RESUMO
Jute, eco-friendly natural fiber, depends on conventional water-based microbial retting process that suffers from the production of low-quality fiber, restricting its diversified applications. The efficiency of water retting of jute depends on plant polysaccharide fermenting pectinolytic microorganisms. Understanding the phase difference in retting microbial community composition is crucial to provide knowledge on the functions of each member of microbiota for the improvement of retting and fiber quality. The retting microbiota profiling of jute was commonly performed previously using only one retting phase with culture-dependent methods which has limited coverage and accuracy. Here, for the first we have analyzed jute retting water through WGS metagenome approach in three phases (pre-retting, aerobic retting, and anaerobic retting phases) and characterized the microbial communities both culturable and non-culturable along with their dynamics with the fluctuation of oxygen availability. Our analysis revealed a total of 25.99 × 104 unknown proteins (13.75%), 16.18 × 105 annotated proteins (86.08%), and 32.68 × 102 ribosomal RNA (0.17%) in the pre-retting phase, 15.12 × 104 unknown proteins (8.53%), 16.18 × 105 annotated proteins (91.25%), and 38.62 × 102 ribosomal RNA (0.22%) in the aerobic retting phase, and 22.68 × 102 ribosomal RNA and 80.14 × 104 (99.72%) annotated protein in the anaerobic retting phase. Taxonomically, we identified 53 different phylotypes in the retting environment, with Proteobacteria being the dominant taxa comprising over 60% of the population. We have identified 915 genera from Archaea, Viruses, Bacteria, and Eukaryota in the retting habitat, with anaerobic or facultative anaerobic pectinolytic microflora being enriched in the anoxic, nutrient-rich retting niche, such as Aeromonas (7%), Bacteroides (3%), Clostridium (6%), Desulfovibrio (4%), Acinetobacter (4%), Enterobacter (1%), Prevotella (2%), Acidovorax (3%), Bacillus (1%), Burkholderia (1%), Dechloromonas (2%), Caulobacter (1%) and Pseudomonas (7%). We observed an increase in the expression of 30 different KO functional level 3 pathways in the final retting stage compared to the middle and pre-retting stages. The main functional differences among the retting phases were found to be related to nutrient absorption and bacterial colonization. These findings reveal the bacterial groups that are involved in fiber retting different phases and will facilitate to develop future phase-specific microbial consortia for the improvement of jute retting process.
Assuntos
Bacillus , Bactérias , Bacillus/genética , Água/metabolismo , Ecossistema , Metagenômica , RNA Ribossômico/metabolismo , RNA Ribossômico 16S/genéticaRESUMO
AIMS: This review aimed to identify interventions that hospitals can implement to reduce preventable hospital readmissions of people with type 2 diabetes mellitus (T2DM). METHODS: A scoping review framework was utilised to inform the overall process. The electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, the University of New England (UNE) library search engine and Google Scholar were utilised to search for relevant literature. RESULTS: The results from this review demonstrate that interventions started at index admission for people diagnosed with T2DM can result in reductions in hospital readmissions. Common strategies which attributed to the success of interventions in reducing hospital readmissions of people with T2DM included a multidisciplinary team approach, a dedicated care team, certified diabetes educator appointments, basic survival skills education and influencing hospital protocol development and implementation. CONCLUSION: This scoping review is an attempt at exploring and synthesising current research on interventions that hospitals can implement to reduce preventable hospital readmissions of people with T2DM.
