Delay In Recovery Research Articles

The effect of post-wildfire management practices on vegetation recovery: Insights from the Sapadere fire, Antalya, Türkiye

Post-wildfire management actions mainly targeting the removal of salvage logs and burned trees is a common but controversial practice. Although it aims to regain some of the natural and economic value of a forest, it also requires disturbing burned areas, which may have some negative consequences affecting, for instance, the carbon cycle, soil erosion, and vegetation cover. Observations from different geographic settings contribute to this scientific debate, and yet, the spatiotemporal evolution of the post-fire road network developed as part of fire management practices and its influence on vegetation recovery has been rarely examined. Specifically, we still lack observations from Türkiye, though wildfires are a common event. This research examined the evolution of the vegetation cover in relation to post-fire road constructions and the resultant debris materials in areas affected by the 2017 Sapadere fire in Antalya, Türkiye. We used multi-sensor, multi-temporal optical satellite data and monitored the variation in both vegetation cover and road network from the pre-to post-fire periods between 2014 and 2021. Our results showed that fire management practices almost doubled the road network in the post-fire period, from 487 km to 900 km. Overall, 7% of the burned area was affected by these practices. As a result, vegetation cover in those areas shows only ∼50% recovery, whereas undisturbed areas exhibit ∼100% recovery 5 years after the event. Notably, such spatiotemporal analysis carried out for different burned areas would provide a better insight into the most suitable post-fire management practices. Our findings, in particular, show that the current practices need to be revisited as they cause a delay in vegetation recovery.

Indications, Complications, and Early Postoperative Course of Recovery of Intraocular Lens Exchange Surgery: a Single-Center Retrospective Study

To analyze the indications, complications, and early course of recovery of intraocular lens (IOL) exchange surgery. Records of patients who underwent IOL exchange during a 6-year period at a tertiary referral center were reviewed and the indications and complications after surgical intervention were analyzed. Their effects on postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), use of IOP-lowering medications, and refractive cylindrical power were assessed. One hundred and seventy-one eyes (165 patients) were investigated. The most frequent indication for IOL exchange was lens dislocation in 163 eyes (95.32%). The main causes of IOL dislocation were pseudoexfoliation syndrome (PEX) in 98 eyes (57.31%) and complications during cataract surgery in 40 eyes (23.39%). During IOL exchange, an anterior iris-claw fixation was performed in 159 eyes (92.98%). After significant initial deterioration to 1.59 ± 1.08 logMAR on postoperative day 1 (p ≤ 0.001), the CDVA recovered to preoperative levels within 28 days. A significant decrease in IOP was observed on postoperative day 1 (p = 0.04). The most common postoperative complications were corneal edema in 114 eyes (66.67%) and vitreous hemorrhage in 67 eyes (39.18%). The high early postoperative prevalence of corneal edema and intraocular hemorrhage was found to affect visual recovery after IOL exchange, causing a significant initial deterioration of CDVA and a delay of full visual recovery. These findings suggest that surgical approaches minimizing the risk of this type of complications should be favored.

Management of Postoperative Peritonitis (POP) in a Disadvantaged Environment

The aim of this work was to describe the management of POP in a precarious environment. It was a retrospective study of descriptive type from January 2007 to December 2012 on the records of patients with POP. Gender, age, qualification of the operating physician, time to management, initial diagnosis, type of initial surgery, treatment, prognosis were the parameters studied. We noted 32 cases of POP out of 4656 laparotomies, i.e. a frequency of 0.7%. The mean age of our patients was 37.7 years. The sex ratio was 1.3 in favor of the male sex. The majority of our patients were referred from other centers with a rate of 78%. Emergencies accounted for 84% of the initial surgical procedures. Initial diagnoses were dominated by acute appendicitis with a rate of 37.5%. Clinical signs were dominated by abdominal pain 87.5%; vomiting 53.1%; tachycardia 68.7% and fever 75%. The main causes were the release of digestive sutures. The management was multidisciplinary. We noted 41% of favorable follow-up; 9% of morbidity and 50% of death. The delay of the operative recovery, the number of visceral failures, the number of iterative and close reoperations were factors that influenced the prognosis. Post-operative peritonitis rapidly challenges the integrity of most major vital functions. Early diagnosis is the key to improving prognosis.

