The Role of Serum Monocytes and Tissue Macrophages in Driving Left Ventricular Systolic Dysfunction and Cardiac Inflammation Following Subarachnoid Hemorrhage.

BACKGROUND: Neurocardiogenic injury is common after aneurysmal subarachnoid hemorrhage (aSAH) despite low prevalence of preexisting cardiac disease. Potential mechanisms include autonomic dysregulation due to excess catecholamines as well as systemic inflammation. Understanding how inflammation contributes to cardiac dysfunction may aid in identifying novel therapeutic strategies. Here, we investigated serum leukocytes as predictors of left ventricular systolic dysfunction in patients with aSAH. We also investigated increased cardiac macrophages in an animal model of SAH and whether immunomodulatory treatment could attenuate this inflammatory response. METHODS: We retrospectively analyzed 256 patients with aSAH admitted to University of Illinois Hospital between 2013 and 2019. Our inclusion criteria included patients with aSAH receiving an echocardiogram within 72 h of admission. Our primary outcome was echocardiographic evidence of systolic dysfunction. We performed multinomial regression and receiver operating curve analysis. We also used the endovascular perforation model of SAH in male Sprague-Dawley rats to assess for myocardial inflammation. Two days after surgery, hearts were collected and stained for the macrophage marker Iba-1. We compared the presence and morphology of macrophages in cardiac tissue isolated from SAH animals and sham controls treated with and without the immunomodulatory agent fingolimod. RESULTS: Of 256 patients with aSAH, 233 (91.0%) underwent echocardiography within 72 h of admission. Of 233, 81 (34.7%) had systolic dysfunction. Patients had baseline differences in the presence of hypertension, alcohol use, and admission Glasgow Coma Scale and Hunt-Hess score. On multivariable analysis, total leukocytes (odds ratio 1.312, p < 0.001), neutrophils (odds ratio 1.242, p = 0.012), and monocytes (odds ratio 6.112, p = 0.008) were independent predictors of reduced systolic function, whereas only monocytes (odds ratio 28.014, p = 0.030) predicted hyperdynamic function. Within the rodent heart, there were increased macrophages after SAH relative to controls, and this was attenuated by fingolimod treatment (p < 0.0001). CONCLUSIONS: Increased serum leukocytes are associated with abnormal left ventricular systolic function following aSAH. The strongest independent predictor of both reduced and hyperdynamic systolic function was increased monocytes. Increased cardiac macrophages after experimental SAH can also be targeted by using immunomodulatory drugs.

Nanostructured lipid carrier-mediated lung targeted drug delivery system to enhance the safety and bioavailability of clofazimine.

Tuberculosis (TB) disease is caused due to the infection of Mycobacterium tuberculosis bacilli which reside in alveolar macrophages (AMs). Clofazimine (CLF) has been reinstated clinically for the treatment of TB. However, major challenge of using CLF is its severe side-effects after oral administration. The present research was aimed to establish the safety and enhance the bioavailability of CLF by loading it into nanostructured lipid carriers (CLF-NLCs) and mannosylated NLCs (M-CLF-NLCs) to selectively target the drug toward AMs. The safety of CLF-NLCs and M-CLF-NLCs was evaluated by in vitro hemocompatibility studies, cell viability studies on macrophage J774 cell lines, and in vivo acute inhalation toxicity studies. The bioavailability was estimated by single-dose pharmacokinetics and biodistribution studies. Hemocompatibility studies showed normal RBCs count and least hemolysis of 0.23 ± 0.081% for M-CLF-NLCs treated group. Cell viability studies revealed greater safety of NLCs than CLF-drug dispersion in the concentration range of 2.5-25 µg/ml. In vivo acute toxicity studies revealed no physiological or behavioral changes and no mortality recorded over 14 days period. In pharmacokinetic studies, a maximum concentration of the drug (Cmax) of 35.44 ± 0.34 µg/g from M-CLF-NLCs after 48 h and longer residence time in lung tissues observed due to its sustained release and mannose receptor-mediated endocytosis. M-CLF-NLCs showed a maximum AUC0-∞ value of 2691.83 h µg/ml in lungs that indicated twofold greater bioavailability as compared to CLF-drug dispersion. Thus, mannosylated NLCs can be used as promising carriers for the safe and effective delivery of CLF via inhalation route for the management of TB disease.

