Nevin Manimala

BMC Med Educ. 2023 Mar 24;23(1):182. doi: 10.1186/s12909-023-04151-1.

ABSTRACT

BACKGROUND: Position transition training for general practitioners in Zhejiang Province started in 2017 and has since been held once a year. By the beginning of 2022, four training sessions were completed. The purpose of this survey was to establish the current situation of trainees after their graduation and provide reference for the evaluation of the training effect.

METHODS: Of the 738 trainees who completed the training, 253 were contacted and followed up. A self-designed questionnaire was used to conduct the survey through online filling in. The content included questions to elucidate the following information: whereabouts after the training, registration as a general practitioner, undertaken general practice teaching and scientific research work, current occupational environment, improvement of post competence after receiving position transition training, willingness to complete survey, willingness to participate in future training programs, etc. RESULTS: A number of 253 valid questionnaires were collected with a recovery rate of 100%. Notably, 93.68% of the participants successfully completed their training and obtained the Training Certificate of General Practitioners. Further, 83.4% were registered as general practitioners, 82.94% of which added on the basis of the original registered scope of practice. Currently, most of them work in primary health care institutions, primarily occupied with medical treatment, chronic disease management, COVID-19 prevention and control, health education, and prevention and health care. Of them, 27.01% were currently undertaking teaching work, and only 3.32% of them were conducting scientific research work related to general practice. The overall satisfaction of the trainees in the three theoretical training bases was above 90%, with no statistically significant difference among them (P > 0.05). Importantly, 84.11% of the followed-up personnel hoped to continue to participate in similar training in the future to improve their general practitioner core competences.

CONCLUSION: The position transition training in Zhejiang Province has achieved good results, but the details of training and the implementation of policies in individual regions need to be improved. Most of the graduates were willing to continue their education, especially in general practitioners with special interests.

PMID:36964607 | DOI:10.1186/s12909-023-04151-1

Confl Health. 2023 Mar 24;17(1):12. doi: 10.1186/s13031-023-00510-3.

ABSTRACT

BACKGROUND: Northwest Syria (NWS) is a complex and extremely fragile operating environment, with more than 2.8 million people needing humanitarian assistance. To support a common standard of care delivery and enable coordination among the multiple providers in NWS, WHO developed an Essential Health Services package (EHSP) in 2016-17 and subsequently supported a facility network model to deliver the EHSP. This article provides an evaluation of the network to date, aiming to inform further development of the network and draw wider lessons for application of similar approaches in complex emergency settings.

METHODS: This mixed method study included document review, participatory, qualitative and quantitative data, gathered in the first half of 2021. Participatory data came from two group model building workshops with 21 funders and implementers. Semi-structured interviews with 81 funders, health professionals and community members were also conducted. Analyses of the workshops and interviews was inductive, however a deductive approach was used for synthesising insights across this and the document review. The final component was a survey of health providers (59 health care professionals) and service users (233 pregnant women and 214 persons living with NCDs) across network and other comparable facilities, analysed using routine descriptive and inferential statistics. Findings across all methods were triangulated.

RESULTS: The study finds that the network and its accompanying essential service package were relevant to the dynamic and challenging context, with high but shifting population needs and multiple uncoordinated providers. Judged in relation to its original goals of comprehensive, coordinated services, equitable access and efficient service delivery, the data indicate that gains have been made in all three areas through the network, although attribution is challenging, given the complex environment. The context remains challenging, with shifting boundaries and populations displaced by conflict, difficulties in retaining staff, the need to import medicines and supplies across borders, and governance gaps.

CONCLUSION: This study adds to a very limited literature on coordinated network approaches used to raise care quality and improve referrals and efficiency in a complex emergency setting. Although areas of ongoing challenge, including for sustainability, are noted, the network demonstrated some resilience strategies and can provide lessons for other similar contexts.