Assuntos
Diabetes Mellitus Tipo 2 , Readmissão do Paciente , Humanos , Diabetes Mellitus Tipo 2/terapia , Hospitalização , Equipe de Assistência ao Paciente , InglaterraRESUMO
BACKGROUND: The emergence of COVID-19 has resulted in health, socio-economic, and political crises. The overall health impact of this disease can be measured by disability-adjusted life years (DALYs) which is the sum of the life years lost due to disability (YLDs) and the years life lost due to premature death (YLLs). The overarching objective of this systematic review was to identify the health burdens of COVID-19 and summarise the literature that can aid health regulators to make evidence-based decisions on COVID-19 mitigation strategies. METHODS: This systematic review was conducted using the PRISMA 2020 guidelines. DALYs-based primary studies were collected from databases, manual searches, and included studies' references. The primary studies published in English language, conducted since the emergence of COVID-19, and using DALYs or its subsets (years life lost due to disability and/or years life lost due to premature death) as health impact metrics, were the inclusion criteria. The combined disability and mortality health impact of COVID-19 was measured in DALYs. The risk of bias due to literature selection, identification, and reporting processes was assessed using the Joanna Bridges Institute critical appraisal tool for cross-sectional studies, and the certainty of evidence was assessed using the GRADE Pro tool. RESULT: Of the 1459 identified studies, twelve of them were eligible for inclusion in the review. The years life lost due to COVID-19 related mortality was dominant over the years life lost due to COVID-19 related disability (disability times from the onset of COVID-19 to recovery, from diseases occurrence to mortality, and the long-term consequences of COVID-19) in all included studies. The long-term consequence disability time and the pre-death disability time were not assessed by most of the reviewed articles. CONCLUSION: The impact of COVID-19 on both the length and quality of life has been substantial and has been causing considerable health crises worldwide. The health burden of COVID-19 was greater than other infectious diseases. Further studies focussing on issues examining increasing preparedness for future pandemics, public sensitization, and multi-sectorial integration are recommended.
Assuntos
COVID-19 , Expectativa de Vida , Humanos , Anos de Vida Ajustados por Deficiência , Anos de Vida Ajustados por Qualidade de Vida , COVID-19/epidemiologia , Qualidade de Vida , Estudos Transversais , Saúde GlobalRESUMO
BACKGROUND: Since its emergence, the COVID-19 pandemic has compromised the food security both directly by impacting food supply chain and indirectly by overwhelming the individual health and/or personal financial situation. The overarching aim of the current study is to assess aspects of the food security crisis that have arisen due to COVID-19 and to identify which, if any, food security dimensions were specifically compromised. METHODS: Primary research articles were initially identified through four online databases (Scopus, PubMed, Google Scholar, and Web of Science), with the references of each paper then also reviewed for additional article. The food security status of individuals and the wider community, both before and after the emergence of COVID-19, were examined. RESULTS: Of the 2,057 studies initially identified, a total of ten were included in the final review. The included studies confirmed that COVID-19 had substantially impacted food security, with individuals, households and the wider community experiencing food insecurity. Nine of the included studies aruged that the food accessibility dimension was the most compromised. CONCLUSION: To address the identified direct and indirect food security issues associated with COVID-19, it is proposed that a combination of prevention practices and proactive food security activities is required. Integrating food security interventions, supporting and facilitating food security resilience, and conducting further studies on the food security of COVID-19 are also recommended.
Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Pandemias , Bases de Dados Factuais , Financiamento Pessoal , Segurança Alimentar , Abastecimento de AlimentosRESUMO
Obesity and diabetes are matters of serious concern in the health sector due to their rapid increase in prevalence over the last three decades. Obesity is a severe metabolic problem that results in energy imbalance that is persistent over a long period of time, and it is characterized by insulin resistance, suggesting a strong association with type 2 diabetes (T2D). The available therapies for these diseases have side effects and some still need to be approved by the Food and Drug Administration (FDA), and they are expensive for underdeveloped countries. Hence, the need for natural anti-obesity and anti-diabetic drugs has increased in recent years due to their lower costs and having virtually no or negligible side effects. This review thoroughly examined the anti-obesity and anti-diabetic effects of various marine macroalgae or seaweeds and their bioactive compounds in different experimental settings. According to the findings of this review, seaweeds and their bioactive compounds have been shown to have strong potential to alleviate obesity and diabetes in both in vitro and in vivo or animal-model studies. However, the number of clinical trials in this regard is limited. Hence, further studies investigating the effects of marine algal extracts and their bioactive compounds in clinical settings are required for developing anti-obesity and anti-diabetic medicines with better efficacy but lower or no side effects.
