Comparison of transcatheter versus surgical closure of perimembranous ventricular septal defect in pediatric patients: A systematic review and meta-analysis

ObjectivePerimembranous ventricular septal defect (pmVSD) is a common congenital heart disease (CHD) usually treated with either catheter or surgical closure. Superiority of one procedure over the other in children is still a matter of debate. We performed this meta-analysis to compare the clinical outcomes and cost of transcatheter and surgical closure of pmVSD in children.Materials and methodsWe searched seven databases (MEDLINE, PubMed, EMBASE, Google Scholar, CENTRAL, CINHAL, and Cochrane library) and literature references for articles published in the past 10 years (between January 2008 and January 2018) comparing closure of pmVSD by both procedures in children. The outcomes of interest were success rate, residual shunt, need for blood transfusion, complications especially complete atrioventricular block, length of hospital stay, and cost.ResultsA total of 1750 articles were identified. However, only five studies fulfilled the inclusion criteria. As regards success rate, no significant difference was found between surgical and catheter closure. Residual shunt was significantly lower in catheter closure than surgical closure [risk ratio (RR) = 0.44; 95% confidence interval (CI), 0.23–0.83, p = 0.01). The need for blood transfusion and the length of hospital stay were significantly lower in the catheter closure compared to surgical closure (RR = 0.02; 95% CI, 0.01–0.08; p < 0.00001), (RR = ?4.81; 95% CI, ?7.76 to ?1.86; p = 0.001), respectively. However, overall complications, complete atrioventricular block, and the cost were comparable in both procedures.ConclusionTranscatheter closure of pmVSD in children was as effective as surgical closure with a lower residual shunt and need for blood transfusion, and shorter hospital stay.     

Assessment of the link between endothelin K198n Snp,endothelin concentration and acute myocardial infarction in Egyptians

The aim of the current study was to assess the link between EDN K198N SNP, ET‐1 serum concentration and acute myocardial infarction (AMI) in Egyptians. The study cohort consisted of 84 patients at AMI onset and 84 age‐matched healthy controls. Endothelin genotypes and concentrations were determined by sequencing and ELISA, respectively. Genotype distribution was not significantly different between AMI patients and controls (P=.8341). The mean serum ET‐1 concentration of patients (13.83±0.7 pg/mL) was significantly higher than controls (7.26±0.2 pg/mL) (P<.0001). ET‐1 serum concentrations did not vary significantly among various EDN genotypes in patients (P=.378) and controls (P=.6164). Hence, we conclude that EDN K198N genotypes were not related to either ET‐1 concentration or incidence of early‐onset AMI in Egyptians. But, AMI patients had higher ET‐1 concentrations than controls.     

Characteristics,sources, and health risks of atmospheric PM10-bound heavy metals in a populated middle eastern city

ABSTRACT

This study reports on the characteristics, sources, and health risks of atmospheric PM₁₀-bound heavy metals (HMs) on citizenship living in different regions of Ahvaz, Southwest of Iran were investigated during 2016–2017. A total of 84 samples were analyzed from different regions: (S1) industrial, (S2) high traffic, and (S3) residential. Blood samples were collected from people who came to the east health center of Ahvaz. High volume air samplers, equipped with quartz fiber filters (8?×?10) were utilized for sampling in this study. Inductively coupled plasma optical emission spectroscopy (ICP-OES) was also used for HMs. Risk assessment and hazard index of these pollutants were estimated, using USEPA’s exposure parameters. Based on the results, the highest and the lowest concentration of HM were observed in industrial and residential areas. Blood’s HMs concentration for chromium (Cr), nickel (Ni), lead (Pb), and zinc (Zn) were 2.932, 4.199, 8.425, and 71.2?μg/dL, respectively. In conclusion, increasing exposure concentration of HMs would have a significant potential for increased cancer and risk of diseases. The results of this study show that increasing exposure concentration to HM in the studied scenarios have a significant potential for generating different health endpoints, although exposing to HMs led to generating diseases in individuals particularly in polluted and populated districts; so, environmental measures should be considered by urban air authorities to mitigate the concentration of these pollutants in ambient air.     