PMID:36964578 | DOI:10.1186/s13031-023-00510-3

J Neuroeng Rehabil. 2023 Mar 24;20(1):36. doi: 10.1186/s12984-023-01158-z.

ABSTRACT

BACKGROUND: In recent years, ambulatory lower limb exoskeletons are being gradually introduced into the clinical practice to complement walking rehabilitation programs. However, the clinical evidence of the outcomes attained with these devices is still limited and nonconclusive. Furthermore, the user-to-robot adaptation mechanisms responsible for functional improvement are still not adequately unveiled. This study aimed to (1) assess the safety and feasibility of using the HANK exoskeleton for walking rehabilitation, and (2) investigate the effects on walking function after a training program with it.

METHODS: A randomized controlled trial was conducted including a cohort of 23 patients with less than 1 year since injury, neurological level of injury (C2-L4) and severity (American Spinal Cord Injury Association Impairment Scale [AIS] C or D). The intervention was comprised of 15 one-hour gait training sessions with lower limb exoskeleton HANK. Safety was assessed through monitoring of adverse events, and pain and fatigue through a Visual Analogue Scale. LEMS, WISCI-II, and SCIM-III scales were assessed, along with the 10MWT, 6MWT, and the TUG walking tests (see text for acronyms).

RESULTS: No major adverse events were reported. Participants in the intervention group (IG) reported 1.8 cm (SD 1.0) for pain and 3.8 (SD 1.7) for fatigue using the VAS. Statistically significant differences were observed for the WISCI-II for both the “group” factor (F = 16.75, p < 0.001) and “group-time” interactions (F = 8.87; p < 0.01). A post-hoc analysis revealed a statistically significant increase of 3.54 points (SD 2.65, p < 0.0001) after intervention for the IG but not in the CG (0.7 points, SD 1.49, p = 0.285). No statistical differences were observed between groups for the remaining variables.

CONCLUSIONS: The use of HANK exoskeleton in clinical settings is safe and well-tolerated by the patients. Patients receiving treatment with the exoskeleton improved their walking independence as measured by the WISCI-II after the treatment.

PMID:36964574 | DOI:10.1186/s12984-023-01158-z

BMC Cancer. 2023 Mar 24;23(1):269. doi: 10.1186/s12885-023-10738-0.

ABSTRACT

OBJECTIVE: To investigate how the negative regulation of CD44st by miR-138-5p affects the invasive ability of breast cancer cell lines and prognosis in postoperative breast cancer patients.

METHODS: RT-PCR, qRT-PCR, and western blot assays were used to detect the expression of CD44s, CD44v6, and CD44st at both mRNA and protein levels. The expression of miR-138-5p in breast cancer cell lines was also evaluated. The binding ability of miR-138-5p to CD44st was determined via a dual-luciferase assay. The CD44 protein expression in breast cancer tissues was detected using immunohistochemistry. A Transwell assay was used to detect the invasive ability of tumor cells. The correlation between CD44st and miR-138-5p mRNA expression in breast cancer tissues was evaluated using qRT-PCR, and the relationship between clinicopathological features was statistically analyzed.

RESULTS: CD44s and CD44v6 were highly expressed in MDAMB-231 cell line, while CD44st was highly expressed in MCF-7/Adr and Skbr-3 cells. None of the CD44 isoforms were expressed in MCF-7 cells. The miR-138-5p was highly expressed in MCF-7 cells, but not in MCF-7/Adr, Skbr-3, and MDAMB-231 cells. The dual-luciferase assay suggested that miR-138-5p could bind to wild-type CD44st 3′-UTR, miR-138-5p overexpression significantly inhibited the expression level of CD44 protein in MCF-7/Adr cells, and miR-138-5p + CD44st (3′-UTR)-treated MCF-7/Adr and Skbr-3 cells were significantly less invasive than those in the control group (P < 0.05). RT-PCR results for 80 postoperative breast cancer patients showed that the mRNA expression rate for CD44st was higher in cancer tissues than in paracancerous tissues, and the expression rate of miR-138-5p was higher in paracancerous tissues than in cancerous tissues (P < 0.01). In cancer tissues, CD44st was negatively correlated with miR-138-5p expression, with correlation coefficient r = -0.76 (Pearson’s correlation), coefficient of determination R2 = 0.573, F = 106.89, and P < 0.001. The median overall survival value for patients in the low miR-138-5p expression group was 40.39 months [95% confidence interval (CI): 35.59-45.18 months] and 56.30 months (95% CI: 54.38-58.21 months) for patients in the high-expression group, with a log rank (Mantel-Cox) of 13.120, one degree of freedom, and P < 0.001.