Assuntos
Fármacos Antiobesidade , Diabetes Mellitus Tipo 2 , Alga Marinha , Animais , Sobrepeso/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Obesidade/tratamento farmacológico , Fármacos Antiobesidade/farmacologia , Fármacos Antiobesidade/uso terapêuticoRESUMO
We have synthesized and characterized nine Ag(I) complexes of Schiff bases containing thiophene, furan, and pyridine moieties for in vitro antibacterial, antioxidant, anticancer activities, and DNA/bovine serum albumin (BSA) binding studies. Based on the analytical and spectral analyses, a linear geometry was proposed for all the Ag(I) complexes, except for one (with the furan moiety), which formed a distorted T-shaped geometry. UV-vis absorption studies on the interactions of calf thymus-DNA (CT-DNA) with the nine Ag(I) complexes pointed to an intercalative binding mode. With a binding constant Kb of 3.75 × 105 M-1 , the complex bearing a benzothiazole moiety (1) interacted stronger with CT-DNA than the rest of the complexes. Fluorescence spectroscopic data revealed that the complexes had a modest binding affinity for BSA through static quenching. The complexes displayed good antioxidant properties, especially those with a benzothiazole moiety. Notable antibacterial activities against methicillin-resistant Staphylococcus aureus, Staphylococcus aureus, Salmonella typhimurium, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae were observed for complexes with the furan and thiophene moieties. The in vitro anticancer studies of selected complexes against three cancer cell lines showed that the complexes were more effective against the inhibition of the growth of cervical cancer cells relative to cisplatin.
Assuntos
Antioxidantes , Staphylococcus aureus Resistente à Meticilina , Antioxidantes/farmacologia , Antioxidantes/química , Prata , Tiofenos/farmacologia , Tiofenos/química , Relação Estrutura-Atividade , Antibacterianos/farmacologia , Antibacterianos/química , DNA/química , Soroalbumina Bovina/química , Benzotiazóis/farmacologia , Bases de Schiff/químicaRESUMO
This systematic review aims to uncover the challenges related to patient flow from a whole public hospital perspective and identify strategies to overcome these challenges. A search in Medline, Emcare and PubMed was conducted and 24 articles published in English, from 2015 to 2020, were selected in relation to patient flow challenges and strategies. Analysis of the articles was completed using a thematic approach to identify common themes in relation to the area of focus. Strategies from the literature were then aligned with the challenges to inform areas of potential improvement in relation to patient flow. The themes generated included Teamwork, Collaboration and Communication; Public Hospitals as complex systems; Timely discharge; Policy, Process and Decision-making; and Resources-capacity and demand. The key finding is that a whole system approach is required to improve patient flow in public hospitals. When effective patient flow is achieved, demand and capacity are matched, increasing patient access to the health service and enabling the resources required to provide high quality patient care. The findings will create a better understanding of improving patient flow in public hospitals.
Assuntos
Serviços de Saúde , Hospitais Públicos , Humanos , Qualidade da Assistência à Saúde , PacientesRESUMO
Type 2 diabetes (T2D) is a global health challenge with increased morbidity and mortality rates yearly. Herbal medicine has provided an alternative approach to treating T2D with limited access to formal healthcare. Tectona grandis is being used traditionally in the treatment of diabetes. The present study investigated the antidiabetic potential of T. grandis leaves in different solvent extractions, and the crude extract that demonstrated the best activity was further fractionated through solvent-solvent partitioning. The ethyl acetate fraction of the ethanol crude extract showed the best antidiabetic activity in inhibiting α-glucosidase, delaying glucose absorption at the small intestine's lumen, and enhancing the muscle's postprandial glucose uptake. The ethyl acetate fraction was further elucidated for its ability to reduce hyperglycemia in diabetic rats. The ethyl acetate fraction significantly reduced high blood glucose levels in diabetic rats with concomitant modulation in stimulated insulin secretions through improved pancreatic ß-cell function, insulin sensitivity by increasing liver glycogen content, and reduced elevated levels of liver glucose-6-phosphatase activity. These activities could be attributed to the phytochemical constituents of the plant.
