Concentration Index Research Articles

Disease burden and health inequality of older adults with edentulism and the projected trend until 2040: based on the global burden of disease study 2021.

To comprehensively analyze the current situation and the trends over the next 21 years, focusing on health inequalities related to edentulism among the elderly across global regions. Data on edentulism in older adults were collected from the 2021 global burden of disease (GBD) study. Disease burden trends were analyzed using a joinpoint model. We used the Slope Index of Inequality (SII) and the Concentration Index (CI) to assess health inequalities. A Bayesian age-period-cohort (BAPC) model was used to analyze the projected trend of prevalence up to 2040. The number of incident, prevalent, and years lived with disability (YLD) cases of edentulism in older adults is increasing globally, while the rate is declining. According to the analysis of health inequality, the burden of edentulism among older adults was gradually concentrated in countries with lowerSociodemographic Index(SDI). Significant downward trends were expected in the global age-standardized prevalence rate (ASPR) of edentulism for both genders from 2020 to 2040; however, the number is increasing. Taken together, the burden of edentulism in older people remains high and generally shifts from higher-SDI countries to lower-SDI countries. There are great differences between countries, and effective measures should be taken in countries with poorer economies. The disease burden of edentulism in older adults is gradually shifting towards lower SDI countries. It is crucial to optimize the utilization and allocation of healthcare resources to reduce health inequities in edentulism in older adults.

Socioeconomic inequality in exposure to second-hand smoke among middle-aged adults of the RaNCD cohort study: a decomposition analysis

BackgroundSecondhand smoke (SHS) can cause various health problems among different age groups worldwide. Socioeconomic factors may influence the distribution of SHS exposure among population subgroups. We aimed to estimate socioeconomic inequality in SHS exposure and identify its contributing factors among a sample of Iranian adults.MethodsThis cross-sectional investigation utilized baseline data from the Ravansar Non-Communicable Disease cohort study. The study population comprised 7991 middle-aged adults aged between 35 and 65 years. To determine socioeconomic status (SES) principal component analysis (PCA) was used. The Wagstaff normalized concentration index (Cn) was utilized to measure the extent of socioeconomic inequality in SHS. Furthermore, decomposition analysis was performed to identify the factors contributing to the observed inequality in SHS exposure.ResultsThe prevalence of SHS exposure among men, women, and the total population was 38.23%, 47.29%, and 43.89%, respectively. The concentration index (Cn) value for SHS exposure was − 0.121 (95% confidence interval [CI]: -0.146, -0.096) in the study participants. Among men and women, the values were − 0.080 (95% CI: -0.122, -0.037) and − 0.095 (95% CI: -0.112, -0.063), respectively, indicating a higher concentration of SHS among individuals with low SES. Female sex (35.17%), socioeconomic status (31.83%), being married (-26.36%), and rural residency (22.44%) were identified as the primary factors contributing to the observed inequality in SHS exposure.ConclusionThe research findings revealed a pro-rich inequality in SHS, with a significant concentration among low-SES individuals. In terms of the main contributors to socioeconomic inequality in SHS exposure, policy interventions need to pay attention to females, individuals with low SES, and married individuals to address inequality in SHS exposure.

Spatial analysis of daily rainfall concentration in Paraíba State, Brazil

Recent studies indicate a reduction of total rainfall and an increase of extreme rainfall events in the Brazilian Northeast region. It is crucial to understand the concentration of daily rainfall for environmental planning and land management. This study performs the analysis of the daily rainfall concentration for the Paraíba State in the period between 1970 and 2019, using data from 26 rainfall stations across the State. Additionally, to the total annual precipitation (PP), the following concentration indicators were applied: frequency of days with precipitation up to 20mm (R20MM), maximum daily rainfall (Rx1Day), maximum rainfall over 5 days (Rx5Day), frequency of days with precipitation in the 10th (P10), 90th (P90), 95th (P95), and 99th (P99) percentiles, number of rainy days (NRD), and the Concentration Index (CI), which estimates the contribution of daily rainfall to the annual total. The Mann-Kendall test and Sen's slope were applied to identify possible trends in the time series and its magnitude. Spatially, the highest concentration values were observed in the Litoral and Brejo regions, decreasing towards the State hinterland. Temporally, most indicators displayed negative trends, suggesting reductions in both annual rainfall totals and rainfall on isolated days or groups of days. However, the CI showed predominantly an upward trend, indicating increased rainfall concentration. P10 values also exhibited an increase tendency, suggesting that days with the lowest rainfall amounts are becoming more frequent.

