strong relationship between publications and citations over the same period (Correlation coefficient 0.809, P = 0.002, CI 0.46-0.98) but there was no significant difference between the number of citations before and after the midpoint.

CONCLUSION: There was an acute dearth of health systems research publication at the beginning of the study period. A few medical institutes are now taking the lead in conducting and publishing health systems research. Technical and financial support is needed to strengthen the capacity of Pakistani medical institutions and researchers to contribute more to knowledge generation within the country.

PMID:39545293 | DOI:10.26719/2024.30.6.430

Bone Jt Open. 2024 Nov 15;5(11):1037-1040. doi: 10.1302/2633-1462.511.BJO-2024-0116.R1.

ABSTRACT

AIMS: The first metatarsal pronation deformity of hallux valgus feet is widely recognized. However, its assessment relies mostly on 3D standing CT scans. Two radiological signs, the first metatarsal round head (RH) and inferior tuberosity position (ITP), have been described, but are seldom used to aid in diagnosis. This study was undertaken to determine the reliability and validity of these two signs for a more convenient and affordable preoperative assessment and postoperative comparison.

METHODS: A total of 200 feet were randomly selected from the radiograph archives of a foot and ankle clinic. An anteroposterior view of both feet was taken while standing on the same x-ray platform. The intermetatarsal angle (IMA), metatarsophalangeal angle (MPA), medial sesamoid position, RH, and ITP signs were assessed for statistical analysis.

RESULTS: There were 127 feet with an IMA > 9°. Both RH and ITP severities correlated significantly with IMA severity. RH and ITP were also significantly associated with each other, and the pronation deformities of these feet are probably related to extrinsic factors. There were also feet with discrepancies between their RH and ITP severities, possibly due to intrinsic torsion of the first metatarsal.

CONCLUSION: Both RH and ITP are reliable first metatarsal pronation signs correlating to the metatarsus primus varus deformity of hallux valgus feet. They should be used more for preoperative and postoperative assessment.

PMID:39545268 | DOI:10.1302/2633-1462.511.BJO-2024-0116.R1

J Pharm Technol. 2024 Oct 22:87551225241288137. doi: 10.1177/87551225241288137. Online ahead of print.

ABSTRACT

BACKGROUND: Dexmedetomidine is a centrally acting alpha-2-adrenoceptor agonist that is usually used in the intensive care unit (ICU) for its sedative, analgesic, and anxiolytic properties. Studies have shown that dexmedetomidine can be an effective adjunct analgesic, but they are limited and usually use a population of intubated patients. To better evaluate the role of dexmedetomidine use in the adult ICU, more information needs to be gathered on its analgesic effect and its utility in non-intubated patients.

METHODS: This study was a retrospective cohort analysis between adult non-intubated ICU patients on dexmedetomidine and non-intubated ICU patients not on dexmedetomidine who were admitted to a 302-bed tertiary academic medical center between October 1, 2022, and August 31, 2023. Inclusion criteria necessitated an as-needed opioid order with a corresponding pain score and at least 1 other pain assessment and no history of symptomatic bradycardia, nor could it be present on admission. The primary study objective was to assess the amount of morphine milligram equivalents (MMEs) received during ICU admission with concomitant dexmedetomidine infusion. Secondary outcomes included the time to first dose of rescue opioid analgesia and ICU length of stay.

RESULTS: A total of 38 patients were included. Baseline demographics did not differ significantly between groups. There was a significant statistical difference in the total amount of MMEs received, with the dexmedetomidine group having significantly less than the control group (P < 0.001). The dexmedetomidine group also had a significantly longer time to first rescue analgesia dose (P = 0.025) and a significantly increased incidence of delirium (P < 0.001). There was no difference in other adverse events between groups.

CONCLUSION: Dexmedetomidine significantly decreased MME requirements and increased time to first rescue analgesia dose in non-intubated ICU patients without increasing adverse effects but was associated with an increased incidence of delirium.