Assuntos
Acetatos , Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 2 , Hiperglicemia , Animais , Ratos , Hipoglicemiantes/farmacologia , Hipoglicemiantes/uso terapêutico , Estreptozocina , Glucose , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Experimental/tratamento farmacológico , Hiperglicemia/tratamento farmacológico , Frutose , SolventesRESUMO
Since ancient times, plants have been used as green bioresources to ensure a healthier life by recovering from different diseases. Kattosh (Lasia spinosa L. Thwaites) is a local plant with various traditional uses, especially for arthritis, constipation and coughs. This research investigated the effect of Kattosh stem extract (LSES) on streptozotocin-induced damage to the pancreas, kidney, and liver using in vitro, in vivo and in silico methods. In vitro phytochemical, antioxidative and anti-inflammatory effects of LSES were accomplished by established methods followed by antidiabetic actions in in vivo randomized controlled intervention in STZ-induced animal models for four weeks. In an in silico study, LSES phytocompounds interacted with antidiabetic receptors of peroxisome proliferator-activated receptor-gamma (PPAR, PDB ID: 3G9E), AMP-activated protein kinase (AMPK, PDB ID: 4CFH) and α-amylase enzyme (PDB ID: 1PPI) to verify the in vivo results. In addition, LSES showed promising in vitro antioxidative and anti-inflammatory effects. In contrast, it showed a decrease in weekly blood glucose level, normalized lipid profile, ameliorated liver and cardiac markers, managed serum AST and ALT levels, and increased glucose tolerance ability in the animal model study. Restoration of pancreatic and kidney damage was reflected by improving histopathological images. In ligand-receptor interaction, ethyl α-d-glucopyranoside of Kattosh showed the highest affinity for the α-amylase enzyme, PPAR, and AMPK receptors. Results demonstrate that the affinity of Kattosh phytocompounds potentially attenuates pancreatic and kidney lesions and could be approached as an alternative antidiabetic source with further clarification.
Assuntos
PPAR gama , Extratos Vegetais , Proteínas Quinases Ativadas por AMP , Animais , Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Rim/patologia , PPAR gama/metabolismo , Pâncreas/patologia , Extratos Vegetais/farmacologia , Estreptozocina/toxicidade , alfa-Amilases/farmacologiaRESUMO
The entire world has been suffering from the coronavirus disease 2019 (COVID-19) pandemic since March 11, 2020. More than a year later, the COVID-19 vaccination brought hope to control this viral pandemic. Here, we review the unknowns of the COVID-19 vaccination, such as its longevity, asymptomatic spread, long-term side effects, and its efficacy on immunocompromised patients. In addition, we discuss challenges associated with the COVID-19 vaccination, such as the global access and distribution of vaccine doses, adherence to hygiene guidelines after vaccination, the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, and vaccine resistance. Despite all these challenges and the fact that the end of the COVID-19 pandemic is still unclear, vaccines have brought great hope for the world, with several reports indicating a significant decline in the risk of COVID19-related infection and hospitalizations.
Assuntos
COVID-19/prevenção & controle , SARS-CoV-2/imunologia , Vacinação , COVID-19/epidemiologia , COVID-19/imunologia , COVID-19/virologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/provisão & distribuição , Saúde Global , Humanos , Hospedeiro Imunocomprometido , Mutação , SARS-CoV-2/genética , Vacinação/efeitos adversos , Vacinação/psicologia , Hesitação Vacinal , Eficácia de VacinasRESUMO
Diterpenes are a diverse group of structurally complex natural products with a wide spectrum of biological activities, including antidiabetic potential. In the last 25 years, numerous diterpenes have been investigated for antidiabetic activity, with some of them reaching the stage of clinical trials. However, these studies have not been comprehensively reviewed in any previous publication. Herein, we critically discussed the literature on the potential of diterpenes as antidiabetic agents, published from 1995 to September, 2021. In the period under review, 427 diterpenes were reported to have varying degrees of antidiabetic activity. Steviol glycosides, stevioside (1) and rebaudioside A (2), were the most investigated diterpenes with promising antidiabetic property using in vitro and in vivo models, as well as human subjects. All the tested pimaranes consistently showed good activity in preclinical evaluations against diabetes. Inhibitions of α-glucosidase and protein tyrosine phosphatase 1B (PTP 1B) activities and peroxisome proliferator-activated receptors gamma (PPAR-γ) agonistic property, were the most frequently used models for studying the antidiabetic activity of diterpenes. The molecular mechanisms of action of the diterpenes include increased GLUT4 translocation, and activation of phosphoinositide 3-kinase (PI3K) and AMP-activated protein kinase (AMPK)-dependent signaling pathways. This review revealed that diterpenes hold promising antidiabetic potential while stevioside (1) and rebaudioside A (2) are the only diterpenes that were advanced to the clinical trial stage of the drug discovery pipeline. Diterpenes belonging to the abietane, labdane, pimarane and kaurane classes have shown promising activity in in vitro and in vivo models of diabetes and should be further investigated.