Local Social Inequality, Economic Inequality, and Disparities in Child Height in India.

This study investigates disparities in child height-an important marker of population-level health-among population groups in rural India. India is an informative context in which to study processes of health disparities because of wide heterogeneity in the degree of local segregation or integration among caste groups. Building on a literature that identifies discrimination by quantifying whether differences in socioeconomic status (SES) can account for differences in health, we decompose height differences between rural children from higher castes and rural children from three disadvantaged groups. We find that socioeconomic differences can explain the height gap for children from Scheduled Tribes (STs), who tend to live in geographically isolated places. However, SES does not fully explain height gaps for children from the Scheduled Castes (SC) and Other Backward Classes (OBCs). Among SC and OBC children, local processes of discrimination also matter: the fraction of households in a child's locality that outrank her household in the caste hierarchy predicts her height. SC and OBC children who are surrounded by other lower-caste households are no shorter than higher-caste children of the same SES. Our results contrast with studies from other populations where segregation or apartheid are negatively associated with health.

Mechanism of the formation of microphase separated water clusters in a water-mediated physical network of perfluoropolyether tetraol.

Perfluoropolyether tetraol (PFPE tetraol) possesses a hydrophobic perfluoropolyether chain in the backbone and two hydroxyl groups at each chain terminal, which facilitates the formation of hydrogen bonds with water molecules resulting in the formation an extended physical network. About 3 wt% water was required for the formation of the microphase separated physical network of PFPE tetraol. The mechanism responsible for the microphase separation of water clusters in the physical network was studied using a combination of techniques such as NMR spectroscopy, molecular dynamics (MD) simulations and DSC. MD simulation studies provided evidence for the formation of clusters in the PFPE tetraol physical network and the size of these clusters increased gradually with an increase in the extent of hydration. Both MD simulations and NMR spectroscopy studies revealed that these clusters position themselves away from the hydrophobic backbone or vice versa. The presence of intra- and inter-chain aggregation possibility among hydrophilic groups was evident. DSC results demonstrated the presence of tightly and loosely bound water molecules to the terminal hydroxyl groups of PFPE tetraol through hydrogen bonding. The data from all the three techniques established the formation of a physical network driven by hydrogen bonding between the hydrophilic end groups of PFPE tetraol and water molecules. The flexible nature of the PFPE tetraol backbone and its low solubility parameter favour clustering of water molecules at the terminal groups and result in the formation of a gel.

Comparative study to evaluate bone loss during osteotomy using standard drill, bone trephine, and alveolar expanders for implant placement.

STATEMENT OF PROBLEM: Various osteotomy modalities seem to have an impact on the primary and secondary stability of the dental implant. The available literature lacks the comparison of various available osteotomy modalities used for the dental implant placement and its effects on the initial surgical bone removal. PURPOSE: The purpose of this study is to compare and evaluate the osteotomy sites created using standard drill, bone trephine, and alveolar expanders for dental implant surgery. MATERIALS AND METHODS: The study was done on ten goat hemimandibles. Three osteotomy sites were prepared at the inferior border of the mandible using standard drill, trephine, and alveolar expander in each hemimandibles and the sites were subjected to cone-beam computed tomography (CBCT). The CBCT images obtained were compared for the amount of cortical bone and bone marrow loss at osteotomy sites in different techniques. RESULTS: The mean and standard deviation of loss of cortical bone with standard drills, trephines, and alveolar expanders was 3.62 ± 4.216 × 10-2, 3.6 ± 4.681 × 10-16 and 3.15 ± 7.071 × 10-2. At the middle-third region, the loss of marrow bone was 3.38 ± 7.88 × 10-2, 2.15 ± 8.498 × 10-2 and 0.03 ± 9.487 × 10-2, and at lower third region, it was 2.3 ± 4.714 × 10-2, 0.02 ± 6.325 × 10-2, and 0.0, respectively. CONCLUSION: CBCT images showed minimum bone loss with the use of alveolar expander which may be due to the lateral bone condensation rather the removal of the marrow. Trephine showed less marrow removal in comparison to the standard drill used for dental implant surgery.

A systematic review of community-based participatory research studies involving individuals with mental illness.

