Safety and immunogenicity of Zika virus vaccine: A systematic review of clinical trials.

Several phase-1 clinical trials have been performed to evaluate the safety and efficacy of candidate anti-Zika vaccines. In this systematic review, we systematically evaluated the safety and immunogenicity of candidate vaccines, which would aid researchers in formulating an effective vaccination strategy for phase-2 trials based on current evidence. A literature search was conducted using the electronic databases MEDLINE through Pubmed, Web of Science, and Cochrane Database for relevant studies on candidate anti-zika vaccines. Studies on animal models were excluded from our study. Healthy individuals who were administered candidate Zika vaccines to evaluate the immune response and adverse events (AEs) compared to placebo were considered. Data were extracted, tabulated, and analysed using Microsoft Excel, while the risk of bias plots were generated using tidyverse and Robvis packages in R-studio. A total of five phase-1 clinical trials were included in our analysis comprising of studies on inactivated, viral vector, and DNA vaccines. Immunogenicity ranged from 10% to 100% after vaccination with the lowest seroconversion rate (10%) and geometric mean titre (GMT) (6.3; 95% confidence interval (CI):3.7-10.8) observed among recipients of single-dose inactivated anti-zika vaccine (ZPIV). For DNA vaccines, the seroconversion rate ranged from 60% to 100% with the highest seroconversion rate (100%) and GMT (2871; 95% CI:705.3-11688) observed among recipients of three shots of high dose GLS-5700 vaccine. For viral vector vaccine (Ad26.ZIKV.001) seroconversion rate (100%) and GMT peaked after two shots with both low and high-dose vaccines. In all those studies AEs were mostly local including injection site pain, erythema, and itching. The most common systemic AEs included fever, myalgia, nausea, and fatigue. In phase-1 clinical trials, all candidate vaccines were found to be highly immunogenic and relatively safe, especially when administered in higher doses and with the help of needle-free devices.

Oral killed cholera vaccines for preventing cholera.

BACKGROUND: Cholera causes acute watery diarrhoea and death if not properly treated. Outbreaks occur in areas with poor sanitation, including refugee camps. Several vaccines have been developed and tested over the last 50 years. This is an update of a Cochrane review, originally published in 1998, which explored the effects of all vaccines for preventing cholera. This review examines oral vaccines made from killed bacteria. OBJECTIVES: To assess the effectiveness and safety of the available World Health Organization (WHO)-prequalified oral killed cholera vaccines among children and adults. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register; CENTRAL, MEDLINE; Embase; LILACS; and two trials registers (February 2023). SELECTION CRITERIA: We included randomized controlled trials (RCTs), including cluster-RCTs. There were no restrictions on the age and sex of the participants or the setting of the study. We considered any available WHO-prequalified oral killed cholera vaccine as an intervention. The control group was given a placebo, another vaccine, or no vaccine. The outcomes were related to vaccine effectiveness and safety. We included articles published in English only. DATA COLLECTION AND ANALYSIS: Two review authors independently applied the inclusion criteria and extracted data from included studies. We assessed the risk of bias using the Cochrane ROB 1 assessment tool. We used the generic inverse variance and a random-effects model meta-analysis to estimate the pooled effect of the interventions. We assessed the certainty of the evidence using the GRADE approach. For vaccine effectiveness (VE), we converted the overall risk ratio (RR) to vaccine effectiveness using the formula: VE = (1 - RR) x 100%. MAIN RESULTS: Five RCTs, reported in 12 records, with 462,754 participants, met the inclusion criteria. We identified trials on whole-cell plus recombinant vaccine (WC-rBS vaccine (Dukoral)) from Peru and trials on bivalent whole-cell vaccine (BivWC (Shanchol)) vaccine from India and Bangladesh. We did not identify any trials on other BivWC vaccines (Euvichol/Euvichol-Plus), or Hillchol. Two doses of Dukoral with or without a booster dose reduces cases of cholera at two-year follow-up in a general population of children and adults, and at five-month follow-up in an adult male population (overall VE 76%; RR 0.24, 95% confidence interval (CI) 0.08 to 0.65; 2 trials, 16,423 participants; high-certainty evidence). Two doses of Shanchol reduces cases of cholera at one-year follow-up (overall VE 37%; RR 0.63, 95% CI 0.47 to 0.85; 2 trials, 241,631 participants; high-certainty evidence), at two-year follow-up (overall VE 64%; RR 0.36, 95% CI 0.16 to 0.81; 2 trials, 168,540 participants; moderate-certainty evidence), and at five-year follow-up (overall VE 80%; RR 0.20, 95% CI 0.15 to 0.26; 1 trial, 54,519 participants; high-certainty evidence). A single dose of Shanchol reduces cases of cholera at six-month follow-up (overall VE 40%; RR 0.60, 95% CI 0.47 to 0.77; 1 trial, 204,700 participants; high-certainty evidence), and at two-year follow-up (overall VE 39%; RR 0.61, 95% CI 0.53 to 0.70; 1 trial, 204,700 participants; high-certainty evidence). A single dose of Shanchol also reduces cases of severe dehydrating cholera at six-month follow-up (overall VE 63%; RR 0.37, 95% CI 0.28 to 0.50; 1 trial, 204,700 participants; high-certainty evidence), and at two-year follow-up (overall VE 50%; RR 0.50, 95% CI 0.42 to 0.60; 1 trial, 204,700 participants; high-certainty evidence). We found no differences in the reporting of adverse events due to vaccination between the vaccine and control/placebo groups. AUTHORS' CONCLUSIONS: Two doses of Dukoral reduces cases of cholera at two-year follow-up. Two doses of Shanchol reduces cases of cholera at five-year follow-up, and a single dose of Shanchol reduces cases of cholera at two-year follow-up. Overall, the vaccines were safe and well-tolerated. We found no trials on other BivWC vaccines (Euvichol/Euvichol-Plus). However, BivWC products (Shanchol, Euvichol/Euvichol-Plus) are considered to produce comparable vibriocidal responses. Therefore, it is reasonable to apply the results from Shanchol trials to the other BivWC products (Euvichol/Euvichol-Plus).

