Adherence to antihypertensives in the United States: A comparative meta-analysis of 23 million patients.

Adherence to antihypertensives is crucial for control of blood pressure. This study analyzed factors and interventions that could affect adherence to antihypertensives in the US. PubMed, Scopus, Web of Science, and Embase were searched on January 21, 2022 and December 25, 2023 for studies on the adherence to antihypertensives in the US. Nineteen studies and 23 545 747 patients were included in the analysis, which showed that adherence to antihypertensives was the highest among Whites (OR: 1.47, 95% CI 1.34-1.61 compared to African Americans). Employment status and sex were associated with insignificant differences in adherence rates. In contrast, marital status yielded a significant difference where unmarried patients demonstrated low adherence rates compared to married ones (OR: 0.8, 95% CI 0.67-0.95). On analysis of comorbidities, diabetic patients reported lower adherence to antihypertensives (OR: 0.95, 95% CI 0.92-0.97); furthermore, patients who did not have Alzheimer showed higher adherence rates. Different BMIs did not significantly affect the adherence rates. Patients without insurance reported significantly lower adherence rates than insured patients (OR: 3.93, 95% CI 3.43-4.51). Polypill users had higher adherence rates compared with the free-dose combination (OR: 1.21, 95% CI 1.2-1.21), while telepharmacy did not prove to be as effective. Lower adherence rates were seen among African Americans, uninsured, or younger patients. Accordingly, interventions such as fixed-dose combinations should be targeted at susceptible groups. Obesity and overweight did not affect the adherence to antihypertensives.

Anthracyclines and the risk of arrhythmias: A systematic review and meta-analysis.

BACKGROUND: There have been controversial findings from recent studies regarding anthracyclines use and the subsequent risk of arrhythmias. This study aimed to evaluate the existing evidence of the risk of arrhythmias in patients treated with anthracyclines. METHODS: PubMed, Scopus, and Web of Science databases were searched up to April 2022 using keywords such as "anthracycline" and "arrhythmia." Dichotomous data were presented as relative risk (RR) and confidence interval (CI), while continuous data were presented as mean difference (MD) and CI. Revman software version 5.4 was used for the analysis. RESULTS: Thirteen studies were included with a total of 26891 subjects. Pooled analysis showed that anthracyclines therapy was significantly associated with a higher risk of arrhythmia (RR: 1.58; 95% CI: 1.41-1.76; P < .00001), ST segment and T wave abnormalities (RR: 1.73, 95% CI: 1.18-2.55, P = .005), conduction abnormalities and AV block (RR = 1.86, 95% CI = 1.06-3.25, P = .03), and tachycardia (RR: 1.736, 95% CI: 1.11-2.69, P = .02). Further analyses of the associations between anthracyclines and atrial flutter (RR = 1.30, 95% CI = 0.29-5.89, P = .74), atrial ectopic beats (RR: 1.27, 95% CI: 0.78-2.05, P = .34), and ventricular ectopic beats (RR: 0.93, 95% CI: 0.53-1.65, P = .81) showed no statistically significant results. Higher doses of anthracycline were associated with a higher risk of arrhythmias (RR: 1.49; 95% CI: 1.08-2.05; P = .02) compared to the lower doses (RR: 1.36; 95% CI: 1.00-1.85; P = .05). Newer generations of Anthracycline maintained the arrhythmogenic properties of previous generations, such as Doxorubicin. CONCLUSION: Anthracyclines therapy was significantly associated with an increased risk of arrhythmias. Accordingly, Patients treated with anthracyclines should be screened for ECG abnormalities and these drugs should be avoided in patients susceptible to arrhythmia. The potential benefit of the administration of prophylactic anti-fibrotic and anti-arrhythmic drugs should also be explored.

Association between insomnia and the incidence of myocardial infarction: A systematic review and meta-analysis.