OBJECTIVE: This systematic review examined community-based participatory research (CBPR) studies in which people with mental illness (PWMI) directly contributed to research projects. The purpose was to describe study characteristics, team structure and logistics, and level of involvement of in the research process. METHOD: We searched the PsycINFO database from January 2000 to July 2020, identifying 1,395 records and analyzing the 31 that met inclusion criteria. Articles were eligible if they were (a) published in English in a peer-reviewed journal; (b) explicitly stated that at least one adult with mental illness assisted with the study as a CBPR team member; and (c) included a research outcome. RESULTS: Most studies collected qualitative data. Project length, team composition, and frequency of meetings were not specified in about one third of the articles. Twenty-nine studies reported involvement of people with mental illness in research activities such as recruitment, data collection, transcription, and analysis. Nearly half did not specify if they received any training. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Individuals with mental illness were heavily involved in planning and conducting research, demonstrating the feasibility of meaningful involvement. Future research should consider how people with lived experience can assist with quantitative methods, and articles should clearly and explicitly describe characteristics of the partnership (e.g., team composition, frequency of meetings, compensation). The protocol is published in Open Science registry at https://osf.io/mshfb. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Are households with under-five children in Nigeria socioeconomically disadvantaged?

Although the sociodemographic and economic contributors to under-five mortality are well established, very little research has been done to assess the levels of disadvantage under-five children in Nigeria face along these dimensions. Nigeria has the second-highest under-five mortality rate (U5MR) in the world (111 deaths per 1000 live births) and contributed to the highest number of annual under-five deaths globally in 2020 (844,321 deaths). The country has also implemented several decades of policy interventions to reduce under-five mortality by improving sociodemographic and economic conditions at the household level. In this paper, we assess the sociodemographic and economic disadvantages that households with children under-five face compared to other households and discuss the implications for health policy. Using the Nigeria Living Standard Survey 2018-19, we conducted a bivariate analysis to compare the sociodemographic and economic characteristics of households with and without under-five children. We performed independent samples t-test and proportions test to assess whether these sociodemographic and economic factors were significantly different for both groups. We found that households with under-five children typically had larger sizes (6.6 vs. 3.6), lower mean adult age (36.5 vs. 45.3), and male household heads (91.3% vs. 71.5%) than households without under-five children. Furthermore, households with under-five children were less likely to have access to improved drinking water (77.2% vs. 86.0%) and sanitation sources (54.0% vs. 61.9%) than those without under-five children. Despite having more adult working members, 71.2% of households with under-five children lived below the poverty line compared to 37.7% of other households. Although their total consumption expenditure was lower than households without under-five children, they spent a higher proportion of their expenditure on health care and were at a higher risk of experiencing catastrophic health expenditure. Our study has shown that households with children under five are disproportionately disadvantaged than other households in Nigeria. The households with under-five children are larger, younger, and poorer than those without children. We also show a wide variation in the proportion of households with children under five by state. Any efforts to reduce under-five mortality and morbidity in Nigeria should recognize these sociodemographic and economic differences.

Estradiol improves behavior in FAD transgenic mice that express APOE3 but not APOE4 after ovariectomy.

Increasing evidence suggests that female individuals have a higher Alzheimer's disease (AD) risk associated with post-menopausal loss of circulating estradiol (E2). However, clinical data are conflicting on whether E2 lowers AD risk. One potential contributing factor is APOE. The greatest genetic risk factor for AD is APOE4, a factor that is pronounced in female individuals post-menopause. Clinical data suggests that APOE impacts the response of AD patients to E2 replacement therapy. However, whether APOE4 prevents, is neutral, or promotes any positive effects of E2 is unclear. Therefore, our goal was to determine whether APOE modulates the impact of E2 on behavior and AD pathology in vivo. To that end, mice that express human APOE3 (E3FAD) or APOE4 (E4FAD) and overproduce Aß42 were ovariectomized at either 4 months (early) or 8 months (late) and treated with vehicle or E2 for 4 months. In E3FAD mice, we found that E2 mitigated the detrimental effect of ovariectomy on memory, with no effect on Aß in the early paradigm and only improved learning in the late paradigm. Although E2 lowered Aß in E4FAD mice in the early paradigm, there was no impact on learning or memory, possibly due to higher Aß pathology compared to E3FAD mice. In the late paradigm, there was no effect on learning/memory and Aß pathology in E4FAD mice. Collectively, these data support the idea that, in the presence of Aß pathology, APOE impacts the response to E2 supplementation post-menopause.

