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The Coronavirus Disease 2019 (COVID-19) pandemic is a global public health threat ravaging the health systems. In low and middle-income countries (LMICs), COVID-19 and several other challenges concurrently worsen the health outcome indicators. Interestingly, vaccines have been identified as the most reliable and cost-effective public health intervention, and the governments in LMICs have instituted an array of plans to ensure every eligible person gets vaccinated. However, there is still considerable apathy around the use of the available COVID-19 vaccines in LMICs which is impeding the fight against the COVID-19 pandemic. In this paper, we explore the multiple interrelated factors behind low COVID-19 vaccination coverage in LMICs. It is therefore recommended that the governments in LMICs embrace multicomponent and wide-ranging strategies. This should involve utilising community-based approaches such as community pharmacy-led vaccination to promote community access to COVID-19 vaccines and to revive trust in national health authorities by offering population-specific, target-driven, transparent, and timely communication to the community who they serve about the safety and efficacy of the COVID-19 vaccine. Communication strategies should be tailored to reflect diverse political orientations as this can enhance vaccine acceptance. Additionally, local political parties and representative should be engaged in broad alliances to facilitate community mobilisation and support for vaccination campaigns. Also, relevant Nongovernmental Organisations and Community-based Organisations should institute programs at the grassroots that incorporate the gatekeepers to the community aimed at influencing population behaviour regarding COVID-19 vaccine hesitancy. Besides, the public health department in the ministry of health in LMICs should create more awareness, through social and mass media, particularly in the rural, semi-urban, and slum communities about the pivotal role of vaccination. Thus, we opined that these strategies will help LMICs achieve the COVID-19 vaccination target and further reposition the healthcare systems, and promote other public health interventions now and in the future.
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INTRODUCTION: Multiple sclerosis (MS) is a debilitating neurological condition affecting nearly one million people across the United States. Among the most prominent symptoms of the condition are excessive fatigue and daytime sleepiness. Numerous clinical trials have investigated the efficacy of modafinil in addressing fatigue among these patients. OBJECTIVE: The objective of the present study is to assess the safety and efficacy of modafinil for the treatment of fatigue in MS. METHODOLOGY: An electronic search of PUBMED, ScienceDirect, and Cochrane Central was conducted for articles published from inception to December 2023 using search terms such as "modafinil," "fatigue," and "MS." RESULTS: Seven studies were included in our analysis. Modafinil leads to a meaningful reduction in fatigue when compared with placebo, as measured by Modified Fatigue Impact Scale [mean difference (MD) = -4.42 [-8.01, -.84]; I2 = 45%; p = .02] and Epworth Sleepiness Scale [MD = -.87 [-1.64, -.10]; I2 = 0%; p = .03]. Modafinil also demonstrated a greater risk of precipitating adverse events (e.g., insomnia, gastrointestinal symptoms) when compared with placebo [RR = 1.30 [1.03, 1.66]; I2 = 0%; p = .03]. In quality-of-life assessments, modafinil was associated with overall improvement in well-being [standardized mean difference = .18 [.01, .35]; I2 = 56%; p = .04]. CONCLUSION: The data indicates that modafinil confers a therapeutic benefit when treating fatigue in patients with MS and improves overall quality of life; however, there is a risk of precipitating adverse events. Ultimately, higher quality of evidence may be required to better inform clinical management.
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Fadiga , Modafinila , Esclerose Múltipla , Modafinila/uso terapêutico , Modafinila/efeitos adversos , Modafinila/farmacologia , Humanos , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/complicações , Fadiga/tratamento farmacológico , Fadiga/etiologia , Promotores da Vigília/uso terapêutico , Promotores da Vigília/efeitos adversos , Promotores da Vigília/farmacologia , Ensaios Clínicos Controlados como AssuntoRESUMO
Background: Efpeglenatide, a novel GLP-1 receptor agonist, has shown promise in improving glycemic control and inducing weight loss in individuals with type 2 diabetes (T2DM). This meta-analysis assessed its therapeutic potential and safety profile. Methods: A literature search was conducted on PubMed, SCOPUS, and Cochrane Central from inception until September 2023. We selected patients with T2DM and identified and compared those receiving efpeglenatide to placebo. Outcomes assessed included fasting plasma glucose (FPG), HbA1c, body weight, BMI, and cardiometabolic parameters. Data were analyzed using a random-effects model, with results presented as mean differences (MD) for continuous outcomes and risk ratios (RR) for safety analysis, along with their respective 95% confidence intervals. Quality assessment was conducted using the Cochrane risk of bias tool. Results: We included 11 studies in our analysis. Efpeglenatide demonstrated significant reductions in FPG (MD = -1.53 mmol/L, 95% CI = [-2.86, -0.66], p < 0.01), HbA1c (MD = -0.84, 95% CI= [-1.08, -0.60], p < 0.01), body weight (MD = -2.24 kg, 95% CI = [-4.20, -2.00], p < 0.01), and BMI (MD = -1.61 kg/m2, 95% CI= [-2.12, -1.09], p < 0.01). However, efpeglenatide was associated with a moderate increase in the risk of gastrointestinal adverse events, nausea, diarrhea, and vomiting. There was a non-significant elevated risk of hypoglycemia. Conclusions: Efpeglenatide significantly improves glycemic outcomes and promotes weight loss in individuals with diabetes. However, it is associated with moderate adverse effects related to the gastrointestinal system. Thus, further trials are warranted to comprehensively assess its safety and efficacy to derive a robust conclusion. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-024-01409-3.