An unusual case of delayed recovery from spinal anesthesia in a patient with Lambert-Eaton myasthenic syndrome—a case report

BackgroundThe Lambert-Eaton myasthenic syndrome (LEMS) is a rare disorder characterized by proximal muscle weakness and autonomic dysfunction due to involvement of the neuromuscular junction A case of delayed unilateral recovery from spinal anesthesia in a patient with LEMS undergoing open cholecystectomy is described.Case presentationA 42-year-old lady, on treatment for LEMS with pyridostigmine, prednisolone, and azathioprine presented with cholelithiasis and was scheduled for open cholecystectomy. Neuraxial anesthesia combined with a light plane of general anesthesia provided adequate muscle relaxation without the use of neuromuscular blocking drugs. In spite of perioperative continuation of anticholinesterases, the patient required 12 h post-surgery for complete bilateral motor recovery from spinal anesthesia.ConclusionsA combination of spinal anesthesia with a light plane of general anesthesia appears to be a safe anesthetic technique for managing patients with Lambert-Eaton myasthenic syndrome undergoing open cholecystectomy. However, neurologically asymptomatic patients with good treatment compliance may also show an unusual delay in recovery from neuraxial anesthesia.

Influence of Recovery Time After Warm-up on Vertical Jump Performance in Trained Prepubertal and Postpubertal Male Athletes.

Ferrari, A, Baquet, G, Blazevich, AJ, and Ratel, S. Influence of recovery time after warm-up on vertical jump performance in trained prepubertal and postpubertal male athletes. J Strength Cond Res 37(10): 1985-1992, 2023-The aim of this study was to examine the concurrent effects of maturity status and recovery delay after a standardized dynamic warm-up on vertical jump performance. Thirteen prepubertal boys (9.4 ± 1.1 years) and 12 postpubertal boys (16.6 ± 0.8 years) were tested on squat jump (SJ) and drop jump from 30 cm (DJ 30 ) before and after a standardized, 8-minute, dynamic warm-up, including low-intensity, nonspecific dynamic exercises progressing to maximal, specific exercises, over 6 separate occasions. In each session, subjects jumped at 0, 1.5, 3, 5, 7, or 10 minutes after warm-up in a randomized order. Measurements included SJ height, DJ 30 height, ground contact time (GCT), and reactive strength index (RSI) from DJ 30 . The results revealed no significant recovery time × maturity group interaction effects for SJ height ( p = 0.36), DJ 30 height ( p = 0.45), GCT ( p = 0.75), or RSI ( p = 0.09), meaning that maturity status did not have a significant effect on changes in vertical jump performance after the warm-up. However, there were significant time effects for SJ height, DJ 30 height, and RSI ( p < 0.001 for all), with DJ 30 height and RSI increasing significantly by 16.9% at 1.5 minutes ( p < 0.001) and SJ height increasing significantly by 12.0% until 3 minutes after the warm-up ( p < 0.001). To conclude, the standardized dynamic warm-up had beneficial effects on vertical jump performance within the first 3 minutes after completion of the intervention. However, vertical jump performance after the warm-up was not dependent on the children's maturity status.

Moisturizing at a molecular level - The basis of Corneocare.

This review covers the last 20 years of research we and our collaborators have conducted on ethnic differences in facial skin moisturization placed in historical context with previous research. We have focussed particularly on the biochemical and cellular gradients of the stratum corneum (SC) with the aim of discovering new skin moisturization and SC maturation mechanisms, identifying new technologies and/or providing conceptual innovations for ingredients that will improve our understanding and treatment of dry skin. Specifically, we discuss gradients for corneodesmosomes and proteases, corneocyte phenotype-inducing enzymes, filaggrin and natural moisturizing factor (NMF), and barrier lipids. These gradients are interdependent and influence greatly corneocyte maturation. The interrelationship between corneodesmolysis and the covalent attachment of ω-hydroxy ceramides and ω-hydroxy fatty acids to the corneocyte protein envelope forming the corneocyte lipid envelope is especially relevant in our new understanding of mechanisms leading to dry skin. This process is initiated by a linoleoyl-ω-acyl ceramide transforming enzyme cascade including 12R lipoxygenase (12R-LOX), epidermal lipoxygenase-3 (eLOX3), epoxide hydrolase 3 (EPHX3), short-chain dehydrogenase/reductase family 9C member 7 (SDR9C7), ceramidase and transglutaminase 1. Our research has opened the opportunity of using novel treatment systems for dry skin based on lipids, humectants, niacinamide and inhibitors of the plasminogen system. It is clear that skin moisturization is a more complex mechanism than simple skin hydration.

Association Between First Attempt Buffalo Concussion Treadmill Test and Days to Recovery in 855 Children With Sport-Related Concussion: A Historical Cohort Study and Prognostic Factors Analysis.