Initial inflammatory response of skeletal muscle to commonly used suture materials: an animal model study to evaluate muscle healing after surgical repair - histopathological perspective.

OBJECTIVES: To evaluate initial inflammatory response of skeletal muscle to a few commonly used suture materials for muscle repair namely nylon, polydiaxonone (PDS II), plain catgut and polygalactin 910 which in turn determines the scarring of muscle and loss of function. MATERIAL AND METHODS: Inflammation and healing of muscle post repair was evaluated in the lateral thigh muscle (biceps femoris) of 8 adult healthy male Rattus norvegicus. The inflammatory reaction & healing of the skeletal muscle was evaluated histologically at the end of 48 hours, 1 week and 3 weeks. RESULTS: At 48 hours post-surgery, Nylon samples showed severe inflammation followed by Catgut and Polygalactin. At 1 week post-surgery, the catgut group demonstrated increased macrophages infiltration while Nylon demonstrated persistant lymphocytic pro-inflammatory component. PDS sutures elicited minimal inflammatory response all through. CONCLUSION: In the present study the most desirable suture material was determined to be PDS due to its minimal tissue response and superior handling qualities. However the fact that the presence of macrophages in healing muscle enhances the repair process would be a pointer to create an environment which contains the sustained presence of macrophages to enhance optimal healing of skeletal muscle in the presence of an ideal suture material.

Formulation Optimization and Evaluation of Nanocochleate Gel of Famciclovir for the Treatment of Herpes Zoster.

BACKGROUND: Herpes zoster is a viral infection triggered due to the reactivation of the varicella- zoster virus in the posterior dorsal root ganglion. Herpes zoster infections occur mostly in the facial, cervical and thoracic regions of the body, beginning with pain and resulting in the vesicular eruption. Recently, this infection was observed during the COVID-19 pandemic and also after the induction of mRNA-based vaccine for coronavirus at an extended level. Nanocochleates are cylindrical (cigarshape) microstructure lipid-based versatile carriers for drug delivery systems. Famciclovir is an antiviral agent employed for the treatment of Herpes zoster infections. OBJECTIVE: The current research patent aims to develop a novel nanocochleate gel of Famciclovir for the treatment of herpes zoster infections with higher efficacy. METHODS: The interaction studies using FTIR were carried out and indicated no such interactions between the drug and lipids. The nanocochleates were developed using hydrogel, trapping, liposome before cochleate dialysis, direct calcium dialysis and binary aqueous-aqueous emulsion methods, respectively. The 32 Box-Behnken design was applied by considering the concentration of lipids (phosphatidylcholine and cholesterol) and speed of rotation as independent factors, whereas particle size and entrapment efficiency as dependable factors. RESULTS: The developed nanocochleates were estimated for the particle size (276.3 nm), zeta potential (-16.7 mV), polydispersity index (0.241), entrapment efficiency (73.87±0.19%) and in vitro diffusion release (>98.8% in 10 h). The optimized batch was further converted into the topical gel using carbopol 940 as a gelling agent. The prepared gel was smooth, rapidly spreadable with a viscosity (5998.72 cp), drug content (95.3%) and remained stable during stability studies. CONCLUSION: A novel nanocochleate gel of Famciclovir was successfully developed for the treatment of infections associated with Herpes Zoster with sustained release action.

Nanostructured lipid carrier-loaded metformin hydrochloride: Design, optimization, characterization, assessment of cytotoxicity and ROS evaluation.

Metformin hydrochloride (MET) is commonly used in diabetes treatment. Recently, it has gained interest for its anticancer potential against a wide range of cancers. Owing to its hydrophilic nature, the delivery and clinical actions of MET are limited. Therefore, the present work aims to develop MET-encapsulated NLCs using the hot-melt emulsification and probe-sonication method. The optimization was accomplished by 33 BB design wherein lipid ratio, surfactant concentration, and sonication time were independent variables while the PS (nm), PDI, and EE (%) were dependent variables. The PS, PDI, % EE and ZP of optimized GMSMET-NLCs were found to be 114.9 ± 1.32 nm, 0.268 ± 0.04 %, 60.10 ± 2.23 %, and ZP - 15.76 mV, respectively. The morphological features, DSC and PXRD, and FTIR analyses suggested the confirmation of formation of the NLCs. Besides, optimized GMSMET-NLCs showed up to 88 % MET release in 24 h. Moreover, GMSMET-NLCs showed significant cell cytotoxicity against KB oral cancer cells compared with MET solution as shown by the reduction of IC50 values. Additionally, GMSMET-NLCs displayed significantly increased intracellular ROS levels suggesting the GMSMET-NLCs induced cell death in KB cells. GMSMET-NLCs can therefore be explored to deliver MET through different routes of administration for the effective treatment of oral cancer.