Gastro-Protective and Therapeutic Effect of Punica granatum against Stomach Ulcer Caused by Helicobacter Pylori.

Gastric ulcer is a chronic condition that occurs when the mucosa of the stomach is broken. There is a physiological equilibrium between aggressive factors and mucosal defense. The purpose of this research was to compare the prevention level and efficiency of herbal medicinal plants (Punica granatum) to the omeprazole drug. Many groups were prepared from Albino male rats, the first control group (inoculate with H. pylori and fed with standard pellet), the Second group, rats inoculated by H. pylori and prevented with Punica granatum aqueous extracts (PGAE) in two dosages (250mg/kg, 500mg/kg), and last group inoculated by H. pylori and prevented with standard drug omeprazole at the dose (20mg/kg). The results showed that the Ulcer Inhibition % of Punica granatum with a high dose of 500mg/kg and a low dose of 250mg/kg was 84.60±5.48 and 42.87±7.14, respectively. While in the omeprazole treatment group, Ulcer Inhibition % was 24.50±6.35 and this Ulcer Inhibition %  in the Punica granatum treatment groups was significant compared to the omeprazole treatment group and the control group (P=0.0001). PGAE displayed a significant lessening in stomach index and infectious cell proliferation with much cell damage. Although the result of the current study improves, a high dosage of aqueous extracts of plants has more effectiveness than a low dosage of aqueous extracts plants.

Good death for people living with dementia: a qualitative study.

BACKGROUND: Ensuring a good death is one of the primary objectives of palliative care and end-of-life care. There is insufficient evidence regarding what defines a good death for people living with dementia. Obtaining an understanding of what constitutes a good death could help improve dementia care. This study aimed to explore how multiple stakeholders perceive a good death for people living with dementia. METHODS: This qualitative study was carried out across six prefectures in Japan. Enrollment of participants took place within dementia outpatient clinics, hospitals, daycare centers, and community centers. A total of thirty-three in-depth interviews with people living with dementia, physicians, and nurses were conducted. Six focus group discussions were performed with family caregivers and care workers. Verbatim transcripts of the interviews were prepared, and inductive content analysis was used to examine the data. FINDINGS: Regarding the perception of a good death, the following themes were derived: (1) painless death; (2) dying in a preferred environment; (3) family's coping with loss; (4) maintaining regular life; (5) living with respect; and (6) preparation for death. All these themes are interrelated. Participants viewed a good death as a process rather than a single event. CONCLUSION: This study identifies crucial components of a good death for people living with dementia. The findings could be used to improve dementia care.