Stimuli-responsive graphene-incorporated multifunctional chitosan for drug delivery applications: a review

Introduction: Recently, the use of chitosan (CS) in the drug delivery has reached an acceptable maturity. Graphene-based drug delivery is also increasing rapidly due to its unique physical, mechanical, chemical, and electrical properties. Therefore, the combination of CS and graphene can provide a promising carrier for the loading and controlled release of therapeutic agents.

Area covered: In this review, we will outline the advantages of this new drug delivery system (DDS) in association with CS and graphene alone and will list the various forms of these carriers, which have been studied in recent years as DDSs. Finally, we will discuss the application of this hybrid composite in other fields.

Expert opinion: The introducing the GO amends the mechanical characteristics of CS, which is a major problem in the use of CS-based carriers in drug delivery due to burst release in a CS-based controlled release system through the poor mechanical strength of CS. Many related research on this area are still not fully unstated and occasionally they seem inconsistent in spite of the intent to be complementary. Therefore, a sensitive review may be needed to understand the role of graphene in CS/graphene carriers for future drug delivery applications.     

Dietary total antioxidant capacity and incidence of chronic kidney disease in subjects with dysglycemia: Tehran Lipid and Glucose Study

Purpose

We aimed to investigate the association of dietary total antioxidant capacity (TAC) with incidence of CKD in subjects with dysglycemia.

Methods

We followed-up 1179 subjects aged ≥30 years with dysglycemia from the Tehran Lipid and Glucose Study (TLGS) for 3 years, who were initially free of CKD. Dietary intakes of TAC, vitamin C, vitamin E, and β-carotene were assessed by a food-frequency questionnaire at the baseline. Dietary TAC was estimated using the oxygen radical absorbance capacity method. Estimated glomerular filtration rate (eGFR) was calculated, using the Modification of Diet in Renal Disease Study equation and CKD was defined as eGFR <60 mL/min/1.73 m². Odds ratios (ORs) using multivariable logistic regression were reported for the association of incident CKD with dietary TAC.

Results

A total of 197 (16.7%) cases of incident CKD were recorded after 3 years of follow-up. After adjustment for age, sex, smoking, physical activity, body mass index, hypertension, and total energy intake, the top tertile of dietary TAC compared to the bottom was associated with 39% [95% confidence interval (CI) = 0.40–0.93] lower risk of incident CKD (P for trend = 0.025). Furthermore, the highest tertile of vitamin C intake compared to the lowest risk of incident CKD was decreased (OR 0.60; 95% CI 0.38–0.93, P trend 0.023). Intakes of vitamin E and β-carotene were not significantly associated with incident CKD risk.

Conclusion

Our findings suggest that diets high in TAC are associated with a lower risk of incident CKD among subjects with hyperglycemia after 3 years of follow-up.

     

The effect of nettle (Urtica dioica) supplementation on the glycemic control of patients with type 2 diabetes mellitus: A systematic review and meta‐analysis

Type 2 diabetes mellitus (T2DM) is a major health problem, worldwide, that is associated with increased morbidity and mortality. Several randomized controlled clinical trials (RCTs) have investigated the effect of nettle (Urtica dioica) supplementation on markers of glycemic status in patients with T2DM, with conflicting results. Therefore, the present study assessed the effect of nettle on some glycemic parameters in patients with T2DM. A comprehensive search was conducted in PubMed, Scopus, Cochrane Library, and Web of Science, from database inception up to June 2019, to identify RCTs investigating the effect of nettle supplementation on glycemic markers, including fasting blood sugar (FBS) concentrations, insulin levels, homeostasis model assessment‐estimated insulin resistance index, and glycosylated hemoglobin percentage in adults with T2DM. The Cochrane Collaboration tool was used to assess the methodological quality of the included studies. Results of this meta‐analysis were reported based on the random effects model. Eight RCTs, comprising 401 participants, were included in the present systematic review and meta‐analysis. Based on the Cochrane Collaboration risk of bias tool, five studies were considered as good quality, one was fair, and two studies were poor, respectively. The results of the meta‐analysis revealed a significant reduction in FBS concentrations (weighted mean difference [WMD]: ?18.01 mg/dl, 95% confidence interval [CI]: ?30.04 to ?5.97, p < .001, I² = 94.6%) following nettle supplementation. However, no significant reduction was observed in insulin levels (WMD: 0.83 Hedges' g, 95% CI: ?0.26 to 1.92, p = .13, I² = 89.4%), homeostasis model assessment‐estimated insulin resistance index (WMD: ?0.22, 95% CI: ?0.83 to 0.40, p = .49, I² = 69.2%), or glycosylated hemoglobin percentage (WMD: ?0.77%, 95% CI: ?1.77 to 0.22, p = .12, I² = 83.0%). The findings of the present study suggest that nettle supplementation may be effective in controlling FBS for T2DM patients. However, further studies are needed to confirm the veracity of these results.     

