Systematic Literature Review on the Incidence and Prevalence of Heart Failure in Children and Adolescents.

While the epidemiology of adult heart failure has been extensively researched, this systematic review addresses the less well characterized incidence and prevalence of pediatric HF. The search strategy used Cochrane methodology and identified 83 unique studies for inclusion. Studies were categorized according to whether the HF diagnosis was reported as primary (n = 10); associated with other cardiovascular diseases (CVDs) (n = 49); or associated with non-CVDs (n = 24). A narrative synthesis of the evidence is presented. For primary HF, the incidence ranged from 0.87/100,000 (UK and Ireland) to 7.4/100,000 (Taiwan). A prevalence of 83.3/100,000 was reported in one large population-based study from Spain. HF etiology varied across regions with lower respiratory tract infections and severe anemia predominating in lower income countries, and cardiomyopathies and congenital heart disease major causes in higher income countries. Key findings for the other categories included a prevalence of HF associated with cardiomyopathies ranging from 36.1% (Japan) to 79% (US); associated with congenital heart disease from 8% (Norway) to 82.2% (Nigeria); associated with rheumatic heart diseases from 1.5% (Turkey) to 74% (Zimbabwe); associated with renal disorders from 3.8% (India) to 24.1% (Nigeria); and associated with HIV from 1% (US) to 29.3% (Brazil). To our knowledge, this is the first systematic review of the topic and strengthens current knowledge of pediatric HF epidemiology. Although a large body of research was identified, heterogeneity in study design and diagnostic criteria limited the ability to compare regional data. Standardized definitions of pediatric HF are required to facilitate cross-regional comparisons of epidemiological data.

An investigation on the fabrication and characterization of friction stir processed nano-HAp reinforced AZ91D magnesium matrix surface composite for bio-implants.

In the present research, friction stir processed (FSPed) nano-hydroxyapatite reinforced AZ91D magnesium matrix surface composite has been developed with improved ultimate tensile strength (UTS) and biological performance, which are needed for the bio-implants. Nano-hydroxyapatite reinforcement with varying proportions (5.8%, 8.3%, and 12.5%) was introduced into the AZ91-D parent material (PM) by the grooving method with different grooves of 0.5, 1 & 1.5 mm of width and 2 mm depth machined on the surface of the PM. Taguchi's L-9 orthogonal array was employed to optimize the processing variables for enhancing the UTS of the developed composite material. The optimum parameters were discovered to be the tool rotational speed of 1000 rpm, transverse speed of 50 mm/min, and 12.5% reinforcement concentration. The results revealed that the tool rotational speed contributes the highest effect (43.69%) on UTS, followed by the reinforcement percentage (37.49%) and transverse speed (18.31%). The FSPed samples at the optimized parameter setting confirmed the enhancement of 30.17% and 31.86% in UTS and micro-hardness, respectively, compared to the PM. Cytotoxicity of the optimized sample was also found superior compared to the other FSPed samples. The optimized FSPed composite's grain size was 6.88 times smaller than the AZ91D parent matrix material. The improved mechanical and biological performances of the composites are attributed to the significant grain refinement and proper dispersion of the nHAp reinforcement in the matrix.

Model parameters influencing the cost-effectiveness of sacubitril/valsartan in heart failure: evidence from a systematic literature review.

OBJECTIVES: To summarize cost-effectiveness (CE) evidence of sacubitril/valsartan for the treatment of heart failure (HF) patients with reduced ejection fraction (HFrEF). The impact of different modeling approaches and parameters on the CE results is also described. METHODS: We conducted a systematic literature review using multiple databases: Embase®; MEDLINE®; MEDLINE®-In Process; NIHR CRD database including DARE, NHS EED, and HTA databases; and the Cost Effectiveness Analysis registry. We also reviewed HTA countries' websites to identify CE reports of sacubitril/valsartan, published up to 25-July-2021. Articles published in English as full-texts, conference-abstracts, or HTA reports were included. RESULTS: We included 44 CE models [39 from 37 publications (22 full-texts; 15 conference-abstracts) and 5 HTAs; Europe, n = 20; North and South Americas, n = 14; Asia and Australia, n = 10]. Most models adopted a Markov structure with constant transition probabilities of events (n = 27) or a mix of Markov and regression-based models (n = 16), with variations in structural assumptions and chosen parameters. Study authors concluded sacubitril/valsartan to be a cost-effective therapy in 37/41 models in chronic HFrEF patients and 2/3 models in hospitalized patients stabilized after an acute decompensation for HF. CE models showing sacubitril/valsartan not to be a cost-effective treatment generally modeled a shorter time horizon. Effect of sacubitril/valsartan on cardiovascular and all-cause mortality, cost, duration of effect and time horizon was the main model drivers. CONCLUSIONS: Most evidence indicated sacubitril/valsartan is cost-effective in HFrEF. The use of a lifetime horizon is recommended in future models as HF is a chronic disease. Data on the CE of sacubitril/valsartan in the inpatient setting were limited and further research is warranted.

Contaminants in milk and impact of heating: an assessment study.

