Global health journal (Amsterdam, Netherlands)最新文献

The occurrence of cardiovascular illness in the human immunodeficiency virus (HIV) community is increasing, with a particular focus on coronary heart disease. Patients infected with HIV have a higher risk of myocardial infarction compared to the general population in modern countries due to the development of effective antiretroviral medications and increased life expectancy. Those not receiving highly active antiretroviral therapy (ART) may experience common cardiac consequences, including myocarditis, dilated cardiomyopathy, endocarditis, pulmonary hypertension, pericardial effusion, and cardiotoxicity associated with non-antiretroviral drugs. After the use of highly active ART, continuing immune activation and systemic inflammation seem to play a central role in this process. Recent studies suggest that protease inhibitors might negatively impact the progression of HIV-related heart failure (HF), which complicates the determination of the best therapy strategy for HIV-associated cardiomyopathy. The objective of this review is to examine the pathophysiology and correlation of various antiretroviral drugs leading to HIV-associated HF. Additionally, we explore the causes of HIV-associated atherosclerotic cardiovascular disease, including the high frequency of classic cardiovascular risk factors in HIV-infected patients, as well as HIV-related factors like the use of ART and chronic inflammation despite successful treatment of HIV infection. Numerous studies have revealed that individuals living with HIV/acquired immune deficiency syndrome frequently experience HF. In conclusion, despite advancements in HIV care, HIV-infected individuals continue to face an increased risk of HIV-associated cardiomyopathy and atherosclerosis. Further research is necessary to comprehend the underlying causes and develop effective treatments for cardiovascular disease in this population. We also discuss the currently available therapeutic options and ongoing research to mitigate the risk of cardiovascular disease and inflammation in HIV-infected individuals.

Objective

Socioeconomic status (SES) is associated with childhood obesity, but the underlying factors remain unknown. This study aimed to identify mediators that may explain SES disparities in childhood obesity in China.

Methods

Nationally representative longitudinal data from the China Education Panel Survey of 11 019 children (13.03 ± 0.79) collected from 2013‒2014 to 2016‒2017 academic years. Overweight/obesity was defined using Chinese national body mass index cut-points. Principal component analysis was used to convert the four SES indicators (maternal and paternal education, and occupation) into one comprehensive variable. Mediation analysis for SES disparities in childhood obesity was conducted using structure equation models.

Results

The prevalence of overweight/obesity was 12.8%, and was higher in boys than in girls (17.8% vs. 7.6%, P < 0.001) at baseline. Among boys, relative risk (RR) of obesity was 1.23 (95% CI: 1.09 to 1.40, P < 0.001) for per unit change in SES. There was no significant association between obesity and SES among girls. Mediation analyses showed that among boys, birth weight, being the only child in the family and children's self-perceived weight status mediated 70.0% of the effects of SES on obesity. No mediation effect was detected in girls.

Conclusions

Chinese boys are more likely to be overweight or obese than girls. SES may impact childhood obesity through birth weight, being the only child in the family and children's self-perceived body weight status in boys, but not in girls. More attention should be made to address childhood obesity in high SES families among boys. Interventions targeting at these mediators are needed.

Background and objective

To provide good health and well-being as established by the Sustainable Development Goal (SDG) 3, access to digital technologies can act as conduits to achieve such progress in a population. As guided by the World Health Organization, antenatal care (ANC) attendance is one of the measures promoted to curtail the global health burden of maternal and infant mortality. ANC services are seldom utilized to their full potential in Zimbabwe. This study explores if any of the women's digital technology characteristics were associated with antenatal care visits.

Methods

The study analyzed population-based cross-sectional data with a subsample of 1 932 women aged 15‒49 years from the 2019 Zimbabwe Multiple Indicator Cluster Survey. Test of associations with chi-square test, bivariate, and multivariate multinomial logistic regression analyses were used to examine the predictors of adequate (4‒7) and optimal (≥ 8) ANC visits relative to undesirable (1‒3) antenatal care visits among women who had given births 2 years before the survey.

Results

The results indicate that 64.5% (1246/1 932) of the women attained adequate ANC while about 9.8% (189/1 932) attained optimal ANC. Reading a newspaper/magazine at least once a week (odds ratio [OR] 1.73, β’ = 0.551, t = 2.030, P = 0.043) and watching television at least once a week (OR 1.72, β’ = 0.545, t = 2.454, P = 0.015), listening to the radio less than once a week (OR 1.28, β’ = 0.247, t = 1.750, P = 0.080), and owning a mobile phone (OR 1.48, β’ = 0.394, t = 3.020, P = 0.003) were positively associated with adequate ANC. Optimal ANC was significantly associated with women being able to read a newspaper at least once a week (OR 2.93, β’ = 1.074, t = 3.120, P = 0.002), listen to the radio less than once a week (OR 2.07, β’ = 0.73, t = 2.700, P = 0.007) and have ownership of a mobile phone (OR 1.88, β’ = 0.631, t = 2.620, P = 0.009).