Educational inequalities and decomposition of the urban-rural disparities in maternal health care utilization in Ethiopia: further analysis of 2019 intermediate Ethiopian demography and health survey

IntroductionThe utilization of maternal health services is vital to prevent maternal and child health problems. However, there is limited evidence as to why rural women have lower utilization and educational inequality in maternal health services utilization in Ethiopia. Identifying the causes is the first step to achieving maternal and child health initiatives.ObjectiveThe objective of this study was to decompose the urban-rural disparities and educational inequalities in maternal health care utilization in Ethiopia.MethodsThe study used the 2019 Ethiopian Demography Health Survey. Blinder-Oaxaca decomposition and multivariate decomposition analyses were done on a weighted 3,926.7 women to see the urban-rural differences in maternal health service utilization by using Stata 17.0. For the educational inequality of maternal health service utilization, concentration curve and concentration index were used by using conindex. P value < 0.005 was used to declare association.Result84.89% of urban and 70.75% of rural residents use antenatal care and 73% of urban and 44% rural use institutional delivery. There was no urban-rural difference in postnatal care utilization. There was educational inequality in antenatal care (CIx 0.0926; p < 0.001), delivery care (CIx 0.2137; p < 0.001 and postnatal care (CIx 0.1272; p < 0.001) utilization in Ethiopia. 83.3% of antenatal care urban-rural difference was explained by women’s characteristics difference. Secondary (16.51%) and higher (23.01%) educational level difference of urban and rural women widening antenatal care utilization. Living regions (-1.33%) difference of urban and rural women mitigated antenatal care utilization. About 76.07% of the urban-rural difference in institutional delivery was explained by differences in the characteristics of women. Attending primary (3.76%), secondary (11.83%), and higher (8.44%) education, antenatal care (15.81%) difference of urban and rural women were widening institutional delivery utilization.ConclusionThe urban-rural disparity in antenatal care and delivery care utilization is significant in the country. There were educational inequalities in maternal health service utilization. Attending, Secondary, higher, educational levels widening antenatal care and institutional delivery care utilization. Living regions mitigated antenatal care utilization. Antenatal care utilization widening institutional delivery utilization. Special attention is needed for rural women to improve maternal health service utilization through health extension workers and the women’s developmental army.

Spatio-temporal rainfall variability and trends using a Kriging-interpolation and Innovative trend analysis approach: the case of Wolaita zone, south Ethiopia

Climate change is one of the worst environmental issues, with a negative impact on most developing countries across the globe and in some regions, including Ethiopia. This study seeks to establish the temporal and spatial changes in rainfall for the period 1987–2021. In this study, ordinary statistical measures, such as the mean and coefficient of variation, precipitation concentration index (PCI), and standardized anomaly index (SAI), were applied to investigate the rainfall variation. Concerning the estimation of the spatiotemporal distribution and magnitude of changes in, non-parametric Mann-Kendall (MK) tests, Sen’s slope estimator, and innovative trend analysis (ITA) were also conducted in ArcGIS 10.8 environment and XLSTAT/R. The study showed significant fluctuations in rainfall in the Wolaita zone, with minimum mean annual rainfall in 1997 and maximum rainfall in 2003. All but the Belg season had more negative seasonal anomalies than positive ones. The annual rainfall for each of the AEZs in different parts of the country ranged from one another; it was 969.03 mm in a southeast lowland AEZ and 1648.75 mm in the northwest highland AEZ. Rainfall was not uniformly distributed throughout the year and study area; the highland AEZs received more rainfall in the Belg and Kermit seasons than in the lowland seasons. In the ordinary kriging results, the extent of variability in the CV of the mean annual rainfall for each zone was identifiable. The southwest lowland AEZ produced a CV of 24.22% with a decrease in rainfall amounts, and the northeast highland AEZ produced a CV of 31.63% of the rainfall distribution amounts. This area includes lowland and highland AEZs of the northeastern part of the study area’s rainfall, which is moderately distributed by PCI. This information is helpful when attempting to associate development and cropping systems with temporal and spatial climatic patterns with respect to rainfall for agro-climatological activities and projects or flood regulatory measures.

A systematic review and individual bacterial species level meta-analysis of in vitro studies on the efficacy of ceftazidime/avibactam combined with other antimicrobials against carbapenem-resistant Gram-negative bacteria.