Aducanumab for the treatment of Alzheimer's disease: a systematic review.

Aducanumab is a novel disease-modifying anti-amyloid-beta (Aß) human monoclonal antibody specifically targeted to the pathophysiology of Alzheimer's disease (AD). It was granted for treating AD in June 2021 by the United States Food and Drug Administration. We systematically analyzed available trials to evaluate the efficacy and safety of aducanumab treating AD. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We conducted an extensive literature search using the electronic databases MEDLINE through PubMed, EMBASE, Cochrane, Web of Science, and Scopus for suitable studies on aducanumab. We considered human clinical trials of aducanumab, assessing its efficacy and adverse effects in treating AD, excluding any experimental animal studies. We included three randomised controlled trials. Studies reported that aducanumab reduced brain amyloid-beta plaques in a time- and dose-dependent manner (dose-response, P < 0.05) and a slowed decline in cognition (22% reduction) in the high-dose treated group, difference of -0.39 versus placebo in Clinical Dementia Rating Scale Sum Boxes (95% CI, -0.69 to -0.09; P = 0.012) along with a reduced amyloid positron emission tomography standard uptake value ratio score (P < 0.001) and plasma p181-tau (phosphorylated tau) level. Amyloid-related imaging abnormality was reported as a serious adverse event and was profound in high-dose treated group (425/1029 in 10 mg/kg). Aducanumab has been reported to affect two main pathophysiologic hallmarks (Aß and tau) of AD. We suggest future studies addressing aducanumab's efficacy and safety to confirm that the benefit of this drug outweighs the risk.

Everyday wishes of older people living with dementia in care planning: a qualitative study.

BACKGROUND: The dementia care policy in Japan emphasizes the views of people living with dementia in care planning. An exploration of the everyday wishes of older people living with dementia can help clarify their priorities and assist in improving dementia care. This study aimed to explore the everyday wishes of older people living with dementia in Japan. METHODS: This qualitative study was conducted in Aichi prefecture in Japan. Older people with mild to moderate dementia were considered for inclusion. Participants were recruited from a dementia outpatient clinic. In-depth interviews were conducted with 36 participants in the same dementia outpatient clinic from January to October 2019. Audio-recorded interviews were transcribed verbatim. Inductive content analysis was carried out to analyze the data. FINDINGS: Participants expressed their everyday wishes within five themes (desire of being connected, freedom to decide, involvement in activities, status quo, and self-reliance). Older people living with dementia loved the connection with their family and wanted to have an enjoyable life by engaging in several activities without others' interference. They desired to maintain the status quo and not be a burden to others. CONCLUSIONS: This study provides evidence on the everyday wishes of people living with dementia. Identified wishes are mostly on emotional aspects of their daily lives. The findings of our study might help provide care for the people living with dementia considering their wishes. Further exploration, including people with severe dementia, is needed.

Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression.

BACKGROUND: Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates. OBJECTIVES: To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR. SEARCH STRATEGY: PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. SELECTION CRITERIA: Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors. DATA COLLECTION AND ANALYSIS: Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. MAIN RESULTS: We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation. CONCLUSIONS: An appropriate reporting of CDMR should be a key priority in maternal health policies and practices. TWEETABLE ABSTRACT: Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.

Concentration and pressure scaling of CH2O electronic-resonance-enhanced coherent anti-Stokes Raman scattering signals.

Nanosecond electronic-resonance-enhanced coherent anti-Stokes Raman scattering (ERE-CARS) is evaluated for the measurement of formaldehyde (CH2O) concentrations in reacting and nonreacting conditions. The three-color scheme utilizes a 532 nm pump beam and a scanned Stokes beam near 624 nm for Raman excitation of the C-H symmetric stretch (ν1) vibrational mode; further, a 342 nm resonant probe is tuned to produce the outgoing CARS signal via the 101403 vibronic transition between the ground (X~1A1) and first excited (A~1A2) electronic states. This allows detection of CH2O at concentrations as low as 9×1014molecules/cm3 (55 parts per million) in a calibration cell with CH2O and N2 at 1 bar and 450 K with 3% uncertainty. The measurements show a quadratic dependence of the signal with CH2O number density. Pressure scaling experiments up to 11 bar in the calibration cell show an increase in signal up to 8 bar. We study pressure dependence up to 11 bar and further apply the technique to characterize the CH2O concentration in an atmospheric premixed dimethyl ether/air McKenna burner flame, with a maximum concentration uncertainty of 11%. This approach demonstrates the feasibility for spatially resolved measurements of minor species such as CH2O in reactive environments and shows promise for application in high-pressure combustors.

