Tag: pubmed

J Infect Dev Ctries. 2022 Oct 31;16(10):1542-1554. doi: 10.3855/jidc.16884.

ABSTRACT

INTRODUCTION: There is lack of universal agreement on the management of COVID-19. Intravenous high dose vitamin C (HDVC), remdesivir (RDV), and favipiravir (FPV) have been suggested as part of the treatment regimens and only RDV is approved by the Food and Drug Administration (FDA) so far. There is no study in Lebanon that addresses the descriptive cohort of HDVC and antiviral therapy amongst COVID-19 inpatients. Our goal was to highlight such a cohort.

METHODOLOGY: A retrospective electronic chart review of COVID-19 inpatients was done over a period of 10 months (August 2020 to April 2021). Comparative data analysis was performed between HDVC and non-HDVC (NHDVC) groups, and RDV and FPV groups.

RESULTS: Among HDVC patients, 70.1% (p = 0.035) and 67.2% (p = 0.008) had dyspnea and desaturation respectively. Patients on HDVC were less likely to remain in hospital for more than 20 days (p = 0.003). HDVC patients were more likely to be on oxygen therapy with 74.7% (p = 0.002). RDV patients were more likely to be on other COVID-19-related medications during hospitalization including the use of tofacitinib, baricitinib, tocilizumab, and anticoagulation as recommended in the guidelines. Statistical significance was noted for the status on discharge as 90.1% of the patients that received RDV were discharged after clinical improvement, compared to the 74.2% of the FPV patients.

CONCLUSIONS: Further research is needed to establish local guidelines for the treatment of COVID-19. A significant role of HDVC and FPV might resurface if randomized control trials are conducted.

PMID:36332206 | DOI:10.3855/jidc.16884

J Asthma. 2022 Nov 4:1-17. doi: 10.1080/02770903.2022.2144354. Online ahead of print.

ABSTRACT

Objectives: Childhood asthma is one of the most common non-communicable diseases in the world. Several perinatal and postnatal factors have been associated with increased risk of developing childhood asthma. The present study aims to assess whether childhood overweight and obesity and abnormal birth anthropometric measures affect the risk of developing childhood asthma in pre-school age. Methods: In the present study, 5215 pre-school children at the age of 2-5 years were enrolled after applying several inclusion and exclusion criteria and they examined whether they present asthma symptoms. Non-adjusted and adjusted statistical analysis was performed to assess whether perinatal and postnatal factors increase the risk of developing childhood asthma. Results: A prevalence of 4,5% of childhood asthma was recorded. Among children diagnosed with asthma, 19,4% were affected by overweight and 13,9% were obese. Childhood overweight/obesity was indepedently associated with a 76% higher risk of childhood asthma than normal weight. Abnormal birth anthropometric measures, i.e. birth weight, length and head circumference, were independently associated with higher odds (87%, 29% and 23%, respectively) of childhood asthma than normal ranges. Conclusion: This is a cross-sectional, nationally representative study which supported evidence that childhood overweight/obesity and abnormal birth anthropometric measures may independently increase the risk of childhood asthma in pre-school age. Emergent health policies and strategies are recommended to promote healthy lifestyle, preventing childhood obesity at the early stages of life.

PMID:36332163 | DOI:10.1080/02770903.2022.2144354

Anal Chem. 2022 Nov 4. doi: 10.1021/acs.analchem.2c02332. Online ahead of print.

ABSTRACT

Estimation of the stoichiometric ratio of a supramolecular aggregate formed by different compounds is very important in elucidating the structure and function of the aggregate. Many spectroscopic methods used to estimate the stoichiometric ratios of coordination complexes become invalid when characteristic peaks of the aggregate overlap with peaks of compounds that form the aggregate. Previously, we combined the asynchronous orthogonal sample design with Job’s method to address the abovementioned problem. However, the interference of noise may lead to incorrect results. Herein, a new method has been developed. In the generation of corresponding Job’s curve, the intensity of a cross peak at a single apex is replaced by the volume of the cross peak. Since most noise is canceled in the calculation of the volume of the cross peak, resultant Job’s curve is robust to noise. Moreover, the Jonckheere-Terpstra statistical test, a famous nonparametric method to detect whether the data has an upward or downward trend, could further reduce the risk of yielding incorrect results caused by noise. We have applied this approach to two real-world examples (resveratrol/β-Cyclodextrin (β-CD) and N, N-diethyl-N‘-benzoylthiourea (DEBT)/Cu²⁺) with satisfactory results. The method described in this paper provides a robust way to measure the stoichiometric ratio in supramolecular systems.