Carbapenem-resistant Gram-negative bacteria (CR-GNB) develop resistance to many antimicrobials. To effectively manage infections caused by these organisms, novel agents and/or combinations of antimicrobials are required. Evaluated the in vitro efficacy of ceftazidime/avibactam in combination with other antimicrobials against CR-GNB. PubMed, Web of Science, Embase and Scopus were searched. Study outcomes were quantified by counting the number of isolates exhibiting synergy, defined as a fractional inhibitory concentration index ≤ 0.5 for checkerboard and Etest, and a >2 log cfu/mL reduction for time-kill studies. The proportion of synergy was calculated as the ratio of isolates exhibiting synergy to the total number of isolates tested. These proportions were analysed using a random-effects model, following the Freeman-Tukey double-arcsine transformation. Forty-five in vitro studies were included. A total of 734 isolates were tested, and 69.3% of them were resistant to ceftazidime/avibactam. The combination of ceftazidime/avibactam with aztreonam showed a high synergy rate against carbapenem-resistant Klebsiella pneumoniae (effect size, ES = 0.91-0.98) and Escherichia coli (ES = 0.75-1.00). Ceftazidime/avibactam also demonstrated a high synergy rate (ES = 1) in time-kill studies when combined with azithromycin, fosfomycin and gentamicin against K. pneumoniae. Compared to ceftazidime/avibactam alone, a higher bactericidal rate was reported when ceftazidime/avibactam was combined with other antimicrobials against carbapenem-resistant K. pneumoniae (57% versus 31%) and E. coli (93% versus 0%). Ceftazidime/avibactam frequently demonstrates synergistic bactericidal activity when combined with various antimicrobials against CR-GNB in in vitro tests. Further pre-clinical and clinical studies are warranted to validate the utility of ceftazidime/avibactam-based combination regimens for CR-GNB infections.

Socioeconomic inequality in cervical cancer screening uptake among women in sub-Saharan Africa: a decomposition analysis of Demographic and Health Survey data

ObjectiveTo examine socioeconomic inequalities in the use of cervical cancer screening among women in sub-Saharan Africa.DesignSecondary data from the Demographic and Health Survey data in sub-Saharan Africa.SettingSub-Saharan Africa.ParticipantsWomen aged 15–64...

Inequality in modern contraceptive use and unmet need for contraception among women of reproductive age in Zambia. A trend and decomposition analysis 2007–2018

BackgroundAccess to contraception can be a transformational intervention towards advancement of education, health, and freedom of choice. Countries have committed to improving access to contraception enshrined in the sustainable development goals (SDGs), indicator 3.7.1. Our study seeks to investigate the level of inequality in current use of modern contraception and unmet need for contraception among sexually active women of reproductive age in Zambia during 2007, 2013/14 and 2018 to inform family planning policy.MethodsWe use three rounds of Zambia demographic and health survey datasets for the years 2007, 2013/14 and 2018, which are nationally representative surveys. We included a total of 19,973 sexually active women of reproductive age from 15 to 49 years living in Zambia. The level of inequality was assessed using concentration curves, and indices. The concentration indices were decomposed to identify the causes of the inequality.ResultsOur analysis shows that there was inequality in the current use of modern contraception across the years 2007, 2013/14 and 2018. The concentration curves showed that current use of modern contraception was higher among the wealthy than the poor. This pro-rich trend was consistent throughout the study period. Erreygers concentration Index (EI) values were 0.2046 in 2007, 0.1816 in 2013/14, and 0.1124 in 2018. The inequality in current use of modern contraception was significantly influenced by having access to contraceptive counselling, education level and being in a union (living with a partner). In addition, there was inequality in unmet need for contraception with concentration curves showing that unmet need for modern contraception was experienced more among the poor compared to the wealthy. Unmet need was thus pro poor. The EI values were – 0.0484 in 2007, – 0.0940 in 2013/14 and – 0.0427 in 2018. This inequality was significantly influenced by education, employment status, being in a union, and having health insurance.ConclusionInequality in modern contraceptive use and unmet need for contraception exists and has persisted over the years in Zambia. Such inequality can be addressed through a multipronged approach that includes encouraging women to visit health facilities, access to contraceptive counselling, and promoting formal education.

