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2.
Pak J Biol Sci ; 25(1): 1-8, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35001569

RESUMO

The novel coronavirus infection is also called COVID-19 (coronavirus disease 2019). The infection has affected millions of people worldwide and caused morbidity as well mortality in patients with pre-existing chronic conditions such as metabolic, respiratory and cardiovascular disorders. The severity of the disease is mostly seen in people with low immunity and chronic sufferers of respiratory, cardiovascular and metabolic disorders. To date, there is no specific treatment available for COVID-19. Precaution and prevention are the most recommended options followed for controlling the spread of infection. Trace elements such as zinc, calcium, iron and magnesium play an important role in boosting the immunity of the host system. These components assist in the development and functioning of lymphocytes, cytokines, free radicals, inflammatory mediators and endothelial functioning. This review summarizes the common dietary supplements that are regularly consumed in Saudi Arabia and are known to contain these vital trace elements. Data available in Google Scholar, NCBI, PUBMED, EMBASE and Web of Science about COVID-19, micronutrients, trace elements and nutritional supplements of Saudi Arabia was collected. By highlighting the traditionally used dietary components containing the essential elements, this review could provide useful knowledge crucial for building immunity in the population.


Assuntos
COVID-19/tratamento farmacológico , Suplementos Nutricionais/estatística & dados numéricos , Oligoelementos/uso terapêutico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Cálcio/uso terapêutico , Suplementos Nutricionais/normas , Humanos , Ferro/uso terapêutico , Magnésio/uso terapêutico , Arábia Saudita/epidemiologia , Zinco/uso terapêutico
10.
Chem Pharm Bull (Tokyo) ; 70(1): 25-31, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980729

RESUMO

We report on the recommendation of the simple and versatility of methylated reference (MR) to improve applications in the single reference (SR)-LC based on relative molar sensitivity (RMS). Three curcuminoids (Curs) such as curcumin, demethoxycurcumin and bisdemethoxycurcumin in turmeric products were determined using authentic standards and methylated curcumin. In addition, high-speed countercurrent chromatography (HSCCC) purification is necessary to separate Curs for indicating the RMS. For HSCCC separation, a biphasic solvent system was used to obtain these fractions, which were then subjected to 1H quantitative NMR to determine their contents in each test solution. Using these solutions, the RMS of Curs are calculated from slopes ratios of calibration curves (three ranges from 0-100 µmol/L, r2 > 0.998). The averaged RMS of Curs were 8.92 (relative standard deviation (RSD), 1.17%), 8.97 (2.18%), and 9.61 (0.77%), respectively. Cur concentrations in turmeric products can be determined using RMS, peak area, and MR content added in these samples. This proposed method, which is based on chemical methylation and the SR-LC assay has been successfully applied for the simple and reliable estimation of Curs in turmeric products.


Assuntos
Diarileptanoides/química , Cromatografia Líquida de Alta Pressão/normas , Metilação , Estrutura Molecular , Padrões de Referência
11.
Med Care ; 60(1): 22-28, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34670222

RESUMO

BACKGROUND: Before the Affordable Care Act (ACA), most women who gained pregnancy-related Medicaid were not eligible for Medicaid as parents postpartum. The ACA aimed to expand health insurance coverage, in part, by expanding Medicaid; introducing mandates; reforming regulations; and establishing exchanges with federal subsidies. Federal subsidies offer a means to coverage for individuals with income at 100%-400% of the federal poverty level who do not qualify for Medicaid. OBJECTIVE: The objective of this study was to identify the effects of the ACA's non-Medicaid provisions on women's postpartum insurance coverage and depressive symptoms in nonexpansion states with low parental Medicaid thresholds. PARTICIPANTS: Women with incomes at 100%-400% of the federal poverty level who had prenatal insurance and completed the Pregnancy Risk Assessment Monitoring System (2012-2015). SETTING: Five non-Medicaid expansion states with Medicaid parental eligibility thresholds below the federal poverty level. DESIGN: Interrupted time-series analyses were conducted to examine changes between pre-ACA (January 2012-November 2013) and post-ACA (December 2013-December 2015) trends for self-reported loss of postpartum insurance and symptoms of postpartum depression. RESULTS: The sample included 9,472 women. Results showed significant post-ACA improvements where the: (1) trend for loss of postpartum insurance reversed (change of -0.26 percentage points per month, P=0.047) and (2) level of postpartum depressive symptoms decreased (change of -3.5 percentage points, P=0.042). CONCLUSIONS: In these 5 states, the ACA's non-Medicaid provisions were associated with large increases in retention of postpartum insurance and reductions in postpartum depressive symptoms, although depressive symptoms findings are sensitive to model specification.