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INTRODUCTION: Smoke from traditional cigarettes and e-cigarette aerosols have distinct chemical compositions that may impact blood pressure (BP) and heart rate (HR) differently. AIMS: This study compared the impact of nicotine-containing e-cigarettes (EC+) versus nicotine-free (EC-) on BP, HR and endothelial markers, and assessed if EC+ posed fewer risks than tobacco cigarettes (TC). METHODS: Electronic databases were searched from inception until November 2023 for studies reporting changes in systolic and diastolic BP (SBP, DBP) and HR and endothelial parameters before and after the use of EC+, EC- and TC. Data were analyzed using weighted mean differences (WMDs) and 95% confidence intervals (CIs). RESULTS: Fifteen studies (n = 752) were included in our meta-analysis. We demonstrate that EC+ significantly increased systolic BP (WMD = 3.41, 95% CI [0.1,6.73], p = 0.04], diastolic BP (WMD = 3.42, 95% CI [1.75, 5.09]; p < 0.01], and HR (WMD = 5.36 BPM, 95% CI [1.87, 8.85]; p < 0.01) compared to EC-. However, EC+ was observed to cause less detrimental effect on SBP (WMD = - 4.72 mmHg, 95% CI [- 6.58, - 2.86], p < 0.01), and HR (WMD = - 3.11 BPM, 95% CI [- 4.54, - 1.68]; p < 0.01) as compared to TC with no difference on DBP (WMD = - 1.14 mmHg, 95% CI [- 2.38, 0.1]; p = 0.07). EC+ also led to greater deterioration of endothelial parameters as compared to EC- but to a lesser degree as compared to TC. CONCLUSION: EC+ shows greater impairment in hemodynamic and endothelial parameters than EC- but less than TC. Additional studies are needed to evaluate prolonged effects of EC use.
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Pressão Sanguínea , Sistemas Eletrônicos de Liberação de Nicotina , Endotélio Vascular , Frequência Cardíaca , Nicotina , Produtos do Tabaco , Vaping , Humanos , Vaping/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Endotélio Vascular/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Nicotina/efeitos adversos , Nicotina/administração & dosagem , Masculino , Feminino , Produtos do Tabaco/efeitos adversos , Adulto , Pessoa de Meia-Idade , Agonistas Nicotínicos/efeitos adversos , Agonistas Nicotínicos/administração & dosagem , Medição de Risco , Fatores de Risco , Adulto Jovem , Idoso , Hemodinâmica/efeitos dos fármacos , Fatores de TempoAssuntos
Bloqueio Nervoso Autônomo , Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Humanos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/cirurgia , Gânglio Estrelado , Injeções , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/prevenção & controle , Vasoespasmo Intracraniano/cirurgiaRESUMO
OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially for type 2 diabetes mellitus, show promise in promoting weight loss and improving heart health in obese individuals without diabetes. Our goal was to examine existing research for conclusive evidence on various types of GLP-1 RAs for weight loss and cardiometabolic benefits in obesity without diabetes. METHODS: We conducted an electronic search on PubMed, Scopus, and Cochrane Central using keywords, such as "GLP-1 RA," "obesity," and "weight loss." We considered all available global GLP-1 RAs for inclusion. Our analysis focused on weight loss, blood pressure (BP) changes (systolic and diastolic BPs), and lipid profile effects (high-density lipoprotein, low-density lipoprotein, total cholesterol, and triacylglycerol). We used a random-effects meta-analysis with the standardized mean difference (SMD), mean difference (MD), odds ratio, and relative risk to present the results. RESULTS: Our search yielded a total of 7535 articles. We included 15 trials in our study. GLP-1 RAs led to significant weight loss (MD, -8.77 kg; P <.01) in obese individuals. GLP-1 RAs also improved the systolic BP (MD, -4.13 mm Hg; P <.01), diastolic BP (MD, -1.39 mm Hg; P <.01), and lipid profiles, including improved levels of triacylglycerol (SMD, -0.99 mg/dL; P <.01), total cholesterol (SMD, -0.73 mg/dL; P <.01), very low-density lipoprotein (SMD, -1.11 mg/dL; P <.01), and low-density lipoprotein (SMD, -0.27 mg/dL; P <.01), and significantly increased high-density lipoprotein levels (SMD, 0.11 mg/dL; P <.01). However, GLP-1 RAs were associated with an increased risk of gastrointestinal adverse events. CONCLUSION: GLP-1 RAs were found to be beneficial for not only weight loss but also reduction in risk factors for cardiovascular disease such as BP and lipid profile. Consistent beneficial results were observed across the various subtypes of GLP-1 RAs.