Measurement and decomposition of education-related inequality in exclusive breastfeeding practice among Ethiopian mothers: applying Wagstaff decomposition analysis

BackgroundHuman breast milk, a naturally balanced source of infant nutrition, promotes optimal growth and health when exclusively fed for 6 months. Exclusive breastfeeding reduces common childhood infections, provides protection against some chronic illnesses, and contributes to achieving several Sustainable Development Goals. Despite its benefits, only 58% of Ethiopian women practice it, and the associated education-related inequality is not well documented. Thus, this study aims to quantify and decompose the education-related inequality in exclusive breastfeeding practice among Ethiopian mothers.MethodsA total of 1,504 weighted samples were studied using a Performance Monitoring for Action Ethiopia longitudinal panel survey dataset (2021–2023). Wagstaff normalized concentration index and its concentration curve were used to assess education-related inequality in exclusive breastfeeding practice. Wagstaff decomposition analysis was performed to decompose the concentration index and identify factors contributing to the observed education-related inequality. Significance was declared at p-value &amp;lt;0.05.ResultsThe overall prevalence of exclusive breastfeeding among Ethiopian women was 57.29% (95% CI: 54.79, 59.80%), with a greater concentration found among women with lower levels of education. This indicates an inequality that favors less educated women (pro-less educated inequality), as demonstrated by the Wagstaff normalized concentration index of −0.058 (95% CI: −0.113, −0.002). Factors that made a significant contribution to the observed education-related inequality in exclusive breastfeeding practice were residence (18.80%), region (29.31%), place of birth (−7.38%), and the wantedness status of the indexed pregnancy (82.58%). The indexed pregnancy’s wantedness was made a more elastic (elasticity = 0.282) contribution.ConclusionThe study identified a small yet significant education-related inequality in exclusive breastfeeding, favoring less educated women. Hence, emphasis should be placed not only on educating women but also on healthy habits that they can leave behind when they learn. Residence, region, place of birth, and indexed pregnancy’s wantedness significantly contributed to the observed education-related inequality. The elasticity value for each factor suggests that policy changes addressing these factors could readily reduce the observed inequality.

Geospatial analysis of sports tourism resources in China's urban clusters: a case study of the Sichuan-Chongqing region utilizing GIS and the geographic detector

IntroductionThis study aims to elucidate the temporal and spatial distribution patterns of sports tourism resources within the Sichuan-Chongqing Urban Agglomeration, examining how these distributions reflect the developmental pathways of urban regions. The theoretical framework posits that the availability and allocation of sports tourism resources are influenced by various geographical and socio-economic factors, with topography, economic conditions, and population density playing pivotal roles in determining their distribution and development.MethodsUtilizing GeoDetector technology alongside indices such as the Geographic Concentration Index and the Disparities Index, we conducted a comprehensive analysis of the spatiotemporal dynamics of sports tourism resources, revealing that the distribution of these resources serves as a key indicator of urban development speed.ResultsOur findings indicate that topographical features significantly influence sports tourism resource development differently in Chengdu compared to Chongqing. Furthermore, we identified a strong positive correlation between population density and the distribution of sports tourism resources, highlighting the motivational role of populated areas and emphasizing potential inequalities if attention is focused solely on densely populated regions.DiscussionThis research provides novel insights into the complex relationships governing sports tourism resource distribution by employing advanced geo-analytical tools. It offers a strategic roadmap for equitable and sustainable urban development by addressing disparities in resource allocation, ultimately contributing to informed policy-making and enhanced regional resilience. This research aids in the strategic planning and sustainable development of sports tourism, providing a blueprint for urban development in the region that balances the needs of diverse populations and landscapes.

Unraveling the variability and geoclimatic drivers of daily precipitation concentration over a Western Himalayan Province of India.