Assuntos
Diabetes Mellitus , Diterpenos do Tipo Caurano , Diterpenos , Proteínas Quinases Ativadas por AMP , Diabetes Mellitus/tratamento farmacológico , Diterpenos/farmacologia , Diterpenos/uso terapêutico , Diterpenos do Tipo Caurano/farmacologia , Diterpenos do Tipo Caurano/uso terapêutico , Humanos , Hipoglicemiantes/farmacologia , Hipoglicemiantes/uso terapêutico , Fosfatidilinositol 3-QuinasesRESUMO
In this communication, we feature the synthesis and in-depth characterization of a series of silver(I) complexes obtained from the complexation of quinolin-4-yl Schiff base ligands ((E)-2-((quinolin-4-ylmethylene)amino)phenol La, 2-(quinolin-4-yl)benzo[d]thiazole Lb, (E)-N-(2-fluorophenyl)-1-(quinolin-4-yl)methanimine Lc, (E)-N-(4-chlorophenyl)-1-(quinolin-4-yl)methanimine Ld, (E)-1-(quinolin-4-yl)-N-(p-tolyl)methanimine Le, (E)-1-(quinolin-4-yl)-N-(thiophen-2-ylmethyl)methanimine Lf) and three different silver(I) anions (nitrate, perchlorate and triflate). Structurally, the complexes adopted different coordination geometries, which included distorted linear or distorted tetrahedral geometry. The complexes were evaluated in vitro for their potential antibacterial and antioxidant activities. In addition, their interactions with calf thymus-DNA (CT-DNA) and bovine serum albumin (BSA) were evaluated. All the complexes had a wide spectrum of effective antibacterial activity against gram-positive and gram-negative bacterial and good antioxidant properties. The interactions of the complexes with CT-DNA and BSA were observed to occur either through intercalation or through a minor groove binder, while the interaction of the complexes with BSA reveals that some of the complexes can strongly quench the fluorescence of BSA through the static mechanism. The molecular docking studies of the complexes were also done to further elucidate the modes of interaction with CT-DNA and BSA.
Assuntos
Anti-Infecciosos , Antineoplásicos , Complexos de Coordenação , Ânions , Antibacterianos/química , Antibacterianos/farmacologia , Antineoplásicos/química , Antioxidantes/química , Antioxidantes/farmacologia , Complexos de Coordenação/química , Complexos de Coordenação/farmacologia , Simulação de Acoplamento Molecular , Soroalbumina Bovina/química , Relação Estrutura-AtividadeRESUMO
BACKGROUND: Community pharmacy professionals have great potential to deliver various public health services aimed at improving service access, particularly in countries with a shortage of health professionals. However, little is known about their involvement in child health service provision in Ethiopia. OBJECTIVE: The purpose of this study was to evaluate the level of involvement of community pharmacy professionals in child health service provision within Ethiopia. METHODS: A multi-center cross-sectional survey was conducted among 238 community pharmacy professionals from March to July 2020 in Amhara regional state of Ethiopia. Independent samples t-test and one way Analysis of Variance (ANOVA) was used to test the mean difference. RESULTS: Most community pharmacy professionals were 'involved' in providing child health services related to 'advice about vitamins/supplements' (46.6%), 'advice about infant milk/formulas' (47.1%) and 'responding to minor symptoms' (50.8%) for children. The survey revealed that, community pharmacy professionals were less frequently involved in providing childhood 'vaccination' services. Further, level of involvement of community pharmacy professionals differed according to participants' licensure level, setting type, responsibility in the facility and previous training experience in child health services. CONCLUSION: Community pharmacy professionals have been delivering various levels of child health services, demonstrating ability and capacity in improving access to child health services in Ethiopia. However, there is a need for training and government support to optimize pharmacist engagement and contribution to service delivery.