CONCLUSION: In breast cancer cell lines, miR-138-5p negatively regulated expression of CD44st and affected the invasive ability of tumor cells and patient prognosis after breast cancer surgery.

PMID:36964570 | DOI:10.1186/s12885-023-10738-0

Confl Health. 2023 Mar 24;17(1):13. doi: 10.1186/s13031-023-00509-w.

ABSTRACT

BACKGROUND: During the Covid-19 epidemic, the increased number of people seeking medical attention worsened hospital shortages. This shortage required reallocating the workforce, personal protective equipment (PPE), medical equipment, medical disposables, and hospital wards. This reallocation delayed a number of elective surgeries. This study explored the financial, physical, and psychological implications of deferring elective surgeries on Palestinians in three West Bank hospitals during the pandemic.

METHODS: This cross-sectional study included 398 patients from tertiary hospitals in Palestine whose elective surgical procedures were deferred due to the COVID-19 pandemic. Between 8/8/2021 and 6/9/2021, data were collected on patients who had elective surgery deferral at three government hospitals in the West Bank of the Palestinian territories. There were five parts to the study tool; personal information, access to the health system, physical affection, financial effect, and psychological effect. Statistical analysis included a univariate, bivariate and multivariate.

RESULTS: The healthcare system’s response to the COVID-19 epidemic directly affected patients whose surgeries were deferred. The healthcare system’s response was the cause of the delay in 91.5% of the cases. Orthopedic and neurological surgeries account for 48.3% of deferred surgery. Other than delayed surgeries, 30.2% of patients were unable to get additional health care services. Physically, 55.5% of patients were impacted, 45% were anxious, and 29.6% were depressed.

CONCLUSIONS: Patients who had procedures deferred as a result of the healthcare system’s response to the COVID-19 epidemic were impacted physically, financially, and psychologically. There should bea better crisis management strategyto ensure that certain hospitals are able to operate regularly despite the situation.

PMID:36964566 | DOI:10.1186/s13031-023-00509-w

Biomed Eng Online. 2023 Mar 24;22(1):30. doi: 10.1186/s12938-023-01093-z.

ABSTRACT

Major trauma is a condition that can result in severe bone damage. Customised orthopaedic reconstruction allows for limb salvage surgery and helps to restore joint alignment. For the best possible outcome three dimensional (3D) medical imaging is necessary, but its availability and access, especially in developing countries, can be challenging. In this study, 3D bone shapes of the femur reconstructed from planar radiographs representing bone defects were evaluated for use in orthopaedic surgery. Statistical shape and appearance models generated from 40 cadaveric X-ray computed tomography (CT) images were used to reconstruct 3D bone shapes. The reconstruction simulated bone defects of between 0% and 50% of the whole bone, and the prediction accuracy using anterior-posterior (AP) and anterior-posterior/medial-lateral (AP/ML) X-rays were compared. As error metrics for the comparison, measures evaluating the distance between contour lines of the projections as well as a measure comparing similarities in image intensities were used. The results were evaluated using the root-mean-square distance for surface error as well as differences in commonly used anatomical measures, including bow, femoral neck, diaphyseal-condylar and version angles between reconstructed surfaces from the shape model and the intact shape reconstructed from the CT image. The reconstructions had average surface errors between 1.59 and 3.59 mm with reconstructions using the contour error metric from the AP/ML directions being the most accurate. Predictions of bow and femoral neck angles were well below the clinical threshold accuracy of 3°, diaphyseal-condylar angles were around the threshold of 3° and only version angle predictions of between 5.3° and 9.3° were above the clinical threshold, but below the range reported in clinical practice using computer navigation (i.e., 17° internal to 15° external rotation). This study shows that the reconstructions from partly available planar images using statistical shape and appearance models had an accuracy which would support their potential use in orthopaedic reconstruction.