A sound understanding of daily precipitation concentration provides critical insights about extreme precipitation and associated hazards such as rainstorms, flash floods, cloud bursts, and soil erosion. Therefore, this study examines the spatiotemporal variability and geoclimatic drivers of daily precipitation concentration using the concentration index (CI), precipitation concentration degree (PCD), Q Index (QI), and Theil index (TI) over a Western Himalayan Province, namely Himachal Pradesh, India. For this, the daily precipitation data pertaining to 111 grids (0.25° × 0.25° resolution), encompassing entire province, have been downloaded from India Meteorological Department (IMD), Pune, for the period 1951 to 2020. The trends in concentration indices have been detected using Mann-Kendall (MK) and Sen's slope methods, whereas their relationship with geoclimatic drivers have been assessed using Pearson's correlation coefficient (physiographic) and random forest regression model (climatic) at annual and monsoon season time scales. The results have revealed a high correlation between CI-TI (> 0.95), followed by QI-TI (> 0.84), QI-PCD (> 0.80), TI-PCD (> 0.78), QI-CI (> 0.65), and CI-PCD (> 0.60), representing nearly similar precipitation concentration distribution. Among the concentration indices, QI has shown maximum sensitivity to long-term changes followed by TI, CI, and PCD at both time scales. Similarly, physiographic factors have maximum effect on QI, showing its greatest sensitivity to latitude, longitude and elevation. While considering the impact of climatic drivers, Atlantic Meridian Oscillation (AMO) and Sunspot activity have exerted maximum influence on annual variability of CI, PCD, QI, and TI, whereas monsoon variability of these indices has been modulated by Pacific Decadal Oscillation (PDO), especially over northern parts of Himachal Pradesh. These findings will assist soil and water resource managers, disaster executives, agricultural stakeholders, and urban planners in understanding the unexplored aspects of daily precipitation concentration and making informed decisions over the mountainous regions of western Himalaya.

Inequalities in health and health-care accessibility among older people in China

Abstract While health inequalities among older people have long been a research focus and are now high on policy agendas in developed societies, they have often been neglected in less developed ones, despite them experiencing rapid population ageing since the turn of the century. Using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) cohort study (N = 63,578), this paper measures the health status of older people using the Quality of Well-Being scale, and estimates time trends in health inequality with concentration indices, followed by an investigation of their social determinants. Its specific focus is health care accessibility (HA) in the period 2005–2018, when China experienced an unprecedented advance in health-related social policy reform. The analysis reveals pro-rich inequalities in health among older people, but also shows that these have narrowed gradually over the past two decades, which is largely attributable to greater equity in access to health care. Within this general trend of inequality reduction, however, the role of HA has declined and social determinants such as education now have an increasing influence on health inequalities. These findings suggest that social policies targeting not only health improvements among older people but also health inequalities earlier in the life course are required if policy makers want to promote health equity in later life.

The Value of Auditing the Frequency of Inhalational Anesthetics With a Combination of Very Low Bispectral Index and High Fraction of the Age-Adjusted Minimum Alveolar Concentration

The Value of Auditing the Frequency of Inhalational Anesthetics With a Combination of Very Low Bispectral Index and High Fraction of the Age-Adjusted Minimum Alveolar Concentration

Inhibition of Staphylococcus aureus biofilm by quercetin combined with antibiotics

This study aimed to investigate the effects of combined quercetin and antibiotics on the bacteriostatic activity and biofilm formation of Staphylococcus aureus. Optimal concentrations of quercetin and antibiotics (tetracycline and doxycycline) for inhibiting biofilm formation were determined using the Fractional Inhibitory Concentration Index and Minimum Biofilm Inhibitory Concentration assays. The impact of the drug combinations on biofilm clearance at various formation stages was determined using crystal violet staining, scanning electron microscopy and confocal laser microscopy. The results indicated that quercetin enhanced the bactericidal effect of tetracycline antibiotics against S. aureus. The combination significantly reduced both the metabolic activity within S. aureus biofilms and the production of biofilm matrix components. Scanning electron microscopy and confocal laser microscopy confirmed that the combination treatment significantly reduced bacterial cell counts within the biofilm. Quercetin treatment significantly increased the sensitivity of biofilms to antibiotics, supporting its potential application as a novel antibiotic synergist.

Synergistic potential of lopinavir and azole combinational therapy against clinically important Aspergillus species.

Aspergillus fumigatus is a widely distributed pathogen responsible for severe infections, particularly in immunocompromised individuals. Triazoles are the primary treatments options for Aspergillus infections; however, the emergence of acquired resistance to this antifungal class is becoming a growing concern. In this study, we investigated the potential of the antiviral drug, lopinavir (LPV) to restore the susceptibility of A. fumigatus strains to a set of azoles, while also reducing the required azole dosage for treatment of susceptible isolates. The combination of LPV with either itraconazole (ITC) or posaconazole (POS) demonstrated potent synergistic interactions against 16 out of 23 (~70%) and 21 out of 23 (~91%) A. fumigatus isolates, respectively. Moreover, the combination showed synergistic activity against other clinically important Aspergillus species, including A. niger, A. flavus, and A. brasiliensis. The fractional inhibitory concentration index (FICI) for the combinations ranged from 0.18 to 0.313 for ITC and 0.091 to 0.313 for POS, indicating strong synergistic effects. Further investigation revealed that efflux pump inhibition contributed to the synergy observed between azole and LPV. Morphological examination of the fungal cells subjected to this combinational therapy at sub-inhibitory doses showed the presence of carbohydrate granules/patches. The identification of LPV as a promising adjunct therapy holds promise for addressing the emerging challenge of azole resistance in Aspergillus species and improving treatment outcomes for patients.