BACKGROUND: Insomnia has been closely associated with cardiovascular disease (CVD) including myocardial infarction (MI). Our study aims to assess the eligibility of insomnia as a potential risk factor for MI. METHODS: PubMed, Scopus, and Web of Science were searched using terms; such as "Insomnia" and "MI." Only observational controlled studies with data on the incidence of MI among insomniacs were included. Revman software version 5.4 was used for the analysis. RESULTS: Our pooled analysis showed a significant association between insomnia and the incidence of MI compared with noninsomniacs (relative risk [RR] = 1.69, 95% confidence interval [CI] = 1.41-2.02, p < .00001). Per sleep duration, we detected the highest association between ≤5 h of sleep, and MI incidence compared to 7-8 h of sleep (RR = 1.56, 95% CI = 1.41-1.73). Disorders of initiating and maintaining sleep were associated with increased MI incidence (RR = 1.13, 95% CI = 1.04-1.23, p = .003). However, subgroup analysis of nonrestorative sleep and daytime dysfunction showed an insignificant association with MI among both groups (RR = 1.06, 95% CI = 0.91-1.23, p = .46). Analysis of age, follow-up duration, sex, and comorbidities showed a significant association in insomniacs. CONCLUSION: Insomnia and ≤5 h of sleep are highly associated with increased incidence of MI; an association comparable to that of other MI risk factors and as such, it should be considered as a risk factor for MI and to be incorporated into MI prevention guidelines.

Occurrence of Listeria spp. in Soft Cheese and Ice Cream: Effect of Probiotic Bifidobacterium spp. on Survival of Listeria monocytogenes in Soft Cheese.

Listeria monocytogenes is one of the most important emerging foodborne pathogens. The objectives of this work were to investigate the incidence of Listeria spp. and L. monocytogenes in soft cheese and ice cream in Assiut city, Egypt, and to examine the effect of some probiotic Bifidobacterium spp. (Bifidobacterium breve, Bifidobacterium animalis, or a mixture of the two) on the viability of L. monocytogenes in soft cheese. The existence of Listeria spp. and L. monocytogenes was examined in 30 samples of soft cheese and 30 samples of ice cream. Bacteriological analyses and molecular identification (using 16S rRNA gene and hlyA gene for Listeria spp. and L. monocytogenes, respectively) were performed on those samples. Additionally, Bifidobacterium spp. were incorporated in the making of soft cheese to study their inhibitory impacts on L. monocytogenes. Out of 60 samples of soft cheese and ice cream, 25 samples showed Listeria spp., while L. monocytogenes was found in only 2 soft cheese samples. Approximately 37% of soft cheese samples (11 out of 30) had Listeria spp. with about 18.0% (2 out of 11) exhibiting L. monocytogenes. In ice cream samples, Listeria spp. was presented by 47% (14 out of 30), while L. monocytogenes was not exhibited. Moreover, the addition of B. animalis to soft cheese in a concentration of 5% or combined with B. breve with a concentration of 2.5% for each resulted in decreasing L. monocytogenes efficiently during the ripening of soft cheese for 28 d. Listeria spp. is widely found in milk products. Probiotic bacteria, such as Bifidobacterium spp., can be utilized as a natural antimicrobial to preserve food and dairy products.

Knowledge, attitudes, and practices related to COVID-19 infection, related behavior, antibiotics usage, and resistance among Syrian population: A cross-sectional study.

Background and Aims: Antibiotic resistance is seen as a worldwide health risk as a result of the overuse of antibiotics. Many countries noted that antibiotic usage was high during the COVID-19 pandemic. The purpose of this study is to evaluate Syrians' knowledge, attitudes, and practice about the use of antibiotics and antibiotic resistance during the COVID-19 epidemic. Methods: A cross-sectional study was conducted using an online questionnaire to collect the data from the Syrian population from February 5 to March 4, 2022. Syrians 18 years or older all over the world were able to participate in this study. A convenience snowball sampling method was used. SPSS version 20.0 was used to analyze the data. To examine the results, binominal logistic regression was used. Statistical significance was defined as a p < 0.05. Results: Out of 2406 respondents, 60.2% knew that transmission of COVID-19 could occur even if the patient has not developed any symptoms, and 91.6% were able to recognize the main clinical symptoms of COVID-19. There was a statistically significant difference between male and female knowledge of COVID-19 (p = 0.002), with males having 3.78 ± 2.1 (2.7-3.87) and females scoring 3.93 ± 2.3 (3.7-4.1). Newly graduated students have more knowledge of COVID-19 than other subtypes of Job (p = 0.0001), and those with medical practice are more knowledgeable than those without (p = 0.0001). Only 16.6% answered that taking antibiotics would not speed up the recovery from all the infections. 65.3% answered correctly that misuse of antibiotics could cause antibiotic resistance. Conclusion: Our study concluded that the Syrian population demonstrated good knowledge of COVID-19 and moderate acceptance of the new norm. Knowledge regarding antibiotic use and resistance and practice of preventive measures was poor, which can encourage the health authorities to develop community education programs to increase public awareness of the usage of antibiotics and safety protocols during the COVID-19 pandemic.