Assuntos
Depressão Pós-Parto/economia , Cobertura do Seguro/normas , Medicaid/tendências , Patient Protection and Affordable Care Act/estatística & dados numéricos , Governo Estadual , Adulto , Depressão Pós-Parto/epidemiologia , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Medicaid/economia , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/economia , Gravidez , Estados Unidos
12.
Med Care ; 60(1): 50-55, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34739412

RESUMO

BACKGROUND: The Centers for Medicare and Medicaid Services proposed that the Transforming Clinical Practice Initiative (TCPI) would improve health outcomes for patients, reduce utilization of institutional services, and generate significant savings for payers by the end of September 2019. OBJECTIVE: The objective of this study was to investigate whether participation in TCPI's Practice Transformation Networks (PTNs) was associated with improved cost and utilization outcomes for Medicare patients of family medicine-based practices in the first 2 years, that is, 2016-2017, of the Initiative. STUDY DESIGN: A quasi-experimental design with a longitudinal cohort of family medicine-based practices and a propensity-matched comparison sample. SUBJECTS: A total of 761 PTN practices and 3451 non-PTN practices. MEASURES: To measure practice-level patient outcomes, we attributed patients to practice based on the plurality of office visits. We obtained Medicare claims from 2011 to 2017 to assess PTN participation effects for Medicare Part A and B costs, hospital admission, and emergency department visit rates using a Difference-in-Differences design, adjusting for baseline characteristics. RESULTS: The differences in Medicare Part A and B costs (-1.71%, P=0.25), annual rates of hospitalization (-0.59%, P=0.12) and emergency department visit (-0.29%, P=0.46) were not significantly lower among PTN practices (N=761) than among propensity score-matched non-PTN practices (N=3541). CONCLUSIONS: TCPI's transforming efforts, such as the outcomes examined in the study, might need a longer time frame to manifest and require evaluation after the full 4-year participation period. The indistinguishable effect of PTN participation may also be attributed to the fact that non-PTN practices might have participated in other initiatives that changed their care and curbed health care utilization and costs consequently.


Assuntos
Medicina de Família e Comunidade/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos de Coortes , Medicina de Família e Comunidade/normas , Medicina de Família e Comunidade/estatística & dados numéricos , Humanos , Estudos Longitudinais , Medicare/economia , Medicare/estatística & dados numéricos , Estados Unidos
13.
Med Care ; 60(1): 75-82, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34812786

RESUMO

BACKGROUND: In response to concerns about opioid addiction following surgery, many states have implemented laws capping the days supplied for initial postoperative prescriptions. However, few studies have examined changes in the risk of prolonged opioid use associated with the initial amount prescribed. OBJECTIVE: The objective of this study was to estimate the risk of prolonged opioid use associated with the length of initial opioid prescribed and the potential impact of prescribing limits. RESEARCH DESIGN: Using Medicare insurance claims (2007-2017), we identified opioid-naive adults undergoing surgery. Using G-computation methods with logistic regression models, we estimated the risk of prolonged opioid use (≥1 opioid prescription dispensed in 3 consecutive 30-d windows following surgery) associated with the varying initial number of days supplied. We then estimate the potential reduction in cases of prolonged opioid use associated with varying prescribing limits. RESULTS: We identified 1,060,596 opioid-naive surgical patients. Among the 70.0% who received an opioid for postoperative pain, 1.9% had prolonged opioid use. The risk of prolonged use increased from 0.7% (1 d supply) to 4.4% (15+ d). We estimated that a prescribing limit of 4 days would be associated with a risk reduction of 4.84 (3.59, 6.09)/1000 patients and would be associated with 2255 cases of prolonged use potentially avoided. The commonly used day supply limit of 7 would be associated with a smaller reduction in risk [absolute risk difference=2.04 (-0.17, 4.25)/1000]. CONCLUSIONS: The risk of prolonged opioid use following surgery increased monotonically with increasing prescription duration. Common prescribing maximums based on days supplied may impact many patients but are associated with relatively low numbers of reduced cases of prolonged use. Any prescribing limits need to be weighed against the need for adequate pain management.