PMID:36964560 | DOI:10.1186/s12938-023-01093-z

Malar J. 2023 Mar 24;22(1):107. doi: 10.1186/s12936-023-04542-1.

ABSTRACT

BACKGROUND: For a country such as South Africa which is targeting malaria elimination, mobile and migrant populations pose a substantial risk to importation of malaria parasites. It has been hypothesized that halting cross-border movement of mobile and migrant populations will decrease the importation of malaria, however this option is not a politically, operationally, and financially viable prospect. It has social impacts as well, since families live on either side of the border and preventing travel will challenge family ties. Due to the COVID-19 pandemic and closure of ports of entry (land and air) for non-essential travel into South Africa, a unique opportunity arose to test the hypothesis.

METHODOLOGY: An interrupted time series analysis was done to assess whether the post-lockdown trends (April-December 2020) in monthly reported imported and local cases differed from the pre-lockdown trends (January 2015-March 2020). The analysis was conducted separately for KwaZulu-Natal, Mpumalanga, and Limpopo provinces.

RESULTS: On average, imported cases were lower in the post-intervention period in all three provinces, and local cases were lower in Mpumalanga and Limpopo, though no results were statistically significant.

CONCLUSION: Since population movement continued after the travel restrictions were lifted, border screening with testing and treating should be considered for reducing parasite movement. Another option is reducing malaria cases at the source in neighbouring countries by implementing proven, effective vector and parasite control strategies and through a downstream effect reduce malaria entering South Africa.

PMID:36964548 | DOI:10.1186/s12936-023-04542-1

PLOS Glob Public Health. 2022 Jun 15;2(6):e0000599. doi: 10.1371/journal.pgph.0000599. eCollection 2022.

ABSTRACT

There is an excessive burden of diabetes complications in low-resource settings. We conducted a systematic review to determine the nature and frequency of diabetes complications in newly diagnosed with type 2 diabetes. A systematic search was performed using Medline, CINAHL and Global Health online databases from inception to July 2020. Articles reporting prevalence of microvascular or macrovascular complications within six months of type 2 diabetes diagnosis and published in English or French from low- and middle-income countries (LMICs) were eligible for analysis. Data were extracted using a standardized data extraction tool. Descriptive statistics were used to describe the prevalence of micro and macrovascular complications in newly diagnosed type 2 diabetes. Assessment of heterogeneity was conducted using the inconsistency index (I2) and Cochran-Q chi2 statistical tests. Publication bias was assessed by the Funnel plot and Egger test. A total of 3 292 records underwent title or abstract screening and 95 articles underwent full text review. Thirty-three studies describing 13 283 participants (aged 20 years and older) met the inclusion criteria. The eligible studies were from Asia (n = 24), Africa (n = 4), Oceania (n = 2), South America (n = 2) and the Caribbean (n = 1). For microvascular complications, the median prevalence (interquartile range) of retinopathy, nephropathy and neuropathy were 12% (6%-15%), 15% (7%-35%) and 16% (10%25%) respectively. For macrovascular complications, the median prevalence (interquartile range) was 10% (7%-17%) for ischaemic heart disease, 6% (1%-20%) for peripheral arterial disease and 2% (1%-4%) for stroke. There was evidence of substantial heterogeneity between studies for all outcomes (I2 > 90%. We found a high prevalence of complications in newly diagnosed type 2 diabetes in LMICs. Findings suggest that many people live with diabetes and are only diagnosed when they present with complications in LMICs. Research is needed to guide timely and effective identification of people living with diabetes in these settings.