PMID:39545245 | PMC:PMC11559726 | DOI:10.1177/87551225241288137

J Pharm Technol. 2024 Nov 5:87551225241289959. doi: 10.1177/87551225241289959. Online ahead of print.

ABSTRACT

BACKGROUND: No head-to-head comparisons of semaglutide formulations currently exist in the literature. In practice, many may think that oral and injectable semaglutide formulations are interchangeable, although there is currently limited real-world data to determine whether this is accurate.

OBJECTIVE: The purpose of this study was to determine the effect of oral versus injectable semaglutide on hemoglobin A_1C (HbA_1C) and weight in patients with type 2 diabetes (T2D).

METHODS: This was a retrospective single-center review of adult patients who had a diagnosis of T2D and were treated with oral or injectable semaglutide between November 1, 2019, and July 31, 2022. Primary outcome was a comparison of changes in HbA_1C (%) and weight (kg) from baseline to 6 months between patients receiving oral versus injectable semaglutide, stratified according to highest dose received. Secondary outcomes included frequency of dose reductions and discontinuations, achievement of clinical goals, and presence of an embedded clinical pharmacist at patients’ primary care office.

RESULTS: A total of 105 patients were included. Patients experienced mean decreases in HbA_1C and weight from baseline to 6 months of -1.75% (P < 0.001) and -3.64 kg (P = 0.015), respectively, in the oral semaglutide group and -1.35% (P < 0.001) and -5.26 kg (P < 0.001), respectively, in the injectable semaglutide group. When directly comparing semaglutide formulations, oral semaglutide demonstrated a 0.4% greater numerical reduction in HbA_1C (P = 0.523) and injectable semaglutide demonstrated a 1.62-kg greater numerical reduction in weight (P = 0.312). Adverse events (AEs) occurred more frequently with oral semaglutide than with injectable semaglutide (16.7% vs 4.9%). Discontinuation due to AEs was more common with oral semaglutide.

CONCLUSION: In this study, patients with T2D who received oral semaglutide demonstrated greater reductions in HbA_1C, whereas those treated with injectable semaglutide had greater reductions in weight, although there were no statistically significant reductions in HbA_1C or weight between the 2 formulations. Rates of AEs and discontinuation were more common in the oral semaglutide group.

PMID:39545243 | PMC:PMC11559783 | DOI:10.1177/87551225241289959

J Pharm Technol. 2024 Oct 27:87551225241288144. doi: 10.1177/87551225241288144. Online ahead of print.

ABSTRACT

BACKGROUND: Inpatient use of intravenous iron has been increasing. Ferric gluconate is traditionally given once daily. Twice-daily dosing provides faster iron repletion, but there are limited data to support the safety of twice-daily dosing.

OBJECTIVE: The aim of this study was to investigate the safety of twice-daily dosing for ferric gluconate compared with daily dosing.

METHODS: This was an institutional review board-approved retrospective observational study of hospitalized adult patients who received intravenous ferric gluconate 250 mg daily or twice daily between January 1 and April 3, 2022. The primary composite safety outcome included hypotension, infusion reaction, rapid response alert, or escalation in level of care. Secondary outcomes included total amount of iron received, hospital length of stay, and changes in laboratory values.

RESULTS: A total of 126 patients were included in this study, with 63 patients in each group. The primary outcome occurred in 29 patients (46%) in the twice-daily group compared with 36 patients (57.1%) in the daily group (relative risk = 0.81; 95% CI, 0.57-1.13; P = 0.212). Changes in iron, hemoglobin, and transferrin saturation were similar between the 2 groups. Median length of stay was statistically shorter in the twice-daily group (7.79 days) compared with the daily group (12.9 days; p = 0.006).

CONCLUSIONS: In this retrospective single-center study of hospitalized adult patients, those who received intravenous ferric gluconate twice daily did not experience an increased rate of a composite safety outcome of hypotension, infusion reactions, or escalation in level of care compared with those with daily dosing.