A measles and rubella (MR) catch-up vaccination campaign in an Egyptian University: Vaccine uptake and knowledge and attitudes of students

Introduction

In 2008, following a rubella epidemic, the Egyptian Ministry of Health implemented a Measles Rubella (MR) catch-up campaign, based on WHO recommendations for supplementary immunization activities to eliminate measles by 2010. The age group targeted was 10–20 years. This campaign was unique in Egypt as it was the first national vaccination campaign which included university students.

Aim

To report uptake of MR vaccine and reasons for declining the vaccine among medical and non-medical students in the campaign and to assess the knowledge about the vaccine and the diseases.

Methods

The study was conducted in two stages. In the first stage during the vaccination sessions, medical and other students (N = 310) were given a questionnaire to assess their knowledge of the campaign and the vaccine. The second stage (N = 341) was carried out when the campaign was completed to assess vaccine uptake among medical students.

Results

Posters displayed inside the university were reported to be the main source of information about the campaign. Students were generally poorly informed about both vaccine adverse effects, and contraindications although medical students tended to be better informed than other students. Overall 64.8% medical students accepted the vaccine with higher uptake among females than males (85.9 and 58.3% respectively). Non-compliant students had a significantly higher mean age. Almost half of students who did not accept the vaccine gave their reason as having little information about the vaccine (43.3%).

Conclusion

The MR campaign in Ain Shams University may have been more successful with better use of health education messages.     

Methods for generalized change-point models: with applications to human immunodeficiency virus surveillance and diabetes data

In many epidemiological and biomedical studies, the association between a response variable and some covariates of interest may change at one or several thresholds of the covariates. Change-point models are suitable for investigating the relationship between the response and covariates in such situations. We present change-point models, with at least one unknown change-point occurring with respect to some covariates of a generalized linear model for independent or correlated data. We develop methods for the estimation of the model parameters and investigate their finite-sample performances in simulations. We apply the proposed methods to examine the trends in the reported estimates of the annual percentage of new human immunodeficiency virus (HIV) diagnoses linked to HIV-related medical care within 3 months after diagnosis using HIV surveillance data from the HIV prevention trial network 065 study. We also apply our methods to a dataset from the Pima Indian diabetes study to examine the effects of age and body mass index on the risk of being diagnosed with type 2 diabetes.     

Development of the Inventory Management and Tracking System (IMATS) to Track the Availability of Public Health Department Medical Countermeasures During Public Health Emergencies

Objective

To bridge gaps identified during the 2009 H1N1 influenza pandemic by developing a system that provides public health departments improved capability to manage and track medical countermeasures at the state and local levels and to report their inventory levels to the Centers for Disease Control and Prevention (CDC).

Materials and Methods

The CDC Countermeasure Tracking Systems (CTS) program designed and implemented the Inventory Management and Tracking System (IMATS) to manage, track, and report medical countermeasure inventories at the state and local levels. IMATS was designed by CDC in collaboration with state and local public health departments to ensure a “user-centered design approach.” A survey was completed to assess functionality and user satisfaction.

Results

IMATS was deployed in September 2011 and is provided at no cost to public health departments. Many state and local public health departments nationwide have adopted IMATS and use it to track countermeasure inventories during public health emergencies and daily operations.

Discussion

A successful response to public health emergencies requires efficient, accurate reporting of countermeasure inventory levels. IMATS is designed to support both emergency operations and everyday activities. Future improvements to the system include integrating barcoding technology and streamlining user access. To maintain system readiness, we continue to collect user feedback, improve technology, and enhance its functionality.

Conclusion

IMATS satisfies the need for a system for monitoring and reporting health departments’ countermeasure quantities so that decision makers are better informed. The “user-centered design approach” was successful, as evident by the many public health departments that adopted IMATS.