Enhancement of in-vitro anti-oral cancer activities of silymarin using dispersion of nanostructured lipid carrier in mucoadhesive in-situ gel.

Silymarin (SME) shows multiple therapeutic actions against several cancers, however, low aqueous solubility and poor bioavailability issues restrict its clinical use. In this study, SME was loaded in nanostructured lipid carriers (NLCs) and further incorporated in mucoadhesive in-situ gel (SME-NLCs-Plx/CP-ISG) for localized treatment of oral cancer. Using a 33 Box-Behnken design (BBD), an optimized SME-NLC formula was developed with the ratios of solid lipids, surfactant concentration, and sonication time as independent variables, while particle size (PS), polydispersity index (PDI), and % encapsulation efficiency (EE) as dependent variables, resulting in 315.5 ± 0.1 nm PS, 0.341 ± 0.01 PDI, and 71.05 ± 0.05 % EE. Structural studies confirmed the formation of SME-NLCs. SME-NLCs incorporated in-situ gel demonstrated a sustained release for SME, indicating enhanced retention on the buccal mucosal membrane. The in-situ gel containing SME-NLCs showed a marked decrease in IC50 value (24.90 ± 0.45 µM) than SME-NLCs (28.40 ± 0.89 µM) and plain SME (36.60 ± 0.26 µM). The studies demonstrated that Reactive oxygen species (ROS) generation potential and SME-NLCs-Plx/CP-ISG induced apoptosis at Sub-G0 phase owing to higher penetration of SME-NLCs led to higher inhibition against human KB oral cancer cells. Therefore, SME-NLCs-Plx/CP-ISG can be the alternative to chemotherapy and surgery with site-specific delivery of SME to oral cancer patients.

Obesity and Cardiovascular Risk among South Asian Americans.

Purpose of review: South Asian Americans experience higher cardiometabolic risk and disproportionately high rates of cardiovascular disease (CVD) compared to other racial and ethnic groups in the United States. The purpose of this review is to summarize recent evidence about the role of obesity in CVD risk in South Asian Americans and identify key evidence gaps and future directions for research and interventions for obesity in this group. Recent findings: South Asian Americans are predisposed to abdominal obesity and have a higher distribution of visceral fat, intermuscular fat, and intrahepatic fat compared to adults of other race and ethnic groups. In this population, the risk for cardiometabolic disease appears to be elevated even at a normal body mass index. Social, cultural, religious, interpersonal, and environmental factors are related to obesity and obesity-related behaviors among South Asian Americans. Summary: There is a relatively high prevalence of obesity in South Asian-origin populations in the United States, who have unique socio-cultural determinants of overweight and obesity. Future research should clarify why the risk for metabolic disease and CVD is elevated at normal BMI in the South Asian American population, and environmental and other structural factors that may influence obesity in this group. Interventions must be adapted to the social and cultural context of South Asian Americans to improve effectiveness and implementation.

Instruments to Measure Betel Quid Dependency among Young and Adult Chewers - A Systematic Review with Meta-analysis.

Background: Betel quid (BQ) consumption is prevalent globally, majorly consumed in South-Asia and South-East Asian countries. Among the other country studies done on BQ, the focus has been on its consumption prevalence, its physiological and psychological effects, and aids to discontinue this habit. Systematic literature research on suitability of different instruments (metric or scale) to measure BQ dependency is scarce, hence pointing to the need of more evidence-based studies in this domain. Aim: The aim of the article was to identify the instruments used in the published literature to measure BQ dependency among young and adult chewers and draw a comparison. Methodology: The electronic retrieval systems and databases PubMed (Medline), Cochrane Library, Scopus, Web of Science, and Google Scholar were searched independently by two authors from January 2011 to September 2022 for the collection of desired data. Results: Among 1271 articles, 337 were duplicates and removed, 866 did not meet selection criteria. Out of 68 articles, 57 were excluded due to the lack of relevant data. Finally, only 11 articles were included for the analysis in this systematic review. Conclusion: Due to a scarcity of researches in this direction, no scale can be assigned as the best Dependence Scale, thus necessitating more such systematic reviews and meta-analysis for better comprehension and usage of present dependence scales.