Little is known about the prognostic value of the Buffalo Concussion Treadmill Test (BCTT) after the acute phase of sport-related concussion (SRC). We examined the added prognostic value of the BCTT performed 10 to 21 days after SRC in children, in addition to participant, injury, and clinical process characteristics on days to recovery. Historical clinical cohort study. Network of approximately 150 Canadian multidisciplinary primary-care clinics. 855 children (mean age 14 years, range 6-17 years, 44% female) who presented between January 2016, and April 2019 with SRC. Participant, injury, and clinical process characteristics, with focus on BCTT exercise intolerance assessed 10 to 21 days after injury. Days to clinical recovery. Children who were exercise intolerant experienced an increase of 13 days to recovery (95% CI, 9-18 days). Each additional day between SRC and first BCTT was associated with a recovery delay of 1 day (95% CI, 1-2 days), and prior history of concussion was associated with a recovery delay of 3 days (95% CI, 1-5 days). Participant, injury, and clinical process characteristics, and the first attempt BCTT result explained 11% of the variation in recovery time, with 4% accounted for by the BCTT. Exercise-intolerance assessed 10 to 21 days after SRC was associated with delayed recovery. However, this was not a strong prognostic factor for days to recovery.

Design, Synthesis, and Bioevaluation of Dexmedetomidine Prodrug.

Dexmedetomidine is commonly used in clinical practice as an anesthetic adjuvant and sedative. Unfortunately, major side effects include significant blood pressure fluctuation and bradycardia. Herein, we report the design and synthesis of four series of dexmedetomidine prodrugs aimed to alleviate hemodynamic fluctuations and simplify the administration procedure. From the in vivo experiments, all the prodrugs took effect within 5 min and did not cause significant recovery delay. The increase in blood pressure generated by one bolus of most of the prodrugs (14.57%-26.80%) was similar to that resulting from a 10 min infusion of dexmedetomidine (15.54%), which is significantly lower than the effect from a single dose of dexmedetomidine (43.55%). The decrease in heart rate induced by some prodrugs (-22.88% to -31.10%) was significantly alleviated compared with dexmedetomidine infusion (-41.07%). Overall, our work demonstrates that the prodrug strategy is useful to simplify administration procedures and mitigate hemodynamic fluctuations induced by dexmedetomidine.

Integration of mental health topics in medical postgraduate specialties programms in 50 countries

AbstractThe prolongation of life expectancy has considerably increased the prevalence of chronic diseases and therefore the concomitant presence of these, this usually predicts a more reserved prognosis for both conditions and can lead to greater complications, more complex treatments (4,5) and therefore more expensive and with considerable delays in recovery.(6)The comorbidity of physical and mental illnesses is common, as both are often interrelated.One of the ways to ensure handling comprehensive and personalized comorbidity should be detected especially at the first level of care for timely treatment, It is the inclusion of mental health topics in the curricula of doctors in training in a specialty.ObjectiveEstablish which programs of the medical and surgical specialties include topics related to mental health in their academic training, in order to strengthen the recovery process of patientsMethodsA descriptive study of the academic programs of Medical specialization in 50 countries. The questions we asked ourselves were:1.What medical specialties contain mental health topics in their training program?How many medical specialties have included the following mental health topics in their regular graduate program: affective disorders, anxiety disorders, psychosomatic disorders, substance use disorders, violence and palliative care?What other mental health topics are included in the different medical specialties?DiscussionThe results obtained indicate the importance of mental health in different states of physical health and especially to be taken into account by decision makers in health policies. Comorbidity in current medicine should be taken into consideration more objectively and thus favor the reduction of the suffering of the sick person. We know that an associated mental and physical condition can give atypical presentations that hinder diagnosis, clinical severity, and response to treatment and therefore may lead to increased utilization of health services. However, the fragmentation of medicine into increasingly limited specialties restricts the ability to see the patient holistically and therefore the decrease in the quality of medical care, increase in costs and delay in the recovery process.Disclosure of InterestNone Declared

Effect of vitamin D supplementation versus placebo on recovery delay among COVID-19 Tunisian patients: a randomized-controlled clinical trial