Therapeutic effects of thymoquinone or capsaicin on acrylamide-induced reproductive toxicity in rats mediated by their effect on oxidative stress, inflammation, and tight junction integrity.

In the field of environmental toxicology, endocrine-disrupting effects have become a major concern. The present research set out to investigate the possible reproductive toxicity of acrylamide. The research was also expanded to explore the protective effects of two nutraceuticals, thymoquinone (TQ) and capsaicin, against acrylamide-induced reproductive toxicity. Six groups of sixty male albino rats were created. Group 1 was used as a control. Rats were administered a daily dose of acrylamide and acted as the model in Group 2. TQ was provided to rats once a day in Group 3. Capsaicin was administered to rats once a day in Group 4. TQ was given once daily to rats exposed to acrylamide in Group 5. Rats were given capsaicin once a day for eight weeks after being exposed to acrylamide in Group 6. Acrylamide induced oxidative stress, testicular NF-κB/p65 expression, and down-regulated the expression of occludin, all of which can contribute to its testicular toxicity, while TQ or capsaicin removes all of these toxicity signs. TQ and capsaicin have shown efficacy in alleviating all of the acrylamide's toxic insults in the current reproductive toxicity model. Both nutraceuticals upregulated the expression of occludin in testicular tissue and restored tight junction integrity, in addition to their well-known antioxidant and anti-inflammatory effects, which were confirmed in this study.

Cohort retrospective study: the neutrophil to lymphocyte ratio as an independent predictor of outcomes at the presentation of the multi-trauma patient.

BACKGROUND: Although the association of neutrophil to lymphocyte ratio (NLR) with mortality in trauma patients has recently been shown, there is a paucity of research on the association with other outcomes. Recent studies suggest that the NLR has a predictive value of mortality in trauma patients during various times of admission. This study aimed to determine the prognostic impact of NLR at the presentation in critically ill trauma patients. METHODS: A retrospective cohort study of adult trauma patients between July 2017 and November 2017 in Tishreen Hospital. All patients who had arrived at the emergency department with multi-trauma injury within the age category (14-80 years) were included in this analysis. The prophetical capability of NLR on mortality was assessed by the receiver operative characteristics (ROC) curve. To identify the impact of the NLR on survival, a separate log-rank test was used. Multivariable Cox proportional hazard modeling was used to identify independent predictors of mortality. RESULTS: Throughout the time of the study, 566 patients met the inclusion criteria. Of these, 98.8% were male, 75.8% sustained penetrating trauma, and median age [IQR25-IQR75] was 26 [23-32]. Ninety-seven patients (17.1%) had major trauma, with an Injury Severity Score (ISS) ≥ 15. Using the ROC curve analyses hospitalization day 1, optimal NLR cutoff values of 4.00 were calculated by maximizing the Youden index. Kaplan-Meier curves revealed an NLR greater than or equal to these cutoff values as a marker for increased in-hospital mortality (p = 0.020, log-rank test). The Cox regression model demonstrated significant collinearity among the predictive variables (all VIF results < 2). Only ISS > 15 has a significant statistical relation with elevated NLR on day 1 (p = 0.010). CONCLUSIONS: Elevated NLR on day 1 has high predictive power for overall survival during the first 30 days after trauma, but it was not independent of other factors.