Factors associated with the nutritional status of the older population in a selected area of Dhaka, Bangladesh.

BACKGROUND: Globally, older population (aged ≥60 years) comprise 11% of the total population, and 23% of them are malnourished. Lack of knowledge and education, adverse dietary habits, depression or psychological disorders, poor oral and dental health, disability, and diseases are the reported factors responsible for malnutrition among them. Geriatric people comprise 7.5% of the total population of Bangladesh, and almost a quarter are malnourished. But there is scarce data on the factors associated with the nutritional status of the older population in Bangladesh. METHODS: A cross-sectional study was conducted among 125 older individuals (male 59, female 66) living in three villages of Uttarkhan, Dhaka, Bangladesh, to identify the factors associated with their nutritional status. The Mini Nutritional Assessment scale, Geriatric Depression Scale-Short Form, and Geriatric Oral Health Assessment Index were used for assessing the nutritional status, mental health status, and oral health quality of the respondents, respectively. Information on socio-demographic characteristics, comorbidities and dietary factors, and food behaviors were gathered by a pretested semi-structured questionnaire. Ethical approval was obtained from the Institutional Review Board of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. RESULTS: The participants' mean age was 67.9 ± 7.1 years. Most of them (53.6%) had no formal education. Among the respondents, 22.0% male and 28.8% female were malnourished. The proportion of malnourished and at risk of malnutrition among the respondents living without a partner were 28.6 and 65.3%, respectively. A significantly (p < 0.05) higher odds of having depression (OR 15.6; 95% CI 3.1-78.1), poor oral health (OR 7.3; 95% CI 1.3-41.8), and no formal education (OR 6.5; 95% CI 1.3-32.1) was observed among the malnourished respondents. Though it was not statistically significant, among the malnourished, 31.3, 25.0 and 25.0% avoided highly oily food, beef/mutton, and sugary food, respectively. CONCLUSIONS: More than two-thirds of the older population were malnourished or at risk of malnutrition, where the female respondents were more vulnerable. Depression, inadequate oral health, and lack of education were negatively associated with the nutritional status of the older population.

Association of gestational diabetes mellitus and thyroid status during pregnancy: a cross-sectional study in a tertiary health care center of Bangladesh.

OBJECTIVE: To find out any association between gestational diabetes mellitus (GDM) and thyroid status (TS) throughout pregnancy in Bangladesh. METHODOLOGY: This study, designed as a cross-sectional study, was performed on randomly chosen 628 patients attending the Ad-Din Women's Medical College antenatal service from January 1 2019 to December 31 2019. After taking a detailed history, oral glucose tolerance test was done for all the participants. If eligible, then thyroid-stimulating hormone (TSH) and free thyroxine (F.T4) tests were done. t-test and Chi-square test were used to compare variables between various classes as necessary. RESULTS: The mean gestational age in GDM and non-GDM groups was 20.5 ± 9.1 years and 17.5 ± 9.2 years, which were significantly different (p<.001). There was a substantial (p<.001) high incidence of thyroid disorder (TD) in the non-GDM community. Mean F.T4 of the GDM group was lower in all three trimesters. The mean TSH of the GDM group was more deficient in the early stage of pregnancy but higher in the later stage (3rd trimester). Euthyroid cases were significantly higher (83.8%; p<.001) while subclinical hypothyroidism (9.5%; p<.001) and transient hyperthyroidism (2.4%; p<.001) cases were significantly lower in GDM group. CONCLUSIONS: Even though GDM and TD are the most prevalent endocrine disorders during pregnancy, neither TS during pregnancy nor any risk factors for TD have been associated with the development of GDM.

Job satisfaction among physicians providing health care to the elderly in Japan: a qualitative study.