Conclusion

Access to a newspaper, radio, television, and mobile phone were important predictors of a woman's ability to achieve her ANC attendance. Policies to improve the knowledge of ANC packages can be facilitated using digital technology to achieve adequate and preferably optimal ANC in Zimbabwe. It is important to improve digital infrastructure to support digital technologies in providing ANC services.

Background

Carbapenems are effective against severe Pseudomonas aeruginosa nosocomial infections. Therefore, carbapenem-resistant Pseudomonas aeruginosa is a serious public health threat. An understanding of the risk of inappropriate exposure to different antimicrobials in resistant Pseudomonas aeruginosa infection could help in elucidating the effective approach towards using antimicrobials in vulnerable patients with CRPA infection.

Object

To investigate the association between exposure of β-lactam antimicrobials and CRPA infection relative to control patients.

Methods

The MEDLINE/PubMed and OVID/Embase databases were used to search case-control and cohort studies in English language which reported antimicrobial exposure as risk factors for CRPA infection. The pooled odds ratios (OR) were calculated using a random-effect and fixed-effect model, and forest plots from a cumulative meta-analysis method were used to better show how pooled OR changed as updated evidence accumulated.

Results

A total of 24 studies comprising 7 039 participants were included for cumulative meta-analysis. A positive correlation was found between development of CRPA infection and exposure of beta-lactam antimicrobials: carbapenems (OR = 7.60, 95% CI: 3.95 to 14.62, P < 0.0001), imipenem (OR = 9.81, 95% CI: 5.56 to 17.33), ampicillin (OR = 1.86, 95% CI: 1.14 to 2.41), piperacillin (OR = 2.82, 95% CI: 1.46 to 2.43), penicillins (OR = 1.42, 95% CI: 0.90 to 2.24), cephalosporins (OR = 1.88, 95% CI: 1.46 to 2.43) and β lactamase inhibitors (OR = 1.96, 95% CI: 1.44 to 2.67). Further, exposure of other antimicrobial agents like quinolone (OR = 2.35, 95% CI: 1.78 to 3.10), ciprofloxacin (OR = 2.35, 95% CI: 1.66 to 3.95), aminoglycoside (OR = 2.17, 95% CI: 1.60 to 2.95), amikacin (OR = 3.11, 95% CI: 2.10 to 4.61), glycopeptides (OR = 3.02, 95% CI: 1.92 to 4.75) and vancomycin (OR = 3.26, 95% CI: 1.48 to 7.18), were also found to be positively associated with development of CRPA infection.

Conclusions

Exposure of all kinds of β-lactams is significantly associated with development of carbapenem-resistant Pseudomonas aeruginosa infection. These findings provide an impetus to take a more active approach while using β-lactam antimicrobials in patients with resistant Pseudomonas aeruginosa infections.

Objective

Polycystic ovary syndrome (PCOS) is a pathophysiological disorder affecting reproductive and metabolic indices in females. The present study was designed to compare the efficacy of metformin and D-chiro-inositol in PCOS patients.

Methods

In a tertiary care hospital in North India, prospective observational research was undertaken on 100 patients with PCOS, which was diagnosed based on European Society of Human Reproduction and Embryology Guidelines and ultrasound of lower abdomen. The study involves various clinical characteristics into consideration for the determination of statistical significance (P < 0.05) in PCOS patients. Student's t-test along with the association between PCOS and patients taking metformin and D-chiro-inositol, as well as their impact on various biochemical parameters, were investigated finally using Pearson Correlation Analysis.

Results

This study comprises 50 patients taking metformin and 50 patients taking D-chiro-inositol in women suffering from PCOS. Body mass index (BMI) and waist-to-hip ratio (WHR) were statistically significant (P < 0.05) within the groups of both metformin and D-chiro-inositol. Biochemical parameters such as luteinizing hormone (LH), follicle stimulating hormone (FSH), anti-mullerian hormone (AMH) and glycated hemoglobin (HbA1c) were found to be statistically significant (P < 0.05) in both groups. LH, FSH and AMH (14.40 ± 0.52; 14.28 ± 0.53; 1.99 ± 0.10) were comparatively lower in patients taking D-chiro-inositol as compared to metformin group (14.17 ± 0.42; 19.88 ± 1.01; 2.61 ± 0.04). HbA1c (3.71 ± 0.08) with P < 0.05 was found to be decreased more in metformin group as compared to patients taking D-chiro-inositol (4.90 ± 0.09). A positive correlation was found between HbA1c and LH in metformin, & HbA1c and FSH in D-chiro-inositol groups, respectively.

Conclusion

The results indicate that D-chiro-inositol shows better results in reducing clinical variables involved in causing PCOS as compared to metformin whereas metformin has better glycemic control in PCOS patients.

Introduction

Heart failure is a major public health issue with a prevalence of about 26 million people worldwide. Reduced nitric oxide availability, lower soluble guanylate cyclase (sGC) activity, and decreased cyclic guanosine monophosphate (cGMP) production are the causes of HF's development. Vericiguat prescribed under the brand name Verquvo was approved by U.S. Food and Drug Administration (FDA) in January 2021. It is a novel agent and the first sGC stimulator which helps to treat patients suffering from heart failure with reduced ejection fraction (HFrEF).

