To estimate the lifetime and 12-month prevalence of occupational exposure to body fluids among health-care workers in Africa.
Embase®, PubMed® and CINAHL databases were systematically searched for ...studies published between January 2000 and August 2017 that reported the prevalence of occupational exposure to blood or other body fluids among health-care workers in Africa. The continent-wide prevalence of exposure was estimated using random-effects meta-analysis.
Of the 904 articles identified, 65 studies from 21 African countries were included. The estimated pooled lifetime and 12-month prevalence of occupational exposure to body fluids were 65.7% (95% confidence interval, CI: 59.7-71.6) and 48.0% (95% CI: 40.7-55.3), respectively. Exposure was largely due to percutaneous injury, which had an estimated 12-month prevalence of 36.0% (95% CI: 31.2-40.8). The pooled 12-month prevalence of occupational exposure among medical doctors (excluding surgeons), nurses (including midwives and nursing assistants) and laboratory staff (including laboratory technicians) was 46.6% (95% CI: 33.5-59.7), 44.6% (95% CI: 34.1-55.0) and 34.3% (95% CI: 21.8-46.7), respectively. The risk of exposure was higher among health-care workers with no training on infection prevention and those who worked more than 40 hours per week.
The evidence available suggests that almost one half of health-care workers in Africa were occupationally exposed to body fluids annually. However, a lack of data from some countries was a major limitation. National governments and health-care institutions across Africa should prioritize efforts to minimize occupational exposure among health-care workers.
Cholinergic activation of nicotinic receptors in the cortex plays a critical role in arousal, attention, and learning. Here we demonstrate that cholinergic axons from the basal forebrain of mice ...excite a specific subset of cortical interneurons via a remarkably slow, non-α7 nicotinic receptor-mediated conductance. In turn, these inhibitory cells generate a delayed and prolonged wave of disynaptic inhibition in neighboring cortical neurons, altering the spatiotemporal pattern of inhibition in cortical circuits.
Animal behavior is motivated by internal drives, such as thirst and hunger, generated in hypothalamic neurons that project widely to many brain areas. We find that water-restricted mice maintain ...stable, high-level contrast sensitivity and brief reaction time while performing a visual task, but then abruptly stop and become disengaged. Mice consume a significant amount of water when freely provided in their home cage immediately after the task, indicating that disengagement does not reflect cessation of thirst. Neuronal responses of V1 neurons are reduced in the disengaged state, but pupil diameter does not decrease, suggesting that animals’ reduced level of arousal does not drive the transition to disengagement. Our findings indicate that satiation level alone does not have an instructive role in visually guided behavior and suggest that animals’ behavior is governed by cost-benefit analysis that can override thirst signals.
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•Mice stop performing in a visual task without reaching satiation and disengage•Contrast sensitivity and reaction times remain stable during the engaged period•Pupil diameter does not decrease across engagement-disengagement states•We suggest that mice perform cost-benefit analysis and can override thirst signals
Ortiz et al. study performance of mice in a visual task during engagement and disengagement. Mice disengage from the task without reaching satiation. Pupil diameter indicates that reduced alertness is not associated with disengagement. We suggest that areas downstream of visual cortex perform cost-benefit analysis governing response to thirst signals.
Transplant renal artery stenosis (TRAS) remains a dreaded complication of renal transplant surgery with potentially devastating sequelae. TRAS occurring early in the posttransplant period is mainly ...due to technical faults related to the graft implantation process. Late TRAS, in contrast, is more the result of either progressive atherosclerotic disease in the recipient vasculature or immunological, infective, and drug toxicity-related intimal injury. The clinical presentation may range from asymptomatic incidentally detected lesions to frank stenosis causing refractory hypertension or graft dysfunction. Accurate diagnosis with prompt intervention in the clinically significant lesions is the hallmark of successful management in TRAS, thereby averting the possible risk of renal artery thrombosis and graft loss.
VACCINE ASSOCIATED ATRIAL FIBRILLATION Ghoweba, Mohamed; Aziz, David; Al-Yafeai, Zaki
Journal of the American College of Cardiology,
03/2022, Volume:
79, Issue:
9
Journal Article
There is an increased evidence for treating hypertension by a combination of two or more drugs. Increasing the number of daily intake of tablets has been reported to negatively affect the compliance ...of patients. Therefore, numerous fixed dose combinations (FDCs) have been introduced to the market. However, the inherent rigid nature of FDCs does not allow the titration of the dose of each single component for an individual patient's needs. In this work, flexible dose combinations of two anti-hypertensive drugs in a single bilayer tablet with a range of doses were fabricated using dual fused deposition modelling (FDM) 3D printer. Enalapril maleate (EM) and hydrochlorothiazide (HCT) loaded filaments were produced via hot-melt extrusion (HME). Computer software was utilised to design sets of oval bi-layer tablets of individualised doses. Thermal analysis and x-ray diffractometer (XRD) indicated that HCT remained crystalline in the polymeric matrix whilst EM appeared to be in an amorphous form. The interaction between anionic EM and cationic methacrylate polymer may have contributed to a drop in the glass transition temperature (Tg) of the filament and obviated the need for a plasticiser. Across all tablet sets, the methacrylate polymeric matrix provided immediate drug release profiles. This dynamic dosing system maintained the advantages of FDCs while providing a superior flexibility of dosing range, hence offering an optimal clinical solution to hypertension therapy in a patient-centric healthcare service.