Association of socioeconomic inequality in cardiovascular disease risk with economic development across 57 low- and middle-income countries: cross-sectional analysis of nationally representative individual-level data

BackgroundAccording to epidemiological transition theory, cardiovascular disease (CVD) risk shifts down the socioeconomic distribution with economic development. MethodsWe tested this hypothesis using nationally representative data on 88,559 individuals aged 40-80 years from 57 low- and middle-income countries (LMICs). We used measured risk factors to estimate the 10-year probability of a CVD event (CVD risk) and proxied socioeconomic status (SES) by years of education. We used a concentration index to measure socioeconomic inequality in CVD risk and decomposed it into risk factor contributions. We estimated associations CVD risk and inequality in that risk with gross national income (GNI) per capita (pc). ResultsWe estimated that a 1% higher GNI pc was associated with higher mean CVD risk of 0.0265 percentage points (pp) (95% CI: 0.0169 – 0.0361) among females and 0.0150 pp (0.0082 – 0.0219) among males. All risk factors, except systolic blood pressure (SBP) and smoking among females, were positively associated with GNI pc. In most countries, lower SES was associated with higher CVD risk. Age, SBP, diabetes (females only) and smoking (males particularly) contributed most to this inequality, while inequality in total cholesterol was mostly in the opposite direction. Lower SES individuals tended to have relatively higher CVD risk at higher GNI pc, particularly among females. This was due to differences in the distributions of SBP and, for females, age and diabetes. ConclusionsEconomic development was associated with higher and more unequal CVD risk, which may warrant shifting targeting of CVD primary prevention to socially disadvantaged groups.

Socioeconomic patterns in indoor environment in Denmark: cross-sectional studies from 2000 and 2021

ObjectivesTo examine changes and socioeconomic patterns in indicators of a poor indoor environment in 2000 and 2021. Study designCross-sectional data from the Danish Health and Morbidity Survey in 2000 and 2021. MethodsThe study included 27,068 participants. Indicators of indoor environment (annoyances from mould, temperature, draught, traffic and neighbour noise, and presence of water damage) were obtained from questionnaires (2021) and partly by interview (2000). Socioeconomic status included home ownership, educational level, and household income. The degree of social inequality in the indoor environment was estimated using the concentration index of inequality. ResultsThe prevalence of annoyances due to draught, temperature, and noise increased significantly from 2000 to 2021 (e.g., temperature 5.9%–25.1%, odds ratio (OR) 6.72, 95% confidence interval (CI) 6.12–7.38), whereas the prevalence of water damage decreased (17.7%–13.8%, OR 0.85, 95% CI 0.76–0.96). No difference was seen in annoyances due to mould (3.1% in 2000 and 2.5% in 2021, OR 0.90, 95% CI 0.69–1.17). Social inequality was present for thermal conditions, annoyances due to noise and presence of water damage when assessed by income but not by educational level. Conditions were more prevalent among individuals with low income in both 2000 and 2021. ConclusionsThe proportion of individuals reporting a poor indoor environment due to thermal conditions and noise increased in the period 2000–2021. Social inequality was observed in all indicators of a poor indoor environment for household income, whereas the inequality was less pronounced when assessed by educational level.

In-vitro Interactions between Fluconazole and Diphenyl Diselenide against Various Candida Species