Assuntos
Serviços de Saúde da Criança , Serviços Comunitários de Farmácia , Farmácias , Criança , Humanos , Estudos Transversais , Etiópia , Cidades , Farmacêuticos , VitaminasRESUMO
Intimate partner sexual violence (IPSV) is considered to be a multifarious critical problem in Bangladesh. This study explored the IPSV correlates in Bangladesh with a specific focus on a rural setting. Cross-sectional survey data were collected from 250 randomly selected married women aged 15-49 years in Kandigoan Union Parishad, Sylhet Sadar Upazila, Bangladesh in 2017. Chi-squared tests and multiple logistic regression techniques were applied to measure the IPSV correlates. Around 25% of respondents reported experience of IPSV over the previous 12 months. The logistic regression results showed that women who had committed to pay dowry upon marriage, suspected their husbands of having extramarital affairs and reported having poor spousal communication were 2.657 times (OR = 2.257; 95% CI = 0.527-9.662), 4.914 times (OR = 4.914; 95% CI = 1.354-17.829) and 3.536 times (OR = 3.536; 95% CI = 0.910-13.745) more likely, respectively to report experiencing IPSV by their husbands compared with their counterparts. The findings are expected to contribute to formulating an appropriate policy to combat IPSV against married women at the household level in rural areas of Bangladesh.
Assuntos
Delitos Sexuais , Bangladesh/epidemiologia , Estudos Transversais , Feminino , Humanos , Prevalência , Fatores de Risco , Parceiros SexuaisRESUMO
Crassocephalum rubens (C. rubens) is a traditional leafy vegetables (TLV) eaten in parts of Africa for the management of symptoms of diabetes mellitus. This study was done to investigate the in vivo anti-diabetic activity of the aqueous extract of C. rubens aerial parts (CRAQ). Type 2 diabetes (T2D) was induced in male Sprague Dawley (SD) rats by feeding them with a 10% fructose solution for two weeks followed by single dose (40 mg/kg body weight) intraperitoneal injection of streptozotocin. After confirmation of T2D, animals were treated with a low and a high dose (150 and 300 mg/kg body weight) of extract for five weeks. Parameters used as markers of hyperglycemia were analyzed in the samples collected from rats. Hematoxylin-eosin staining was used in analyzing the morphological changes of the pancreas. Treatment with high dose of the extract significantly (p < 0.05) lowered blood glucose level, increased oral glucose tolerance level and pancreatic ß-cell function, while restoring the morphology of the pancreatic tissue damage. The high dose also increased insulin secretion, liver glycogen, antioxidant enzyme activities in serum and organs, and prevented liver and renal damages compared to the untreated diabetic animals. Data from this study suggest that C. rubens possesses impressive anti-diabetic activity and could be useful in ameliorating some complications associated with T2D therefore this plant can be exploited in finding new alternative therapies for the treatment of T2D.
Assuntos
Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 2 , Animais , Glicemia/metabolismo , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/patologia , Frutose/toxicidade , Hipoglicemiantes/farmacologia , Insulina , Secreção de Insulina , Rim/patologia , Fígado/patologia , Masculino , Estresse Oxidativo , Pâncreas/metabolismo , Pâncreas/patologia , Extratos Vegetais/uso terapêutico , Ratos , Ratos Sprague-Dawley , Estreptozocina/toxicidadeRESUMO
INTRODUCTION: The overarching objective of this scoping review was to explore the breadth of health care literature in attempts to identify current strategies that hospitals adopt to improve patient bed flow, reduce access and exit block while optimizing patient care. METHODS: PubMed, CINAHL, Embase, Proquest, and Cochrane electronic library databases supported literature search in March 2021. Scholarly articles that met the 3 eligibility criteria-access block causes, effects, and solutions-were considered. Joanna Briggs Institute Guidelines supported first- and second-level literary screening processes. RESULTS: The synthesis included 43 references. Most initiatives addressed access (n = 15), followed by care (n = 16) and then community (n = 9), with a further 3 articles providing commentary across all 3 domains (n = 3). Evidence supported Lean principles in both emergency department and inpatient sector. Lean principles addressing access included physician-led ED triage models, point-of-care testing, overcapacity protocols, mental health team collocation models, and fast-track services. Inpatient care Lean concepts validated gains in multidisciplinary rounds, appropriate allocation of allied health services with a 7-days-a-week model, staggering of elective surgeries, journey boards usage, transit lounges, and lateral transfers. Most literature addressing the backend was narrative in nature, theorized, and advocating for solutions and policy reform. DISCUSSION: This study addressed aims and identified current strategies that hospitals adopt to tackle access block while guaranteeing patient care. Government-supported research to map out evidence-based models of care that address exit block and demonstrate efficiencies is required to optimize access to care in the community.