Assessment and correlation of anxiety, depression and serum cortisol levels in patients with oral submucous fibrosis and leukoplakia: A clinicohematological study.

Context: Potentially malignant disorders (PMDs) of the oral cavity like oral submucous fibrosis (OSMF) and leukoplakia are known to be caused due to addictive habits, while serum cortisol is accepted to be a stress hormone. Aim: The present study was aimed to assess and correlate the anxiety, depression and serum cortisol levels in habit-associated PMDs such as OSMF and leukoplakia and compare it with healthy subjects. Materials and Methods: Ninety patients were included in the study and were divided into three Groups, namely Group I (OSMF), Group II (leukoplakia) and Group III (control group). Serum cortisol levels and severity of anxiety and depression using the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) were recorded and correlated. Results: A significant correlation existed between serum cortisol level and levels of both anxiety and depression between Group I and II as compared to the control group. Conclusion: There exists a definite correlation between serum cortisol levels and the levels of anxiety and depression in patients with leukoplakia and OSMF, with increasing levels of serum cortisol and higher values in both the HAM-A and HAM-D scales in patients with both OSMF and leukoplakia. PMDs such as leukoplakia and OSMF have an established cancer-causing potential. Anxiety and depression although prevalent are underdiagnosed and poorly understood. Hence, a holistic approach in the treatment of such pathologies including hematological investigations and psychological evaluation should be mandatorily made a part of the workup and treatment plan.

The Covid-19 pandemic and gendered division of paid work, domestic chores and leisure: evidence from India's first wave.

Examining high frequency national-level panel data from Centre for Monitoring Indian Economy (CMIE) on paid work (employment) and unpaid work (time spent on domestic work), this paper examines the effects of the first wave of the Covid-19 pandemic on the gender gaps in paid and unpaid work until December 2020, using difference-in-differences (D-I-D) for estimating the before (the pandemic) and after (the pandemic set in) effects, and event study estimates around the strict national lockdown in April 2020. The DID estimates reveal a lowering of the gender gap in employment probabilities which occurs due to the lower probability of male employment, rather than an increase in female employment. The first month of the national lockdown, April 2020, saw a large contraction in employment for both men and women, where more men lost jobs in absolute terms. Between April and August 2020 male employment recovered steadily as the economy unlocked. The event study estimates show that in August 2020, for women, the likelihood of being employed was 9% points lower than that for men, compared to April 2019, conditional on previous employment. However, by December 2020, gender gaps in employment were at the December 2019 levels. The burden of domestic chores worsened for women under the pandemic. Men spent more time on housework in April 2020 relative to December 2019, but by December 2020, the average male hours had declined to below the pre-pandemic levels, whereas women's average hours increased sharply. Time spent with friends fell sharply between December 2019 and April 2020, with a larger decline in the case of women. The hours spent with friends recovered in August 2020, to again decline by December 2020 to roughly one-third of the pre-pandemic levels. The paper adopts an intersectional lens to examine how these trends vary by social group identity.

Early childhood stunting and later life outcomes: A longitudinal analysis.

Using longitudinal data from four countries-Ethiopia, India, Peru and Vietnam- we show that early childhood stunting is highly persistent as measured by the association between stunting status in early childhood and stunting status at age 15. Stunting in early childhood is associated with lower grade completion by age 22 and has a negative relationship with cognition as measured by math, language and reading scores at ages 8, 12 and 15. Stunting in early childhood is also associated with poorer subjective assessment of a child's health at age 15. Analyzing determinants, we show that lack of preventive care and economic shocks are associated with an increase in the probability of stunting in early childhood.

Coverage of social assistance in Ethiopia during the COVID-19 pandemic: a time-to-event analysis.