Aims
Multiple myeloma accounts for over 10–15% of haematological malignancies. Continued molecular advances have resulted in the development of new drugs for treatment of multiple myeloma. Four drugs ...were approved by the Food and Drug Administration (FDA) in 2015, but their safety is not well defined. The aim of this study is to delineate the cardiovascular adverse events of these drugs.
Methods
We reviewed the adverse cardiac events of newly approved FDA drugs since 2015 using the US FDA Adverse Events Reporting System (FAERS) database. We calculated the reporting odds ratio (ROR) with 95% confidence interval (CIs) for the drugs that have the highest incidence of cardiovascular adverse events.
Results
Among the medications that have approved for multiple myeloma between 2015 and 2020, 4 novel drugs showed the highest incidence of cardiotoxicity. ROR (95% CI) for atrial fibrillation due to elotuzumab, ixazomib, daratumumab and panobinostat compared to other FAERS drugs was 5.8 (4.4–7.7), 1.9 (1.5–2.3), 4.8 (4.2–5.6) and 5.7 (4.1–8.1), respectively. The ROR (95% CI) for cardiac failure was 8.2 (6.4–10.5), 4.7 (4.1–5.4), 5.8 (4.9–6.7) and 5.6 (3.8–8.1) and ROR (95% CI) for coronary disease was 2.7 (1.9–3.9), 2.7 (2.3–3.2), 2.3 (1.9–2.8) and 4.6 (3.2–6.6) due to elotuzumab, ixazomib, daratumumab and panobinostat compared to all other drugs in FAERS.
Conclusion
Our results demonstrated that certain newly approved antimyeloma therapies are significantly associated with previously unknown cardiotoxicity. These results warrant further studies and highlight the importance of considering the cardiac history of patients with multiple myeloma when utilizing these novel agents.
'Key Advances in Clinical Informatics' provides a state-of-the-art overview of the most current subjects in clinical informatics. Leading international authorities write short, accessible, ...well-referenced chapters which bring readers up-to-date with key developments and likely future advances in the relevant subject areas. This book encompasses topics such as inpatient and outpatient clinical information systems, clinical decision support systems, health information technology, genomics, mobile health, telehealth and cloud-based computing.
VACCINE ASSOCIATED HEART FAILURE Aziz, David; Ghoweba, Mohamed; Sidhu, Divleen ...
Journal of the American College of Cardiology,
03/2022, Volume:
79, Issue:
9
Journal Article
One of the common GN causing ESKD is focal segmental glomerulosclerosis (FSGS). Recurrence of FSGS post-transplantation can lead to graft loss. Data on management either prophylactically or once ...recurrence occurs are limited. This review article aims to assess the effective management of patients with FSGS recurrence post-transplantation, looking mainly at recurrence post prophylactic treatment and remission in case of treatment post recurrence.
Twenty-three studies were included using the search MeSH terms “FSGS” “recurrence” “adults” “transplantation” “treatment”. Search engines used were Pubmed, clinical key, Scopus and Cochrane library. Inclusion criteria were articles covered adult patients with recurrent FSGS post renal transplantation, treatment with rituximab and plasmapheresis, and articles published from 2000 tt2021. Excluded articles were paediatric population, studies with no reported outcomes of the treatment of FSGS, and Patients who received stem cell transplantation or galactose therapy.
Prophylactic PP did not show a reduction in recurrence of FSGS in 2/3 studies. Prophylactic rituximab was shown to reduce recurrence of FSGS in one-study and case reports. Treatment of recurrent FSGS with PP showed responses ranging from 41% to 100%. Only one study did not show improvement with PP use as treatment having a 27% remission. Treatment with rituximab showed variable results, with reports showing remission ranging from 57% to 100%. Whereas other reports showing no response at all. PP prescription reporting was variable. One study suggested intensified PP regimen while in most other studies PP was guided by the response reflected by the reduction of proteinuria.
Reviewing the treatment of recurrent FSGS is crucial, as there no consensus on treating FSGS as the disease is not very common in the adult population. The evidence of different modalities is based on small cohort studies. This paper supports the use of PP and RTX as treatment of recurrent FSGS.
In conclusion, PP and RTX are the main modalities to treat recurrent FSGS with varying response rates. Prophylactic PP does not play a role in preventing recurrent FSGS. Prophylactic rituximab might play a role in preventing FSGS post-transplantation. PP and RTX, when used as a treatment, show variable response rates. Larger RCTs are needed to have a strong level of evidence to base our clinical management on.
•Evaluate prophylactic plasmapheresis in preventing recurrent FSGS post transplantation.•Evaluate prophylactic Rituximab in preventing recurrent FSGS post transplantation.•Measure the effectiveness of plasmapheresis and rituximab in treatment of recurrence FSGS by assessing proteinuria.•Appraise other available modalities of treatment of recurrent FSGS.
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