PMID:36962416 | DOI:10.1371/journal.pgph.0000599

PLOS Glob Public Health. 2022 Jul 1;2(7):e0000378. doi: 10.1371/journal.pgph.0000378. eCollection 2022.

ABSTRACT

Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) infections have been identified to form a deadly synergy that is posing serious threats to human health and economic development particularly in Sub-Saharan Africa (SSA). Six years into the end TB strategy, it is imperative to assess HIV detection rate among TB patients in order to determine the prevalence as well as establish the temporal trend of the co-morbidity in the Eastern region of Ghana where the magnitude of HIV and TB/HIV co-morbidity have consistently been noted to be high. The study reviewed records of 840 TB patients retrospectively from January 1, 2009 to December 31, 2018 in Suhum Municipal. Socio-demographic characteristics and clinical data of study participants were extracted from the Municipal TB registers using an excel spread sheet. Data were exported into STATA version 16.0 for analysis with statistical significance set at p-value ≤0.05. Of the 840 TB patients, 793 (94.4%) were screened for HIV, with 18.6% (95% CI: 0.16-0.21) yielding positive results. A sharp increase in the trend of the co-infection was observed from 6 (14.6%) in 2009 to 21 (36.8%) in 2010. The highest (40.4%) co-infection prevalence was recorded in 2011. The study recorded an overall decreasing trend of the co-infection. Case detection rate for HIV among persons living with TB was high. TB/HIV co-infection rate in Suhum Municipal is high and occurs more often among females and persons aged 30 years to 49 years. A fairly stable prevalence trend of TB/HIV co-infection rate was also identified. In conclusion, ongoing integrated TB/HIV activities are showing good results and therefore need to be sustained.

PMID:36962411 | DOI:10.1371/journal.pgph.0000378

PLOS Glob Public Health. 2022 Jul 27;2(7):e0000737. doi: 10.1371/journal.pgph.0000737. eCollection 2022.

ABSTRACT

With over twelve months since the start of the COVID-19 pandemic, its morbidity and mortality continue to be a critical health threat despite various instituted preventive and control efforts. Information on the multi-regional public perspective of the diseases is limited. Therefore, this study investigated public knowledge, attitudes, and practices towards COVID-19 across Sub-Saharan Africa (SSA), Middle East and North Africa (MENA), and South Asia (SA) regions of the world. In an online pretested questionnaire-based cross-sectional survey, respondents (n = 2738) were recruited using a convenience sampling technique and data obtained were subjected to descriptive and inferential statistics. The majority of respondents had bachelor’s degrees or higher (91.1%) and were aged between 18 and 39 years (88%). Most of the respondents had satisfactory knowledge (73%, 15.4 ± 2.5), attitudes 76.8%, 7.1 ± 1.1, and perceptions (73.4%, 11±2.8). Participants with higher educational levels and scientific backgrounds were 1.71 times (95% CI: 1.44; 2.03; p < 0.001) more likely to have a better knowledge of COVID-19. Respondents from the SA region were significantly more likely (OR: 1.4; 95% CI: 1.16, 1.68; p < 0.001) to possess satisfactory knowledge of COVID-19. Meanwhile, respondents from the MENA region (OR: 7.81; 95% CI: 6.12, 9.97; p < 0.001) have better attitudes and are more optimistic about ending the pandemic than those from the SSA. Despite the satisfactory knowledge, attitudes, and perceptions towards the regional efforts observed, we emphasize continued adherence by the public to the health regulations and safety measures of countries in these regions. There is a need for the low and middle-income countries to improve awareness of COVID-19 preventive practices.

PMID:36962400 | DOI:10.1371/journal.pgph.0000737