Objective

The mechanism of action (cGMP pathway) of vericiguat, its clinical trials, its use in the treatment of heart failure, and its possible future aspects in therapeutic recommendations are all covered in this review. It will also raise awareness amongst healthcare professionals about the pharmacokinetic and pharmacodynamic parameters, dosing, administration, and drug-related problems of this new drug.

Methods

Various databases for drug review were used in this review like PubMed, Medline, Google scholar, Drug bank, U.S. FDA, Medscape, and European society of cardiology guidelines. A total of 58 articles were screened out of which 39 articles were included in this review.

Results

This review discusses vericiguat's mechanism of action (cGMP pathway), clinical studies, application in the treatment of heart failure, and potential future considerations in therapeutic recommendations. It will also educate healthcare professionals about the new drug's pharmacokinetics and pharmacodynamics, dose, administration, and drug-related problems.

Conclusion

After hospitalization for HFrEF, the 5-year survival rate is just 25%, and disease morbidity and death are still significant. As adjunctive therapy for individuals with heart failure and a low ejection fraction, vericiguat has a moderate level of effectiveness. Vericiguat's efficacy as an adjunct therapy to different drugs used to cure HF has to be further investigated. Vericiguat's safety and dosage in patients who have severe renal or hepatic illness need to be studied further.

Background and object

The burden of neurological disorders in India is expected to increase due to the rapid demographic and epidemiological transition, with irrational drug use, which is also a global concern. Thus, drug utilization evaluation is designed to ensure appropriate medicine use within the healthcare settings. The aim of the study was to assess the rate and pattern of drug utilization in the management of neurological disorders.

Materials and methods

A hospital-based cross-sectional drug utilization evaluation study on neurological drugs was carried out at the Department of Neurology over a span of six months. All legible prescriptions consisting neurological medications irrespective of patient's gender, aged ≥ 18 years were included for the study. The World Health Organization (WHO) core drug use indicators were used to assess the drug prescribing and utilization patterns.

Results

A total of 310 prescriptions were reviewed, where male predominance was found to be 56.45%. Out of 310 prescriptions, drugs belonging to 26 neurological classes were prescribed for the management of various neurological disorders. The majority of patients were diagnosed with epilepsy and the most prescribed drugs per patient were phenytoin (14.8%) and valproic acid (6.45%). By following the WHO core drug prescribing indicators, 65.47% of drugs prescribed from the India National List of Essential Medicines, 2022, followed by 29.83% of drugs prescribed in generic name and 10.86% of prescriptions including injections.

Conclusion

The study findings showed that the prescribing pattern in the Department of Neurology was in accordance with the WHO core prescribing indicators. But, the extent of polypharmacy prescriptions was very high. Therefore, interventions are very necessary to promote rational drug prescribing patterns and thus clinical pharmacists can contribute to assess and review the drug utilization pattern to optimize the drug therapy and improvement in patient safety.

Objective

We examined the association between body mass index (BMI) and body fat percentage (BF%) measured by dual-energy X-ray absorptiometry (DXA) among adults and children in China.

Methods

We searched four databases–PubMed, China National Knowledge Infrastructure, Wanfang, and Vip for studies published in the past 22 years. Meta-analysis was conducted using random- or fixed-effect models.

Results

In total of 21 studies met inclusion criteria and were included in review, and 17 ot them in meta-analysis. They were conducted across China. Their sample size ranged from 62 to 5 726, and participants’ age ranged from 6‒80 years. Meta-analysis revealed strong associations between BMI and BF% measured by DXA in adults (pooled r = 0.71, 95% CI: 0.66 to 0.74) and children (pooled r = 0.60, 95% CI: 0.52 to 0.68). The association was stronger in Northern China than in East China in children (β = −0.40, 95% CI: −0.65 to −0.14) and in Central China in adults (β = −0.25; 95% CI: −0.51 to −0.01). Urban children's BMI was strongly associated with BF% than rural (β = 0.19; 95% CI: 0.04 to 0.35), whereas it was stronger in adults living in rural than in urban (β = −0.35; 95% CI: −0.66 to −0.05).

Conclusions

BMI was strongly associated with BF% measured by DXA, and the association in children and adults in China varied by residence and region.

The monkeypox, a viral zoonotic disease usually found in forest areas of Central and Western Africa, has spread worldwide through new modes of transmission little understood. The WHO on 23 July 2022, declared the virus a Public Health Emergency of International Concern (PHEIC).The declaration has stirred criticism from leading scientists that the criteria for PHEIC as defined by International Health Regulation have not been met and it is non-transparent and contradictory. This paper reviews the criteria of PHEIC and weighs the rationales behind the declaration to increase the clarity of the WHO's decision, justifications, and legitimacy in the ongoing outbreak.