PMID:36332132 | DOI:10.1021/acs.analchem.2c02332

Birth. 2022 Nov 4. doi: 10.1111/birt.12687. Online ahead of print.

ABSTRACT

BACKGROUNDS: Outpatient induction of labor (IOL) is an alternative choice offered to pregnant women requiring cervical ripening. Outpatient IOL can provide solutions in terms of women empowerment, but most importantly promotes as normal labor as possible, within the medical context of the IOL. The objectives of this systematic review were to assess safety and effectiveness of cervical ripening performed with a slow-release dinoprostone vaginal insert in term pregnancies in two settings: the outpatient (home) versus the inpatient (hospital).

METHODS: The electronic databases Cinahl, Embase, Medline and Maternity and Infant Care were searched to detect studies that met the inclusion criteria. Both reviewers collected the data and assessed the quality of the studies and assessed the pooled odds ratio using a 95% confidence interval and a random-effects model. Primary outcomes were linked to maternal and neonatal morbidity. Secondary outcomes were related to birth outcomes.

RESULTS: No statistical difference was seen between the outpatient and inpatient setting in terms of maternal complications, neonatal morbidity, cesarean section, and labor onset <24 h. Women in the outpatient setting were significantly less likely to experience uterine hyperstimulation, and they were also significantly more likely to require oxytocin to augment or induce their labor than the women in the inpatient setting. Women in the outpatient setting were more satisfied with the cervical ripening experience.

CONCLUSIONS: Cervical ripening with a slow-release dinoprostone vaginal insert in term pregnancies in the outpatient setting appears as safe as the inpatient setting in terms of maternal, neonatal, and birth outcomes.

PMID:36332128 | DOI:10.1111/birt.12687

Nephrol Nurs J. 2022 Sep-Oct;49(5):437-450.

ABSTRACT

This quality improvement project was implemented to improve renal hyperparathyroidism in patients with end stage kidney disease who are on hemodialysis through the implementation of a nurse-led etelcalcetide protocol. Results showed that the post-intervention group had a 16.7% increase of the intact parathyroid hormone (iPTH) range within the target goal compared to the 3-month pre-intervention assessment (95% CI; 20.3% to 48.1%). The odds of being in the PTH target range were 1.73 times higher after the 3-month intervention than measurements obtained before starting the intervention (95% CI for the odds ratio: 0.29 to 10.3). Despite the lack of statistical significance (p = 0.688) due to a small sample size, there was an improvement in reaching goal PTH levels. Further studies are needed to analyze the effectiveness of nurse-led protocols in treating renal hyperparathyroidism in dialysis patients.

PMID:36332124

Glob Health Sci Pract. 2022 Jun 29;10(3):e2100413. doi: 10.9745/GHSP-D-21-00413. Print 2022 Jun 29.

ABSTRACT

INTRODUCTION: Although community health workers (CHWs) are effective at mobilizing important health behaviors, there is limited evidence on how financial incentive systems can best be designed to drive their effectiveness. This study intends to bridge this evidence gap by analyzing the compensation model of India’s accredited social health activist (ASHA) program and identifying areas of improvement in the system’s design and implementation.

METHODS: We analyze the ASHA program in Uttar Pradesh, India. ASHAs receive compensation through a mix of program-linked, performance-based, and routine activity-based incentive structures. Using multiple data sources, including a novel linked household and ASHA survey, we estimate ASHA performance-linked incentive earnings under different scenarios of ASHA actions and household behaviors. Juxtaposing statistical projection models and actual government payments, we identified which incentives promised the highest payments, which were claimed or not, which could be claimed more by increasing ASHA actions, and which were paid despite not meeting payment criteria. We also report findings on ASHA awareness of and experiences with claiming incentives.