Assuntos
Analgésicos Opioides/administração & dosagem , Fatores de Tempo , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Cuidados Pós-Operatórios/normas , Cuidados Pós-Operatórios/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Estados Unidos/epidemiologia
14.
Med Care ; 60(1): 83-92, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34812788

RESUMO

IMPORTANCE: Model 3 of the Bundled Payments for Care Improvement (BPCI) is an alternative payment model in which an entity takes accountability for the episode costs. It is unclear how BPCI affected the overall skilled nursing facility (SNF) financial performance and the differences between facilities with differing racial/ethnic and socioeconomic status (SES) composition of the residents. OBJECTIVE: The objective of this study was to determine associations between BPCI participation and SNF finances and across-facility differences in SNF financial performance. DESIGN, SETTING, AND PARTICIPANTS: A longitudinal study spanning 2010-2017, based on difference-in-differences analyses for 575 persistent-participation SNFs, 496 dropout SNFs, and 13,630 eligible nonparticipating SNFs. MAIN OUTCOME MEASURES: Inflation-adjusted operating expenses, revenues, profit, and profit margin. RESULTS: BPCI was associated with reductions of $0.63 million in operating expenses and $0.57 million in operating revenues for the persistent-participation group but had no impact on the dropout group compared with nonparticipating SNFs. Among persistent-participation SNFs, the BPCI-related declines were $0.74 million in operating expenses and $0.52 million in operating revenues for majority-serving SNFs; and $1.33 and $0.82 million in operating expenses and revenues, respectively, for non-Medicaid-dependent SNFs. The between-facility SES gaps in operating expenses were reduced (differential difference-in-differences estimate=$1.09 million). Among dropout SNFs, BPCI showed mixed effects on across-facility SES and racial/ethnic differences in operating expenses and revenues. The BPCI program showed no effect on operating profit measures. CONCLUSIONS: BPCI led to reduced operating expenses and revenues for SNFs that participated and remained in the program but had no effect on operating profit indicators and mixed effects on SES and racial/ethnic differences across SNFs.


Assuntos
Administração Financeira/métodos , Mecanismo de Reembolso/normas , Instituições de Cuidados Especializados de Enfermagem/economia , Administração Financeira/normas , Administração Financeira/estatística & dados numéricos , Humanos , Mecanismo de Reembolso/estatística & dados numéricos , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Estados Unidos
15.
Med Care ; 60(1): 37-43, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34812789

RESUMO

BACKGROUND: Hispanic older adults face substantial health disparities compared with non-Hispanic-White (hereafter "White") older adults. To the extent that these disparities stem from cultural and language barriers faced by Hispanic people, they may be compounded by residence in rural areas. OBJECTIVE: The objective of this study was to investigate possible interactions between Hispanic ethnicity and rural residence in predicting the health care experiences of older adults in the United States, and whether disparities in care for rural Hispanic older adults differ in Medicare Advantage versus Medicare Fee-for-Service. SUBJECTS: Medicare beneficiaries age 65 years and older who responded to the 2017-2018 nationally representative Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. METHODS: We fit a series of linear, case-mix-adjusted models predicting Medicare CAHPS measures of patient experience (rescaled to a 0-100 scale) from ethnicity, place of residence, and Medicare coverage type. RESULTS: In all residential areas, Hispanic beneficiaries reported worse experiences with getting needed care (-3 points), getting care quickly (-4 points), and care coordination (-1 point) than White beneficiaries (all P's<0.001). In rural areas only, Hispanic beneficiaries reported significantly worse experiences than White beneficiaries on doctor communication and customer services (-3 and -9 points, respectively, P<0.05). Tests of a 3-way interaction between ethnicity, rural residence, and coverage type were nonsignificant. CONCLUSIONS: There is a need to improve access to care and care coordination for Hispanic beneficiaries overall and doctor-patient communication and customer service for rural Hispanic beneficiaries. Strategies for addressing deficits faced by rural Hispanics may involve cultural competency training and provision of language-appropriate services for beneficiaries (perhaps as telehealth services).