BACKGROUND: The major contaminants usually encountered in milk and milk products include pesticide residues, heavy metals, and aflatoxin M1 (AFM1). Primarily, milk get contaminated before milching, from the cattle feed, from sources/materials used during the processing of milk as well as improper handling of the milk during the pre- and postprocessing period. OBJECTIVE: The purpose of this study was to evaluate the effect of household practices on milk contaminants. MATERIALS AND METHODS: Samples of pasteurized as well as unpasteurized milk (Vendor's milk) were analyzed for AFM1, pesticide residues, and heavy metals. Simulating the household practices, the impact of boiling on these contaminants was assessed. RESULTS: The contaminant Aflatoxin M1 (AFM1) was detected at a concentration ranging from 0.071-0.075 ppb in unpasteurized as well as pasteurized milk samples analyzed during the course of study. Moreover, boiling had no impact on the quantity of AFM1 present in the milk. Pesticides and heavy metal contents were found to be within acceptable limits in all the milk samples tested. CONCLUSION: Mycotoxins especially aflatoxins in cattle feed and their consequential presence in milk and milk products is a serious concern world over as they are reported carcinogens. These fungal toxins are resistant to high temperatures and may lead to various health hazards. Preventive steps must be taken at each stage to ensure good quality of milk and milk products free from these contaminants. Awareness programs and education for the dairy farmers and milk processors may be helpful in this regard.

A Study of Erosion-Corrosion Behaviour of Friction Stir-Processed Chromium-Reinforced NiAl Bronze Composite.

Corrosion is frequently viewed as a catastrophic and unavoidable disaster in marine applications. Every year, a huge cost is incurred on the maintenance and repair of corrosion-affected equipment and machinery. In the marine environment, as-cast nickel-aluminium bronze (NAB) is susceptible to selective phase corrosion. To solve this problem, chromium-reinforced nickel-aluminium bronze was fabricated using the friction stir process (FSP) with improved microstructures and surface properties. A slurry erosion-corrosion test on as-cast and FSPed composites demonstrated that the developed surfaced composite has lower erosion and corrosion rates than the as-cast NAB alloy. The erosion-corrosion rate increased with a decrease in the impact angle from 90° to 30° for both as-cast NAB and prepared composites, exhibiting a shear mode of erosion. The specimens at impact angle 30° experienced more pitting action and higher mass loss compared with those at impact angle 90°. Due to increases in the mechanical properties, the FS-processed composite showed higher erosion resistance than the as-cast NAB alloy. Furthermore, corrosion behaviour was also studied via the static immersion corrosion test and electrochemical measurements under 3.5 wt.% NaCl solution. In a static immersion corrosion test, the FSPed composite outperformed the as-cast NAB composite by a wide margin. The FSPed composite also demonstrated a reduced electrochemical corrosion rate, as revealed by the polarization curve and electrochemical impedance spectroscopic (EIS) data. This reduced rate is attributed to the formation of a Cr oxide film over its surface in the corrosive environment.

Influence of Culture Conditions on the Production of Extracellular Esterase from Bacillus licheniformis and Its Characterization.

Esterases catalyze the hydrolysis of ester bonds in fatty acid esters with short-chain acyl groups. In the present study, thirty-seven bacterial isolates were isolated from soil contaminated with waste cooking oil, dairy waste etc. from Shimla and Solan district of H.P. Out of 37 isolates, the isolate RL-1, which gave maximum activity, was identified as Bacillus licheniformis MH061919. The optimization of various production parameters resulted in maximum activity at inoculum age of 24 h and inoculum size of 1.5% (v/v). Esterase gave considerable activity in production medium containing sodium chloride (0.5 % w/v), galactose (1%, w/v), coconut oil (2.0%, v/v) and beef extract (0.3%, w/v) at a temperature of 45℃ and pH 8.5.The enzyme production was enhanced by 3-fold after optimization of production parameters. Further, on optimizing reaction conditions, enzyme gave maximum activity at a temperature of 45℃ and pH 8.5. The para-nitrophenyl acetate (p-NPA) was found to be optimum substrate and metal ions and detergents have inhibitory effect on esterase activity.

Systematic literature review on the economic, humanistic, and societal burden of heart failure in children and adolescents.

INTRODUCTION: Unlike the adult heart failure (HF) patient population, there is scarce information on the overall burden of HF in the pediatric population across geographies and within different age groups. AREAS COVERED: A systematic review aims to describe and quantify the economic, humanistic, and societal burden of pediatric (age <18 years) HF on patients and caregivers. Eighteen published studies over a period of 10 years (1 January 2006-20 May 2016) were identified through Embase, Medline, Cochrane Library and selected congresses. Studies from the US reported higher HF-related hospitalization-rates in infants aged <1 year (49.3%-63.9%) versus children aged 1-12 years (18.7%-30.9%) in HF diagnosed patients. Across the studies, the average length of hospital stay was 15 days, increasing to 26 days for infants. Average annual hospital charges were higher for infants (US$176,000) versus children aged 1-10 years (US$132,000) in the US. In Germany, diagnosis-related group (DRG)-based hospital-allowances per HF-case increased from €3,498 in 1995 to €4,250 in 2009. EXPERT OPINION: To our knowledge, this is the first systematic review, which provides valuable insights into the burden of HF in children and adolescents, and strengthens current knowledge of pediatric HF. However, there is a need for larger population-based studies with wider geographical coverage.