RESULTS: We find crucial gaps and implementation challenges in the ASHA incentive structure. ASHAs could double their earnings by completing certain tasks within their control. ASHAs may also be paid for partial completion of activities, as incentives are paid in lump sums for a series of activities rather than for each activity. Family planning incentives have the largest gap between potential and actual earnings. Incentivizing ASHAs for achieving certain health outcomes is inefficient, as no clear linkage was found between the achievability of such health outcomes and the claim amounts.

CONCLUSION: There are several opportunities for improving CHW compensation, from improving the incentive claims process to shifting focus to achievable outcomes. Optimizing incentive system designs can further enhance CHW effectiveness globally to affect key health behaviors.

PMID:36332076 | DOI:10.9745/GHSP-D-21-00413

Glob Health Sci Pract. 2022 Jun 29;10(3):e2100412. doi: 10.9745/GHSP-D-21-00412. Print 2022 Jun 29.

ABSTRACT

BACKGROUND: HIV self-testing (HIVST) is recommended by the World Health Organization, but implementation remains limited. This cross-sectional study evaluated HIVST uptake among female entertainment workers (EWs), men who have sex with men (MSM), and transgender women in Phnom Penh, Cambodia, to inform national implementation.

METHODS: Between December 2018 and September 2019, individuals reached through community outreach or via online advertising were offered HIVST or referrals to facility-based testing. Participants opting for HIVST could choose between test kits employing oral-fluid or finger-prick-based sample collection; and between an “assisted” option in which outreach staff offered instructions and assistance and an “unassisted” option in which participants received a kit with instructions for use. A structured questionnaire was administered to facilitate descriptive statistics and tests for associations between participant characteristics and HIV testing preferences and outcomes.

RESULTS: Among 1,241 eligible individuals; 1,210 (97.5%) provided responses for analysis. Of these, 1,203 (99.4%) were recruited through outreach; 7 (0.6%) through online advertising. Among those recruited by outreach, 1,186 (98.6%) opted for assisted HIVST, and 1,065 (88.5%) opted for oral-fluid versus finger-prick testing. All individuals recruited through online advertisements opted for unassisted oral-fluid testing. Among all participants, 455 (37.6%) were MSM, 325 (26.9%) were transgender women, 430 (35.5%) were female EWs, and overall, 71.7% reported never previously testing for HIV. A total of 84 participants (6.9%) received reactive screening results and 81 (97.5%) were linked to treatment.

CONCLUSION: Uptake of HIVST was high, and most participants preferred oral-fluid over finger-prick-based testing. Many individuals (72%) who had never previously accessed HIV testing services participated in HIVST, with high rates of reactivity.

PMID:36332061 | DOI:10.9745/GHSP-D-21-00412

World J Crit Care Med. 2022 May 9;11(3):160-168. doi: 10.5492/wjccm.v11.i3.160. eCollection 2022 May 9.

ABSTRACT

BACKGROUND: Prematurity in newborns is a condition that is associated with worse hospital outcomes when compared to birth to term. A preterm infant (PI) is classified when gestational age (GA) < 37 wk.

AIM: To analyze prognostic indicators related to the use of oxygen therapy, non-invasive ventilation (continuous positive airway pressure) and mechanical ventilation (MV) in PI.

METHODS: This is a retrospective cohort. The sample was composed of PIs from a private hospital in southern Brazil. We included neonates with GA < 37 wk of gestation in the period of January 1, 2018 to December 31, 2018. For data collection, electronic records were used in the Tasy Philips^TM system, identifying the variables: maternal age, type of birth, prenatal information, GA, Apgar score, birth weight, neonatal morbidities, vital signs in the 1st hour at birth, need for oxygen therapy, continuous positive airway pressure and MV, hospitalization in the neonatal intensive care unit, length of stay and discharge or death.

RESULTS: In total, 90 PI records were analyzed. The median (p25-p75) of GA was 34.0 (31.9-35.4) wk, and there were 45 (50%) males. The most common morbidity among PIs was the acute respiratory discomfort syndrome, requiring hospitalization in the neonatal intensive care unit in 76 (84.4%) cases. The utilization rate of oxygen therapy, continuous positive airway pressure and MV was 12 (13.3%), 37 (41.1%) and 13 (14.4%), respectively. The median (p25-p75) length of stay was 12.0 (5.0-22.2) d, with 10 (11.1%) deaths. A statistical association was observed with the use of MV and GA < 28 wk, lower maternal age, low birth weight, Apgar < 8 and neonatal deaths.