Assuntos
/estatística & dados numéricos , Medicare/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Feminino , Geriatria/métodos , Geriatria/normas , Geriatria/estatística & dados numéricos , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Satisfação do Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Estados Unidos , População Urbana/estatística & dados numéricos
16.
Med Clin North Am ; 106(1): 13-28, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34823726

RESUMO

Unhealthy alcohol and drug use are among the top 10 causes of preventable death in the United States, but they are infrequently identified and addressed in medical settings. Guidelines recommend screening adult primary care patients for alcohol and drug use, and routine screening should be a component of high-quality clinical care. Brief, validated screening tools accurately detect unhealthy alcohol and drug use, and their thoughtful implementation can facilitate adoption and optimize the quality of screening results. Recommendations for implementation include patient self-administered screening tools, integration with electronic health records, and screening during routine primary care visits.


Assuntos
Programas de Rastreamento/métodos , Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Registros Eletrônicos de Saúde , Feminino , Implementação de Plano de Saúde/métodos , Humanos , Masculino , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Autoavaliação (Psicologia) , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Estados Unidos/epidemiologia
17.
Urol Clin North Am ; 49(1): 153-159, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34776048

RESUMO

Ureteroscopy is the most common surgical modality for stone treatment. Reusable flexible ureteroscopes are delicate instruments that require expensive maintenance and repairs. Multiple single use ureteroscopes have been developed recently to combat the expensive and time-intensive sterilization and repair of ureteroscopes. Although multiple studies have looked at different aspects of reusable and single use ureteroscopes, there is significant heterogeneity in performance measures and cost between the 2 categories, and neither has a clear advantage. Both can be used successfully, and individual and institution level factors should be considered when deciding which ureteroscope to use.


Assuntos
Equipamentos Descartáveis , Meio Ambiente , Contaminação de Equipamentos , Ureteroscópios , Equipamentos Descartáveis/economia , Equipamentos Descartáveis/normas , Humanos , Manutenção/economia , Ureteroscópios/economia , Ureteroscópios/normas , Urolitíase/cirurgia
18.
Bioengineered ; 13(1): 876-883, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34968171

RESUMO

This research has developed a method for rapid detection of SARS-CoV-2 N protein on a paper-based microfluidic chip. The chitosan-glutaraldehyde cross-linking method is used to fix the coated antibody, and the sandwich enzyme-linked immunosorbent method is used to achieve the specific detection of the target antigen. The system studied the influence of coating antibody concentration and enzyme-labeled antibody concentration on target antigen detection. According to the average gray value measured under different N protein concentrations, the standard curve of the method was established and the sensitivity was tested, and its linear regression was obtained. The equation is y = 9.8286x+137.6, R2 = 0.9772 > 0.90, which shows a high degree of fit. When the concentration of coating antibody and enzyme-labeled antibody were 1 µg/mL and 2 µg/mL, P > 0.05, the difference was not statistically significant, so the lower concentration of 1 µg/mL was chosen as the coating antibody concentration. The results show that the minimum concentration of N protein that can be detected by this method is 8 µg/mL, and the minimum concentration of coating antibody and enzyme-labeled antibody is 1 µg/mL, which has the characteristics of high sensitivity and good repeatability.