Background: In the immunocompromised population, Candida species are the most aetiologic agents causing severe nosocomial fungal infections. Candida species, irrespective of being commensals in the human microbiome, are the fourth most prevalent source of potentially fatal yeast infections. Monotherapy is frequently employed to treat invasive fungal infections, but sometimes, patients do not favor the monotherapy treatment regime. It may be because of the reduced susceptibility of the pathogen toward traditional antimycotic drugs. Antimycotic drug combination therapy could be a better choice in such specific circumstances. In our study, we evaluated the interactions of fluconazole with diphenyl diselenide. Methods: The antimycotic susceptibilities of Candida species for fluconazole and diphenyl diselenide were determined by broth microdilution assay, and the in-vitro interactions of fluconazole with diphenyl diselenide were studied by using disc diffusion assay and chequerboard assay. The nature of the interactions was assessed by calculating the fractional inhibitory concentration index (FICI). The interactions were also analyzed by the response surface approach. Results: The minimum inhibitory concentrations (MICs) for fluconazole and diphenyl diselenide as determined by the broth microdilution assay against Candida species were 4 μg/ml-512 μg/ml and 1 μg/ml-32 μg/ml, respectively. The FICI values varied from 0.375 to 2. Conclusion: Our finding demonstrated that there is no antagonism interaction between fluconazole and diphenyl diselenide in Candida species. Thus, this innovative combination should be explored in the future.

Combined action of two synthetic ultrashort antimicrobial peptides exhibiting synergistic effects against clinically significant resistant bacteria

Background and Aim: The emergence and proliferation of multidrug-resistant bacteria pose a global health crisis. This issue arises from the overuse and misuse of antibiotics, coupled with the pharmaceutical industry’s limited development of new drugs, which is constrained by financial disincentives and regulatory hurdles. This study aimed to investigate the combined antibacterial efficacy and safety profile of the combined ultrashort antimicrobial peptides (AMPs) WW-185 and WOW against antibiotic-resistant bacterial strains. Materials and Methods: The WW-185 and WOW peptides were synthesized through solid-phase methods and purified using reverse-phase high-performance liquid chromatography, and their purity was confirmed by mass spectrometry. Antibacterial activity was evaluated using broth dilution and checkerboard assays to assess both individual and combined effects of the peptides against Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus [MRSA]) and Escherichia coli (including extended-spectrum beta-lactamases [ESBL]-producing strains). The synergy between the peptides was quantified using fractional inhibitory concentration indices. Hemolytic activity was also assessed to determine cytotoxicity toward red blood cells. Results: The combination of WW-185 and WOW exerted synergistic effects against both MRSA and ESBL-producing E. coli, with reduced minimal inhibitory concentrations compared with the individual treatments. The peptides exhibited minimal hemolytic activity, indicating low toxicity. Conclusion: The combination of the ultrashort AMPs WW-185 and WOW shows promising synergistic antibacterial effects against resistant bacteria, with potential for further therapeutic development due to their enhanced efficacy and low toxicity. Keywords: antimicrobial agents, bacterial infections, multidrug resistance, synergistic effects, ultra-short peptides.

Global, regional, and national pancreatitis burden and health inequality of pancreatitis from 1990 to 2019 with a prediction from 2020 to 2034

BackgroundPancreatitis is a digestive system disease that imposes a significant burden on society. However, there is a lack of comprehensive research on the incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of pancreatitis, as well as on health inequalities and future trends.MethodsPancreatitis burden data, including the number and age-standardized rates (ASR) of incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), were collected from the Global Burden of Diseases 2019 (GBD 2019). SDI and HDI were used to analyze the influence of societal development on the burden of pancreatitis in the population. Additionally, the Gini coefficient and the Concentration index were used to assess health inequalities in the burden of pancreatitis. Global population data from 1990 to 2034 was obtained from WHO. Based on the population data and pancreatitis burden data, a prediction model of the burden was constructed to calculate the number and ASR of incidence, prevalence, deaths, YLLs, YLDs, and DALYs from 2019 to 2034 using the BAPC package and the Nordpred package.ResultsFrom 1990 to 2019, there has been a decreasing trend in the ASR of incidence, prevalence, deaths, YLLs, YLDs, and DALYs in pancreatitis. However, despite this decline, the number of cases has been on the rise. Furthermore, pancreatitis imposes a higher burden on males in comparison to females, and there exists a negative correlation between pancreatitis burden and both the Social Development Index (SDI) and the Human Development Index (HDI). Additionally, health inequalities have progressively worsened globally between 1990 and 2019, particularly concerning the burden of pancreatitis in countries with low Social Development Index (SDI). Looking to the future, it is projected that the number of deaths and new cases will continue to increase from 2020 to 2034.ConclusionsPancreatitis remains a mounting worldwide burden. In order to alleviate this challenge, preventive strategies should focus on males and middle-aged or older individuals, specifically in countries with a low SDI. Pancreatitis is expected to predominantly impact Eastern Europe, characterized by a high ASR of incidence, and Asia, boasting a substantial population.