BACKGROUND: Physicians' job satisfaction plays an important role in service delivery. Japan is a country with a higher number of elderly people and their medical care is a crucial issue. To date, no study has been conducted on the job satisfaction of geriatricians serving the elderly in Japan. This study aims to explore the job satisfaction and motivation of physicians providing health care to the elderly working at different hospitals in Japan. METHODS: In-depth interview of 23 geriatric physicians was conducted and data were coded and analysed. Qualitative content analysis was conducted to identify the response themes. RESULTS: Three major themes emerged from the analysis and they are: satisfaction as a primary care provider, career development, and suitable communication with patients. Geriatric physicians enjoy their work with inter-professional collaboration and are satisfied to provide primary health care to elderly people. Geriatrics is a very promising career to them and they enjoy the communication and empathetic doctor-patient relationship in their service. CONCLUSIONS: Japanese physicians providing health care to the elderly are enjoying their work due to a suitable environment, multi-professional collaboration, work-life balance, and patient-doctor relationship.

Discrimination against the elderly in health-care services: a systematic review.

Ageism in health-care services is a cardinal public health concern in geriatric health. It is important to know the types and extent of discrimination experienced by elderly individuals while seeking health care. This systematic review aimed to explore the available research to identify discrimination of elderly individuals in health-care services. MEDLINE through PubMed, Web of Science, PsycInfo, and Cochrane Database were searched by using a comprehensive search strategy in September 2020 with no limitation in the year of publication and types of publication. Articles published in English focusing on disparities in health-care service among the elderly were included. Two independent authors screened, extracted, and assessed the quality of data using the Joanna Briggs Institute Critical Appraisal Tool. A narrative synthesis was conducted followed by qualitative content analysis to identify themes from the extracted outcomes of the included studies. Of 3117 articles retrieved from the initial search, 21 articles were included. A total of 611 608 participants from 38 countries in four geographic regions were reported. Articles were published between 2003 and 2020. Most of the studies (n = 19) were cross-sectional in design, and the remaining two studies were qualitative. Major themes of discrimination were age-related discrimination, racial discrimination, gender discrimination, wealth-related discrimination, and technology-related discrimination. This systematic review identified the major perspectives on disparities faced by the elderly in accessing health services. There is a huge research gap on this issue. Specific strategies should be incorporated to address the varying types of discrimination experienced by elderly individuals.

Morphological and Interaction Characteristics of Surface-Active Ionic Liquids and Palmitic Acid in Mixed Monolayers.

A series of water soluble, surface-active ionic liquids (SAILs), namely, 1-alkyl-3-methyl imidazolium chlorides ([Cn -mim]Cl) and their mixtures with palmitic acid (PA) are investigated in Langmuir monolayers and Langmuir-Blodgett films. It is inferred from the surface pressure-area isotherms that C16 -mim-IL mixes non-ideally with PA and stabilizes the binary mixed films. In addition, the residence of mim-IL at the water surface is enhanced as a function of the increasing alkyl side chain length. Generally, the compressional moduli values decrease upon increasing the content of the mim-ILs over a wide range of compositions. Furthermore, film relaxation measurements indicate that the IL component is selectively excluded from the mixed films upon achieving a certain target pressure. Brewster angle microscope images demonstrate minimal changes on the PA domains in the presence of either C4 - and C8 -mim-ILs, whereas presence of the hexadecyl counterpart results in the formation of condensed sheets. Atomic force microscopy imaging of deposited films show the formation of propeller-like aggregates when C8 - or C16 -mim-IL is present in the mixed films.

Guillain-Barré syndrome associated with SARS-CoV-2 infection: A systematic review and individual participant data meta-analysis.