Assuntos
Serviço Hospitalar de Emergência , Hospitais , Atenção à Saúde , Hospitalização , Humanos , TriagemRESUMO
BACKGROUND: The recovery approach involves providing a holistic and integrated service that is centered on and adapts to the aspirations and needs of consumers, who are seen as the expert on their health and well-being. Evidence is needed to address the current ambiguities related to the concept of recovery and its application. AIM: A scoping review was conducted to identify papers describing theories, models, and frameworks of recovery to delineate the central domains of recovery. METHODS: Three literature search strategies were used: electronic database searching; hand-searching of key journals; and a reference list review of included papers. Inclusion criteria outlined theories, models and frameworks developed to support consumers' recovery and those supporting mental health professionals (MHPs) to deliver recovery-oriented services. RESULTS: Twelve studies (eleven articles and one book) were included in the review. The dimensions of recovery were synthesized into a framework named the Consolidated Framework for Recovery-oriented Services (CFRS). There are three domains within the framework: mechanisms/strategies; recovery as an internal process; and recovery as an external process. Each of these domains, as well as their relationships, are discussed. CONCLUSIONS: The CFRS can be used by practitioners, researchers, funders, and collaborative members to conceptualize, implement, and evaluate recovery-oriented services.
RESUMO
BACKGROUND: Although it is becoming evident that individual's immune system has a decisive influence on SARS-CoV-2 disease progression, pathogenesis is largely unknown. In this study, we aimed to profile the host transcriptome of COVID-19 patients from nasopharyngeal samples along with virus genomic features isolated from respective host, and a comparative analyses of differential host responses in various SARS-CoV-2 infection systems. RESULTS: Unique and rare missense mutations in 3C-like protease observed in all of our reported isolates. Functional enrichment analyses exhibited that the host induced responses are mediated by innate immunity, interferon, and cytokine stimulation. Surprisingly, induction of apoptosis, phagosome, antigen presentation, hypoxia response was lacking within these patients. Upregulation of immune and cytokine signaling genes such as CCL4, TNFA, IL6, IL1A, CCL2, CXCL2, IFN, and CCR1 were observed in lungs. Lungs lacked the overexpression of ACE2 as suspected, however, high ACE2 but low DPP4 expression was observed in nasopharyngeal cells. Interestingly, directly or indirectly, viral proteins specially non-structural protein mediated overexpression of integrins such as ITGAV, ITGA6, ITGB7, ITGB3, ITGA2B, ITGA5, ITGA6, ITGA9, ITGA4, ITGAE, and ITGA8 in lungs compared to nasopharyngeal samples suggesting the possible way of enhanced invasion. Furthermore, we found comparatively highly expressed transcription factors such as CBP, CEBP, NFAT, ATF3, GATA6, HDAC2, TCF12 which have pivotal roles in lung injury. CONCLUSIONS: Even though this study incorporates a limited number of cases, our data will provide valuable insights in developing potential studies to elucidate the differential host responses on the viral pathogenesis in COVID-19, and incorporation of further data will enrich the search of an effective therapeutics.