PMID:39545241 | PMC:PMC11559894 | DOI:10.1177/87551225241288144

Front Microbiol. 2024 Oct 31;15:1487978. doi: 10.3389/fmicb.2024.1487978. eCollection 2024.

ABSTRACT

OBJECTIVE: The purpose of this study was to explore the potential mechanism of Helicobacter pylori (Hp) eradication by probiotic therapy through 16S rRNA gene sequencing technology and untargeted metabolomics.

METHODS: Twenty four Hp-infected children were recruited from the Shanxi Bethune Hospital, and 24 healthy children were recruited as a blank control group. Group A: fecal samples from 24 healthy children. Group B: fecal samples of 24 children with Hp infection. Group B1 (n = 15): fecal samples of group B treated with probiotic therapy for 2 weeks. Group B2 (n = 19): fecal samples of group B treated with probiotic therapy for 4 weeks. The above fecal samples were analyzed by 16S rRNA gene sequencing technology and untargeted metabolomics.

RESULTS: There was no significant difference in alpha diversity and beta diversity among the four groups, but many bacteria with statistical difference were found in each group at the bacterial genus level and phylum level. LEfSe results showed that in group B, Porphyromonadaceae, Shigella and other microorganisms related to intestinal microecological dysbiosis were enriched. And in group B2, abundant characteristic microorganisms were found, namely Bacillales and Prevotella. KEGG metabolic pathway enrichment analysis showed that groups B1 and B2 were involved in 10 metabolic pathways potentially related to probiotic treatment: purine metabolism, nitrogen metabolism, arginine biosynthesis, alanine, aspartic acid and glutamate metabolism, glyoxylic acid and dicarboxylic acid metabolism, unsaturated fatty acid biosynthesis, fatty acid extension, fatty acid degradation, pyrimidine metabolism, fatty acid biosynthesis.

CONCLUSION: Probiotic therapy can inhibit Hp to some extent and can relieve gastrointestinal symptoms, making it a preferred therapy for children with Hp infection and functional abdominal pain. Hp infection can reduce the diversity of intestinal microbes, resulting in the disturbance of intestinal microbiota and changes in the relative abundance of microbiota in children, while probiotic therapy can restore the diversity of intestinal microbes and intestinal microecological balance.

PMID:39545236 | PMC:PMC11560915 | DOI:10.3389/fmicb.2024.1487978

Tex Heart Inst J. 2024 Nov 13;51(2):e238273. doi: 10.14503/THIJ-23-8273. eCollection 2024 Jul-Dec.

ABSTRACT

BACKGROUND: The appropriateness of aortic valve surgery for patients with moderate aortic valve regurgitation undergoing coronary artery bypass graft (CABG), mitral valve replacement (MVR), or both is uncertain. This study aimed to investigate the outcomes of moderate aortic valve regurgitation following these procedures.

METHODS: This retrospective cohort study included 113 eligible participants with moderate aortic valve regurgitation who underwent CABG, MVR, or both procedures between January 2014 and January 2015 at Tehran Heart Center. Echocardiographic index data were extracted from the Tehran Heart Center data center after a 2-year follow-up to examine changes in the patients’ conditions.

RESULTS: A total of 113 patients (mean [SD] age, 64.7 [9.9] years; 78 [69.0%] female patients) were included in the study and followed up for a mean (SD) of 24 (6) months. Among those patients, 38 (33.6%) experienced improvement, with their aortic valve regurgitation downgraded to mild, while the remaining 75 (66.4%) patients maintained a moderate aortic valve regurgitation level. Notably, combined CABG and MVR procedures were associated with statistically significant improvement, with all cases downgraded to mild aortic valve regurgitation. Baseline characteristics, including diabetes, hypertension, dyslipidemia, smoking, family history of aortic valve regurgitation, and a history of drug use, did not differ statistically significantly between patients with improved aortic valve regurgitation and patients with no changes. Echocardiographic indices related to the aorta, such as aortic valve pressure gradient, showed improvement (P < .001), and ejection fractions before and after surgery remained comparable. Changes in aortic valve regurgitation severity were found to differ statistically significantly between the various procedures (P = .001).