Assuntos
Antígenos Virais/análise , Teste Sorológico para COVID-19/instrumentação , Proteínas do Nucleocapsídeo de Coronavírus/análise , Proteínas do Nucleocapsídeo de Coronavírus/imunologia , Dispositivos Lab-On-A-Chip , SARS-CoV-2/química , SARS-CoV-2/imunologia , Anticorpos Antivirais/imunologia , Engenharia Biomédica , COVID-19/diagnóstico , COVID-19/imunologia , COVID-19/virologia , Teste Sorológico para COVID-19/métodos , Teste Sorológico para COVID-19/normas , Proteínas do Nucleocapsídeo de Coronavírus/normas , Ensaio de Imunoadsorção Enzimática/instrumentação , Ensaio de Imunoadsorção Enzimática/métodos , Ensaio de Imunoadsorção Enzimática/normas , Humanos , Dispositivos Lab-On-A-Chip/normas , Dispositivos Lab-On-A-Chip/estatística & dados numéricos , Procedimentos Analíticos em Microchip/métodos , Procedimentos Analíticos em Microchip/normas , Procedimentos Analíticos em Microchip/estatística & dados numéricos , Papel , Fosfoproteínas/análise , Fosfoproteínas/imunologia , Fosfoproteínas/normas
19.
Anticancer Res ; 42(1): 293-300, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34969737

RESUMO

BACKGROUND/AIM: We investigated treatment outcomes and complications during reirradiation of patients with oral cancers. PATIENTS AND METHODS: Six patients who received definitive radiotherapy for oral cancer as the initial treatment and brachytherapy for recurrence were included. Local control and overall survival rates, soft tissue and mandibular complications, and tooth extraction were investigated. RESULTS: The five-year local control and overall survival rates were 83.3% and 100%, respectively. The occurrence rate of grade 2 soft tissue and mandible complications was 33.3%, and the primary sites were the buccal mucosa and the floor of mouth. The positions of the extracted tooth in the two cases were adjacent to the tumor, and one case developed grade 2 complication of the mandible. CONCLUSION: During recurrence of the buccal mucosa and the floor of mouth cancers, reirradiation should be avoided considering mandibular complications. To avoid reirradiation-related complications, tooth extraction near the radiation field should be avoided.


Assuntos
Isótopos de Ouro/administração & dosagem , Neoplasias Bucais/radioterapia , Recidiva Local de Neoplasia/radioterapia , Reirradiação/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/efeitos adversos , Feminino , Isótopos de Ouro/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Mucosa Bucal/efeitos da radiação , Neoplasias Bucais/patologia , Recidiva Local de Neoplasia/patologia , Dosagem Radioterapêutica/normas , Resultado do Tratamento
20.
Anticancer Res ; 42(1): 329-334, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34969741

RESUMO

BACKGROUND/AIM: This study investigated the feasibility and efficacy of multiparametric magnetic resonance imaging (MRI)-guided dose-escalated hypofractionated intensity-modulated radiation therapy with simultaneous integrated boost (IMRT-SIB) for glioblastoma. PATIENTS AND METHODS: Eighteen patients underwent postoperative IMRT-SIB for glioblastoma using three MRI sequences: double inversion recovery (DIR), diffusion tensor imaging (DTI), and post-gadolinium T1-weighted imaging. Prescribed doses were 60 Gy and 40 Gy in 15 fractions for residual enhancing lesions and surrounding tumor-infiltrating areas, respectively. For surrounding tumor-infiltrating areas, asymmetric margins were set with reference to DTI imaging. RESULTS: The 1-year overall survival rate was 58.0%, and the 1-year local control rate for the residual enhancing lesions was 76.2%, while that for surrounding tumor-infiltrating areas was 39.4%. One patient (6%) developed grade 2 cerebral radiation necrosis 10 months after IMRT-SIB, but there was no grade 3 or higher adverse event. CONCLUSION: Multiparametric MRI-guided dose-escalated IMRT-SIB with DIR and DTI imaging has the potential to improve local control rates without increasing adverse events.


Assuntos
Glioblastoma/radioterapia , Hipofracionamento da Dose de Radiação , Radioterapia Guiada por Imagem , Radioterapia de Intensidade Modulada , Adulto , Idoso , Imagem de Tensor de Difusão/normas , Feminino , Glioblastoma/diagnóstico por imagem , Glioblastoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética Multiparamétrica/normas , Taxa de Sobrevida
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