Several published reports have described a possible association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. This systematic review aimed to summarize and meta-analyze the salient features and prognosis of SARS-CoV-2-associated GBS. We searched the PubMed (Medline), Web of Science and Cochrane databases for articles published between 01 January 2020 and 05 August 2020 using SARS-CoV-2 and GBS-related keywords. Data on sociodemographic characteristics, antecedent symptoms, clinical, serological and electrophysiological features, and hospital outcomes were recorded. We included 45 articles from 16 countries reporting 61 patients with SARS-CoV-2-associated GBS. Most (97.7%) articles were from high- and upper-middle-income countries. Forty-two (68.9%) of the patients were male; median (interquartile range) age was 57 (49-70) years. Reverse transcriptase polymerase chain reaction for SARS-CoV-2 was positive in 90.2% of patients. One report of SARS-CoV-2-associated familial GBS was found which affected a father and daughter of a family. Albuminocytological dissociation in cerebrospinal fluid was found in 80.8% of patients. The majority of patients (75.5%) had a demyelinating subtype of GBS. Intravenous immunoglobulin and plasmapheresis were given to 92.7% and 7.3% of patients, respectively. Around two-thirds (65.3%) of patients had a good outcome (GBS-disability score ≤ 2) on discharge from hospital. Two patients died in hospital. SARS-CoV-2-associated GBS mostly resembles the classical presentations of GBS that respond to standard treatments. Extensive surveillance is required in low- and lower-middle-income countries to identify and report similar cases/series. Further large-scale case-control studies are warranted to strengthen the current evidence. PROSPERO Registration Number CRD42020201673.

Physical activity and sedentary behaviour in Bangladesh: a systematic scoping review.

OBJECTIVES: Lack of physical activity (PA) contributes to increasing prevalence of non-communicable diseases (NCDs) globally. However, little is known about PA and sedentary behaviour (SB) among populations in low- and middle-income countries (LMICs). This systematic review examined prevalence of PA and SB in Bangladesh. STUDY DESIGN: Systematic review of the literature. METHODS: A systematic electronic search in eight databases and a manual search of retrieved articles' references were conducted. Original research conducted in Bangladesh with PA- and/or SB-related outcome(s) were included. RESULTS: Out of 1,162 retrieved titles, 33 articles (32 cross-sectional and one case-control study) met the inclusion criteria. Twenty-nine studies were with healthy populations: adults (n = 19); children and adolescents (n = 7); and children, adolescents and adults (n = 3). Five studies used nationally representative samples of adults and one of adolescents. Most studies (n = 26) assessed PA only; three only SB, and four both PA and SB. All studies used self-reported measures. Among healthy adults, prevalence of insufficient PA ranged from 5% to 83%. Occupational and transport-related PA contributed the most towards total PA with negligible contribution of recreational PA. Among children and adolescents, the prevalence of insufficient PA ranged between 20% and 67%. Females engaged in less PA compared to males. Limited evidence currently exists about the prevalence of SB, especially among adults. CONCLUSIONS: PA and SB research has received little attention in Bangladesh. Critical knowledge gaps identified in this review should be taken into account when designing new research and programmes in Bangladesh and other LMICs with similar socio-economic and cultural settings.

Government health expenditure, out-of-pocket payment and social inequality: A cross-national analysis of China and OECD countries.

This study aims to assess the association between Chinese out-of-pocket payments and government health spending, investigating their variation ratio in the context of OECD countries. Aggregated time-series data of 37 countries (from China and official OECD members) were collected from the World Bank Open Data source and analyzed using the multiple linear regression models. Benchmarking approach was applied to evaluate the causes of healthcare expenditure rise per capita. The results showed that China's government health expenditure was positively associated with out-of-pocket payment rise, with a higher variation score of 42.70%. The association was statistically significant at 5%. Likewise, the association between government expenditure and out-of-pocket payment in the OECD countries was positively significant at 1%, and their variation score was 2.41%. Health financing in OECD countries showed higher stability and equity than that in China. Policy implications for China is to reduce the distributional disparity of government health funds by tax adjustments in health services, universal health coverage, the removal of social health insurance disparities, and a single health payment method.

Utility of endobronchial ultrasound guided trans-bronchial needle aspiration in diagnosis of melioidosis - case series and review of literature.

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is routinely performed for diagnostic evaluation of mediastinal lymphadenopathy due to various etiologies with excellent sensitivity and specificity. Melioidosis can have atypical features like isolated mediastinal lymphadenopathy mimicking as tuberculosis or lymphoma. Differentiation of such atypical melioidosis presentation become difficult due to similar clinical, radiological and even similar EBUS lymph node characteristics. Role of EBUS TBNA in diagnosing melioidosis is under investigated and sparsely reported. We describe two cases of melioidosis diagnosed by point of care rapid lateral flow immunoassay antigen testing and culture of EBUS-TBNA samples from necrotic mediastinal lymph nodes.

Prevalence and factors associated with tobacco use among men in India: findings from a nationally representative data.