OBJECTIVE: In a pandemic, government assistance is essential to support the most vulnerable households as they face health and economic challenges. However, government assistance is effective only when it reaches vulnerable households in time. In this paper, we estimated the timeliness of government assistance for the most vulnerable households (ie, the poor households) in Ethiopia during its COVID-19 response of 2020. In particular, we conducted a time-to-event analysis to compare the time to receive government assistance between poor and non-poor households in Ethiopia. METHODS: We used a semiparametric Cox proportional model to evaluate whether the time to first receipt of government assistance during the COVID-19 response in 2020 differed between poor and non-poor Ethiopian households. We used the Schoenfeld test to check the proportionality assumption and conducted the stratified Cox regression analysis to adjust for non-proportional variables. The data from World Bank's High-Frequency Phone Surveys on COVID-19 and the 2019 Ethiopian Socioeconomic Survey were used for this analysis. RESULTS: We found that the poor households in rural areas were 88% (HR: 1.88; 95% CI: 1.19 to 2.98) more likely to receive government assistance than non-poor households at any point within 10 months after the start of the pandemic. However, there was no significant difference between urban poor and non-poor households' likelihood of receiving government assistance during this timeframe. CONCLUSION: The Ethiopian government has leveraged its existing social protection network to quickly reach poor households in rural areas during the COVID-19 response of 2020. The country will need to continue strengthening and scaling the existing social protection systems to accurately target the wider vulnerable population in urban areas.

Equity assessment of childhood immunisation at national and subnational levels in Myanmar: a benefit incidence analysis.

INTRODUCTION: Myanmar, a conflict-affected geographically and ethnically diverse lower middle-income country, was in the donor transition phase for health prior to the political unrest of the last year. This study analyses the distribution of benefit and utilisation of basic childhood vaccinations from the highly donor-dependent Expanded Program on Immunization for populations of different socioeconomic status (SES). METHODS: We conducted a benefit incidence analysis with decomposition analysis to assess the equity of benefit. We used basic childhood immunisations-BCG, measles, diphtheria, pertussis and tetanus (DPT)/pentavalent, oral polio vaccine (OPV) and full vaccination-as measurements for healthcare use. Childhood immunisation data were collected from Myanmar Demographic and Health Survey. Cost of vaccines was obtained from UNICEF document and 'Immunization Delivery Cost Catalogue' and adjusted with regional cost variations. We reported Concentration Index (CI) and Achievement Index (AI) by SES, including wealth quintiles, maternal education and across geographic areas. RESULTS: Nationally, better-off households disproportionately used more services from the programme (CI-Wealth Index (CI-WI) for BCG, measles, DPT/pentavalent, OPV and full immunisation: 0.032, 0.051, 0.120, 0.091 and 0.137, respectively). Benefits had a pro-poor distribution for BCG but a less pro-rich distribution than utilisation for all other vaccines (CI-WI: -0.004, 0.019, 0.092, 0.045 and 0.106, respectively). Urban regions had a more pro-rich distribution of benefit than that in rural areas, where BCG and measles had a pro-poor distribution. Subnational analysis found significant heterogeneity: benefit was less equitably distributed, and AI was lower in conflict-affected states than in government-controlled areas. The major contributors to vaccine inequality were SES, antenatal care visits and paternal education. CONCLUSION: Donors, national government and regional government should better plan to maintain vaccine coverage while improving equity of vaccine services, especially for children of lower SES, mothers with less antenatal care visits and lower paternal education living in conflicted-affected remote regions.

Analytical Methods for Determination of Apremilast from Bulk, Dosage Form and Biological Fluids: A Critical Review.

Apremilast is an anti-inflammatory agent. It has been a flourishing molecule in the field of dermatology. In the year 2014, Apremilast got its approval for treatment of psoriatic arthritis. Presently it is known to treat a number of other conditions, including atopic dermatitis and plaque psoriasis. Apremilast a phthalimide derivative, is non-hygroscopic in nature. It is practically insoluble in water. Apremilast acts by inhibiting the activity of phosphodiesterase 4 (PDE4), an intracellular enzyme. Analytical method plays a key role to understand the physio-chemical properties of a drug molecule. Because of poor solubility and low permeability, analytical method development and formulation becomes challenging. Till date, there are no standard test methods available to analyze Apremilast. So, a critical review of the analytical techniques of Apremilast was carried out. The literature search was done by screening the papers reporting analytical techniques of Apremilast from year 2014 to 2019. Methodologies particularly UV spectroscopy, HPTLC, HPLC, X-ray diffraction, NMR, LC-MS were collected and reviewed. Interminable efforts are made by the researchers to develop simple, accurate, robust and cost-effective methods of analysis. In pharmaceutical research, this information will aid in the development of new delivery systems. The review will prove beneficial and advantageous pre-formulation studies and will guide the formulation development.