CONCLUSION: The identification of factors related to the need for MV in prematurity may help in the indication of a qualified team and technologies to promptly meet the unforeseen events that may occur after birth.

PMID:36331991 | PMC:PMC9136723 | DOI:10.5492/wjccm.v11.i3.160

PLoS One. 2022 Nov 4;17(11):e0275832. doi: 10.1371/journal.pone.0275832. eCollection 2022.

ABSTRACT

BACKGROUND: Studies from Asia, Europe and the USA indicate that widely available haematological parameters could be used to determine the clinical severity of Coronavirus disease 2019 (COVID-19) and predict management outcome. There is limited data from Africa on their usefulness in patients admitted to Intensive Care Units (ICUs). We performed an evaluation of baseline haematological parameters as prognostic biomarkers in ICU COVID-19 patients.

METHODS: Demographic, clinical and laboratory data were collected prospectively on patients with confirmed COVID-19, admitted to the adult ICU in a tertiary hospital in Cape Town, South Africa, between March 2020 and February 2021. Robust Poisson regression methods and receiver operating characteristic (ROC) curves were used to explore the association of haematological parameters with COVID-19 severity and mortality.

RESULTS: A total of 490 patients (median age 54.1 years) were included, of whom 237 (48%) were female. The median duration of ICU stay was 6 days and 309/490 (63%) patients died. Raised neutrophil count and neutrophil/lymphocyte ratio (NLR) were associated with worse outcome. Independent risk factors associated with mortality were age (ARR 1.01, 95%CI 1.0-1.02; p = 0.002); female sex (ARR 1.23, 95%CI 1.05-1.42; p = 0.008) and D-dimer levels (ARR 1.01, 95%CI 1.002-1.03; p = 0.016).

CONCLUSIONS: Our study showed that raised neutrophil count, NLR and D-dimer at the time of ICU admission were associated with higher mortality. Contrary to what has previously been reported, our study revealed females admitted to the ICU had a higher risk of mortality.

PMID:36331976 | DOI:10.1371/journal.pone.0275832

World J Crit Care Med. 2022 May 9;11(3):149-159. doi: 10.5492/wjccm.v11.i3.149. eCollection 2022 May 9.

ABSTRACT

BACKGROUND: Critically ill patients are at risk of developing stress cardiomyopathy (SC) but can be under-recognized.

AIM: To describe a case series of patients with SC admitted to critical care units.

METHODS: We conducted a retrospective observational study at a tertiary care teaching hospital. All adult (≥ 18 years old) patients admitted to the critical care units with stress cardiomyopathy over 5 years were included.

RESULTS: Of 24279 admissions to the critical care units [19139 to medical-surgical intensive care units (MSICUs) and 5140 in coronary care units (CCUs)], 109 patients with SC were identified. Sixty (55%) were admitted to the coronary care units (CCUs) and forty-nine (45%) to the medical-surgical units (MSICUs). The overall incidence of SC was 0.44%, incidence in CCU and MSICU was 1.16% and 0.25% respectively. Sixty-two (57%) had confirmed SC and underwent cardiac catheterization whereas 47 (43%) had clinical SC, and did not undergo cardiac catheterization. Forty-three (72%) patients in the CCUs were diagnosed with primary SC, whereas all (100%) patients in MSICUs developed secondary SC. Acute respiratory failure that required invasive mechanical ventilation and shock developed in twenty-nine (59%) MSICU patients. There were no statistically significant differences in intensive care unit (ICU) mortality, in-hospital mortality, use of inotropic or mechanical circulatory support based on type of unit or anatomical variant.

CONCLUSION: Stress cardiomyopathy can be under-recognized in the critical care setting. Intensivists should have a high index of suspicion for SC in patients who develop sudden or worsening unexplained hemodynamic instability, arrhythmias or respiratory failure in ICU.

PMID:36331975 | PMC:PMC9136722 | DOI:10.5492/wjccm.v11.i3.149