BACKGROUND: Tobacco consumption causes almost 638,000 premature deaths per year in India. This study sought to examine the prevalence and determinants of tobacco use among men in India. METHODS: We analyzed data from the fourth round of the National Family Health Survey in India. These nationally representative cross-sectional sample data were collected from January 20, 2015, to December 4, 2016. A total of 112,122 men aged 15-54 years were included in this study. Primary outcomes were tobacco use categorized into smoking, smokeless, any tobacco, and both smoked and smokeless tobacco use. Complex survey design and sampling weights were applied in both the descriptive analyses and logistic regression models. We present the findings using odds ratios. RESULTS: The prevalence of tobacco use among men in India for the studied period was 45.5% (95% CI 44.9-46.1), smoking was 24.6% (95% CI 24.1-25.1), smokeless tobacco use was 29.1% (95% CI 28.6-29.6), and both smoked and smokeless tobacco use was 8.4% (95% CI 8.1-8.7). The prevalence of tobacco use among men was higher among the elderly, separated/divorced/widowed individuals, those with lower education and wealth status, alcohol consumers, manual workers, and residents of the northeast region. Multivariate analysis showed that age, lower education, occupation, region, alcohol consumption, separated/divorced/widowed status, and economic status were substantially associated with tobacco use among Indian men. CONCLUSIONS: Innovative and cost-effective strategies targeting high-risk groups are crucial to curbing the tobacco epidemic in India. Anti-smoking campaigns should also focus on mitigating alcohol abuse. Reducing tobacco marketing and implementing formal education about the dangers of tobacco use, progressive taxing, packaging, and labeling of tobacco products and price strategies should be harmonized in legal provisions.

Decoding the enigma of antiviral crisis: Does one target molecule regulate all?

Disease fatality associated with Ebola, SARS-CoV and dengue infections in humans is attributed to a cytokine storm that is triggered by excessive pro-inflammatory responses. Interleukin (IL)-6 acts as a mediator between pro- and anti-inflammatory reactivity by initiating trans- and classical-signaling, respectively. Hence, IL-6 is assumed to provide a target for a broad range of antiviral agents. Available immunosuppressive antivirals are directed to control an often exaggerated pro-inflammatory response that gives rise to complex clinical conditions such as lymphocytopenia. It is known that IL-6, via its soluble receptor (sIL-6R), initiates a pro-inflammatory response while an anti-inflammatory response is triggered by the membrane-bound IL-6 receptor (IL-6R). Future antivirals should thus aim to target the mechanism that regulates switching between IL-6 trans- and classical-signaling. In this review, we propose that the tumour necrosis factor-α converting enzyme ADAM-17 could be the master molecule involved in regulating IL-6 class switching and through this in controlling pro- and anti-inflammatory responses to viral antigenic stimuli. Therefore, ADAM-17 should be considered as a potential target molecule for novel antiviral drug discovery that would regulate host reactivity to infection and thereby limit or prevent fatal outcomes.

Pressure-scaling characteristics of femtosecond two-photon laser-induced fluorescence of carbon monoxide.

Broadband femtosecond (fs) two-photon laser-induced fluorescence (TP-LIF) of the B1Σ+←X1Σ+, Hopfield-Birge system of carbon monoxide (CO) is believed to have two major advantages compared to narrowband nanosecond excitation. It should (i) minimize the effects of pressure-dependent absorption line broadening and shifting, and (ii) produce pressure-independent TP-LIF signals as the effect of increased quenching due to molecular collisions is offset by the increase in number density. However, there is an observed nonlinear drop in the CO TP-LIF signal with increasing pressure. In this work, we systematically investigate the relative impact of potential deexcitation mechanisms, including collisional quenching, forward lasing, attenuation of the source laser by the test cell windows or by the gas media, and a 2+1 photoionization process. As expected, line broadening and collisional quenching play minor roles in the pressure-scaling behavior, but the CO fs TP-LIF signals deviate from theory primarily because of two major reasons. First, attenuation of the excitation laser at high pressures significantly reduces the laser irradiance available at the probe volume. Second, a 2+1 photoionization process becomes significant as the number density increases with pressure and acts as a major deexcitation pathway. This work summarizes the phenomena and strategies that need to be considered for performing CO fs TP-LIF at high pressures.