CONCLUSION: These findings suggest that it is not likely that moderate aortic valve regurgitation will progress after CABG or MVR. Hence, no support was found for concurrent aortic valve replacement during these procedures.

PMID:39545219 | PMC:PMC11563032 | DOI:10.14503/THIJ-23-8273

Nat Rev Neurosci. 2024 Nov 14. doi: 10.1038/s41583-024-00877-z. Online ahead of print.

NO ABSTRACT

PMID:39543247 | DOI:10.1038/s41583-024-00877-z

Sci Rep. 2024 Nov 15;14(1):28102. doi: 10.1038/s41598-024-78852-y.

ABSTRACT

Antioxidant-rich diets serve as protective factors in preventing obesity. The composite dietary antioxidant index (CDAI) represents a novel, comprehensive metric for assessing the antioxidant capacity of diets. Our objective is to investigate the relationship between the CDAI and obesity prevalence among adults in the United States. Dietary and anthropometric information about adults aged 20 years and older were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The CDAI was derived from six dietary antioxidants. Obesity is defined as a body mass index (BMI, kg/m²) ≥ 30 kg/m², and abdominal obesity as a waist circumference (WC, cm) ≥ 102 cm for men and ≥ 88 cm for women. The relationship between CDAI and obesity, including abdominal obesity, was analyzed using logistic regression and subgroup analyses. A total of 25,553 participants were analyzed. With higher tertiles of the CDAI, both obesity (41.28% vs. 38.62 vs. 35.09%, P < 0.001) and abdominal obesity (63.75% vs. 59.54 vs. 52.09%, P < 0.001) prevalence notably declined. Adjusting for multiple confounders, the CDAI was found to be independently linked to obesity (OR = 0.980, 95%CI = 0.971-0.989, P < 0.001) and abdominal obesity (OR = 0.972, 95%CI = 0.963-0.982, P < 0.001) risks. Subgroup analyses revealed a stronger relationship between CDAI and obesity in non-hypertensive individuals and a more significant association with abdominal obesity in women and those without hypertension. Our findings reveal a negative relationship between CDAI levels and both general and abdominal obesity. Additional extensive research is necessary to investigate CDAI’s contribution to obesity.

PMID:39543203 | DOI:10.1038/s41598-024-78852-y

NPJ Breast Cancer. 2024 Nov 14;10(1):98. doi: 10.1038/s41523-024-00696-6.

ABSTRACT

Surgery remains the primary treatment modality in the management of early-stage invasive breast cancer. Artificial intelligence (AI)-powered visualization platforms offer the compelling potential to aid surgeons in evaluating the tumor’s location and morphology within the breast and accordingly optimize their surgical approach. We sought to validate an AI platform that employs dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to render three-dimensional (3D) representations of the tumor and 5 additional chest tissues, offering clear visualizations as well as functionalities for quantifying tumor morphology, tumor-to-landmark structure distances, excision volumes, and approximate surgical margins. This retrospective study assessed the visualization platform’s performance on 100 cases with ground-truth labels vetted by 2 breast-specialized radiologists. We assessed features including automatic AI-generated clinical metrics (e.g., tumor dimensions) as well as visualization tools including convex hulls at desired margins around the tumor to help visualize lumpectomy volume. The statistical performance of the platform’s automated features was robust and within the range of inter-radiologist variability. These detailed 3D tumor and surrounding multi-tissue depictions offer both qualitative and quantitative comprehension of cancer topology and may aid in formulating an optimal surgical approach for breast cancer treatment. We further establish the framework for broader data integration into the platform to enhance precision cancer care.

PMID:39543194 | DOI:10.1038/s41523-024-00696-6