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Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Hipoglicemiantes/efeitos adversos , Agonistas do Receptor do Peptídeo 1 Semelhante ao Glucagon , Peptídeo 1 Semelhante ao Glucagon/efeitos adversos , Obesidade/tratamento farmacológico , Obesidade/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Redução de Peso , Lipídeos , Triglicerídeos , Lipoproteínas HDL , Lipoproteínas LDL , Colesterol , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistasRESUMO
BACKGROUND: The severe neurologic tumor known as glioblastoma (GBM), also referred to as a grade IV astrocytoma, is rapidly progressive and debilitating. Supratotal resection (SpTR) is an emerging concept within glioma surgery, which aims to achieve a more extensive resection of the tumor than is possible with conventional techniques. METHODS: We performed a language-independent search of PubMed, Scopus, and Cochrane CENTRAL to identify all available literature up to August 2022 of patients undergoing SpTR assessing survival outcomes in comparison to other surgical modalities. RESULTS: After screening for exclusion, a total of 13 studies, all retrospective in design, were identified and included in our meta-analysis. SpTR was associated with significantly increased overall survival (hazard ratio 0.77, 95% CI 0.71-0.84; P < 0.01, I2 = 96%) and progression-free survival (hazard ratio 0.2, 95% CI 0.07-0.56; P = 0.002, I2 = 88%). CONCLUSION: SpTR is associated with greater overall survival and PFS when compared with other glioblastoma surgeries like GTR or SubTR.
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Astrocitoma , Neoplasias Encefálicas , Glioblastoma , Glioma , Humanos , Glioblastoma/cirurgia , Estudos Retrospectivos , Neoplasias Encefálicas/cirurgia , Astrocitoma/cirurgia , Glioma/cirurgia , Procedimentos Neurocirúrgicos/métodosRESUMO
As of 6 June 2022, a sum 25,782 of active cases and 524,701 deaths due to Coronavirus disease-19 (COVID-19) have been recorded in India. Stewing in the flares of the pandemic, Kerala is entwined in the wrath of multiple emerging infectious diseases. India, a home to 1.3 billion people, recently faced a devastating second wave of COVID-19 during May of 2021, with a ruckus of chronic shortage of medicine, oxygen supplies, ventilators, besides, being challenged by secondary infections and chronic health ailments. The state of Kerala, alone contributes to 50% COVID-19 caseload, besides, recent simultaneous outbreaks of Zika Virus Disease (ZVD), Nipah Virus Disease (NiVD) and Kala-azar (black fever) on July 8, September 5 and 8, 2021 respectively. Syndemicity and a high case fatality rates of these highly contagious diseases coupled with post infection sequelae, overwhelm the already fragile healthcare system. Thus, these lethal infectious diseases along with an anticipated third wave of COVID-19 pose a serious public health threat in and around South India. With this narrative review, we aim to discuss the challenges that the emergence of intersecting outbreaks of Zika, Nipah, Kala-azar presents with, in the nation, amidst the global pandemic of COVID-19 and provide recommendations so as to help alleviate the situation. The syndemicity of COVID-19 with other infectious diseases, calls for adequate surveillance and monitoring of diseases' outbreaks. To avoid the worst situations like pandemic, the health ministry, public and private health stakeholders in India should strengthen the public healthcare delivery system and providence of quick medical facilities to control the rate of mortality and morbidity during outbreaks.