Assuntos
COVID-19/genética , COVID-19/imunologia , Interações entre Hospedeiro e Microrganismos/genética , Interações entre Hospedeiro e Microrganismos/imunologia , SARS-CoV-2/genética , SARS-CoV-2/imunologia , Adulto , Idoso de 80 Anos ou mais , COVID-19/virologia , Proteases 3C de Coronavírus/genética , Proteases 3C de Coronavírus/imunologia , Citocinas/genética , Feminino , Variação Genética , Humanos , Imunidade Inata/genética , Integrinas/genética , Pulmão/imunologia , Masculino , Pessoa de Meia-Idade , Modelos Imunológicos , Mutação de Sentido Incorreto , Nasofaringe/imunologia , Nasofaringe/virologia , Pandemias , RNA-Seq , SARS-CoV-2/isolamento & purificação , Transdução de Sinais/genética , Transdução de Sinais/imunologia , Transcriptoma , Pesquisa Translacional BiomédicaRESUMO
The antidiabetic effect of l-leucine has been attributed to its modulatory effect on glucose uptake and lipid metabolism in muscles. However, there is a dearth on its effect on glucose metabolism in muscles. Thus, the present study investigated the effect of l-leucine - stimulated glucose uptake on glucose metabolism, dysregulated lipid metabolic pathways, redox and bioenergetic homeostasis, and proteolysis in isolated psoas muscle from Sprague Dawley male rats. Isolated psoas muscles were incubated with l-leucine (30-240 µg/mL) in the presence of 11.1 mMol glucose at 37 ËC for 2 h. Muscles incubated in only glucose served as the control, while muscles not incubated in l-leucine and/or glucose served as the normal control. Metformin (6.04 mM) was used as the standard antidiabetic drug. Incubation with l-leucine caused a significant increase in muscle glucose uptake, with an elevation of glutathione levels, superoxide dismutase, catalase, E-NTPDase and 5'nucleotidase activities. It also led to the depletion of malondialdehyde and nitric oxide levels, ATPase, chymotrypsin, acetylcholinesterase, glycogen phosphorylase, glucose-6-phosphatase, fructose-1,6-bisphosphatase and lipase activities. There was an alteration in lipid metabolites, with concomitant activation of glycerolipid metabolism, fatty acid metabolism, and fatty acid elongation in mitochondria in the glucose-incubated muscle (negative control). Incubation with l-leucine reversed these alterations, and concomitantly deactivated the pathways. These results indicate that l-leucine-enhanced muscle glucose uptake involves improved redox and bioenergetic homeostasis, with concomitant suppressed proteolytic, glycogenolytic and gluconeogenetic activities, while modulating glucose - lipid metabolic switch.
Assuntos
Antioxidantes/farmacologia , Metabolismo Energético , Glucose/metabolismo , Homeostase , Leucina/farmacologia , Metabolismo dos Lipídeos , Músculos Psoas/metabolismo , Animais , Masculino , Oxirredução , Estresse Oxidativo , Músculos Psoas/efeitos dos fármacos , Músculos Psoas/patologia , Ratos , Ratos Sprague-DawleyRESUMO
The antioxidant and anti-proinflammatory activities of L-leucine were investigated on oxidative testicular injury, ex vivo. In vitro analysis revealed L-leucine to be a potent scavenger of free radicals, while inhibiting acetylcholinesterase activity. Oxidative injury was induced in testicular tissues using FeSO4. Treatment with L-leucine led to depletion of oxidative-induced elevated levels of NO, MDA, and myeloperoxidase activity, with concomitant elevation of reduced glutathione and non-protein thiol levels, SOD and catalase activities. L-leucine caused a significant (p < 0.05) alteration of oxidative-elevated acetylcholinesterase and chymotrypsin activities, while concomitantly elevating the activities of ATPase, ENTPDase and 5'-nucleotidase. L-leucine conferred a protective effect against oxidative induced DNA damage. Molecular docking revealed molecular interactions with COX-2, IL-1 beta and iNOS. Treatment with L-leucine led to restoration of oxidative depleted ascorbic acid-2-sulfate, with concomitant depletion of the oxidative induced metabolites: D-4-Hydroxy-2-oxoglutarate, L-cystine, adenosine triphosphate, maleylacetoacetic acid, cholesteryl ester, and 6-Hydroxy flavin adenine dinucleotide. Treatment with L-leucine reactivated glycolysis while concomitantly deactivating oxidative-induced citrate cycle and increasing the impact-fold of purine metabolism pathway. L-leucine was predicted not to be an inhibitor of CYP1A2, CYP2C19, CYP2C9, CYP2D6, and CYP3A4, with a predicted LD50 value of 5000 mg/Kg and toxicity class of 5. Additionally, L-leucine showed little or no in vitro cytotoxicity in mammalian cells. These results suggest the therapeutic potentials of L-leucine on oxidative testicular injury, as evident by its ability to attenuate oxidative stress and proinflammation, while stalling cholinergic dysfunction and modulating nucleotide hyrolysis; as well as modulate oxidative dysregulated metabolites and their pathways.