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With the emergence of COVID-19 vaccines, individuals with comorbidities and immunosuppression require particular attention and should be prioritized for vaccination. However, the majority of vaccine clinical trials excluded people with comorbidities, resulting in a lack of data regarding vaccine efficacy in this demographic. Along with more inclusivity in clinical trials, reaching a definitive conclusion regarding vaccine efficacy in these patients is also crucial. In our review, we highlight the BNT162b2 vaccine safety and efficacy based on the limited number of clinical trials which included this demographic. We also provide vaccine considerations for individuals with cancer, autoimmune diseases, HIV, obesity, diabetes, organ transplant recipients and those undergoing maintenance haemodialysis to help them govern their decision regarding vaccine administration. In conclusion, further studies are required to alleviate any insecurities in patients with comorbidities regarding vaccination and it is recommended that patients are monitored post-vaccination to make sure sufficient immunity is achieved.
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The Coronavirus Disease 2019 (COVID-19) pandemic is a public health threat for Malawi which is facing several challenges concurrently including disease burden; inadequate finances; illiteracy; and public mistrust in government. In this pandemic, vaccines are the most reliable and cost-effective public health intervention, and the Malawian government has instituted an action plan which includes prioritizing the vaccination of traditional and religious leaders, increased vaccination sites to include workplaces and shopping malls, and health promotion. However, there is still considerable hesitancy around the use of the available vaccines in Malawi. In this paper, we explore the multiple interrelated factors driving COVID-19 vaccine hesitancy in Malawi. It is therefore recommended that the Malawian government embrace multicomponent and wide-ranging strategies to address COVID-19 vaccine hesitancy in the country. This includes reviving trust in national health authorities by offering population-specific, target-driven, and effective, transparent, and timely communication to its citizens and relevant stakeholders about the safety and efficacy of the COVID-19 vaccine.
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Pessoal de Saúde , Saúde Mental , Árabes , Pessoal de Saúde/psicologia , Humanos , Estudos LongitudinaisRESUMO
Proper training on the preventive measures against COVID-19 among health-care workers is crucial for mitigating the spread of viral infection. The present study evaluated the efficacy of a brief web-based module on the practice of hand hygiene and respiratory etiquette among respective health-care workers. A comparative study was conducted with a total of 500 participants. A self-reported questionnaire was used for both pre- and post-intervention evaluation. The post-intervention assessment was conducted 1-2 weeks following the intervention. The difference in the practice of hand hygiene and respiratory etiquettes during work hours was recorded. We found that the intervention resulted in an evident difference in the use of alcohol-based hand sanitizer by the participating doctors before examining the patient. Interns showed a much higher propensity to wash their hands for at least 20 s, relative to other health-care workers. The difference between pre- and post-intervention handwashing for >5 times/day was 6.5% in females and 4.5% in males. In short, the study was able to demonstrate that a web-based health education module is an effective tool for the education and promotion of preventative measures in hospital setups, which may ultimately aid in halting the spread of COVID-19 among health-care workers.
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Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Educação em Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , COVID-19 , Feminino , Desinfecção das Mãos/métodos , Higiene das Mãos , Pessoal de Saúde , Humanos , Internet , Masculino , SARS-CoV-2 , Autorrelato , Inquéritos e Questionários , Adulto JovemRESUMO
Introduction Postpartum depression (PPD) is defined as the onset of depressive symptoms within six weeks of childbirth. PPD is more common in resource-constrained countries as compared to developed countries. The study aimed to evaluate the factors associated with PPD among women in Sindh, Pakistan. Methods A multi-centre, cross-sectional study was conducted at three major tertiary care setups in Sindh, Pakistan. All women presenting to the outpatient department within six weeks of giving live birth were eligible to participate. All women who had stillbirths, abortions, or were treated for a past psychiatric illness or neurological disease were excluded from the study. The Edinburgh postpartum depression scale (EPDS) was used as a screening tool. All socio-demographic factors were documented in a predefined pro forma. The data was analyzed using Statistical Package for Social Sciences (SPSS, Version 26, IBM, Chicago, IL). Results According to the Edinburgh postpartum depression scale (EPDS), the incidence of postpartum depression in the current study population was 19.3%. Of these, 12 (3.3%) women had persistently thought about self-harming. Over 100 women did not receive any formal education, constituting the majority of the study population. Formula milk feeding of the newborn was significantly associated with an increased frequency of postpartum depression (p= 0.0001). Conclusion The current study highlights the significant burden of postpartum depression in Pakistan. However, the present study failed to find any significant risk factors associated with postpartum depression. Only formula milk feeding was significantly associated with a higher frequency of PPD among study patients.