IntroductionThe present study aimed to determine the impact of vitamin D supplementation (VDs) on recovery delay among COVID-19 patients.MethodsWe performed a randomized controlled clinical trial at the national COVID-19 containment center in Monastir (Tunisia), from May to August 2020. Simple randomization was done in a 1:1 allocation ratio. We included patients aged more than 18 years who had confirmed reverse transcription-polymerase chain reaction (RT-PCR) and who remained positive on the 14th day. The intervention group received VDs (200,000 IU/1 ml of cholecalciferol); the control group received a placebo treatment (physiological saline (1 ml)). We measured the recovery delay and the cycle threshold (Ct) values in RT-PCR for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The log-rank test and hazard ratios (HR) were calculated.ResultsA total of 117 patients were enrolled. The mean age was 42.7 years (SD 14). Males represented 55.6%. The median duration of viral RNA conversion was 37 days (95% confidence interval (CI): 29–45.50) in the intervention group and 28 days (95% CI: 23–39) in the placebo group (p=0.010). HR was 1.58 (95% CI: 1.09–2.29, p=0.015). Ct values revealed a stable trend over time in both groups.ConclusionVDs was not associated with a shortened recovery delay when given to patients for whom the RT-PCR remained positive on the 14th day.Trial registrationThis study was approved by the Human Subjects Protection Tunisia center (TN2020-NAT-INS-40) on April 28, 2020, and by ClinicalTrial.gov on May 12, 2021 with approval number ClinicalTrials.gov ID: NCT04883203.

The Anti-Epileptic Drugs Lamotrigine and Valproic Acid Reduce the Cardiac Sodium Current.

Anti-epileptic drugs (AEDs) are associated with increased risk of sudden cardiac death. To establish whether gabapentin, lamotrigine, levetiracetam, pregabalin, and valproic acid reduce the Nav1.5 current, we conducted whole-cell patch-clamp studies to study the effects of the five AEDs on currents of human cardiac Nav1.5 channels stably expressed in HEK293 cells, and on action potential (AP) properties of freshly isolated rabbit ventricular cardiomyocytes. Lamotrigine and valproic acid exhibited inhibitory effects on the Nav1.5 current in a concentration-dependent manner with an IC50 of 142 ± 36 and 2022 ± 25 µM for lamotrigine and valproic acid, respectively. In addition, these drugs caused a hyperpolarizing shift of steady-state inactivation and a delay in recovery from inactivation. The changes on the Nav1.5 properties were reflected by a reduction in AP upstroke velocity (43.0 ± 6.8% (lamotrigine) and 23.7 ± 10.6% (valproic acid) at 1 Hz) and AP amplitude; in contrast, AP duration was not changed. Gabapentin, levetiracetam, and pregabalin had no effect on the Nav1.5 current. Lamotrigine and valproic acid reduce the Nav1.5 current density and affect its gating properties, resulting in a decrease of the AP upstroke velocity. Gabapentin, levetiracetam, and pregabalin have no effects on the Nav1.5 current.

Swellable and Thermally Responsive Hydrogel/Shape Memory Polymer Foam Composites for Sealing Lung Biopsy Tracts.

Lung tissue biopsies can result in a leakage of blood (hemothorax) and air (pneumothorax) from the biopsy tract, which threatens the patient with a collapsed lung and other complications. We have developed a lung biopsy tract sealant based on a thiol-ene-crosslinked PEG hydrogel and polyurethane shape memory polymer (SMP) foam composite. After insertion into biopsy tracts, the PEG hydrogel component contributes to sealing through water-driven swelling, whereas the SMP foam contributes to sealing via thermal actuation. The gelation kinetics, swelling properties, and rheological properties of various hydrogel formulations were studied to determine the optimal formulation for composite fabrication. Composites were then fabricated via vacuum infiltration of the PEG hydrogel precursors into the SMP foam followed by thermal curing. After drying, the composites were crimped to enable insertion into biopsy tracts. Characterization revealed that the composites exhibited a slight delay in shape recovery compared to control SMP foams. However, the composites were still able to recover their shape in a matter of minutes. Cytocompatibility testing showed that leachable byproducts can be easily removed by washing and washed composites were not cytotoxic to mouse lung fibroblasts (L929s). Benchtop testing demonstrated that the composites can be easily deployed through a cannula, and the working time for deployment after exposure to water was 2 min. Furthermore, testing in an in vitro lung model demonstrated that the composites were able to effectively seal a lung biopsy tract and prevent air leakage. Collectively, these results show that the PEG hydrogel/SMP foam composites have the potential to be used as lung biopsy tract sealants to prevent pneumothorax post-lung biopsy.

Four reasons why we should screen for dissociation in competitive sports

Four reasons why we should screen for dissociation in competitive sports

INVESTIGATION OF RISK FACTORS AND BACTERIAL PATHOGENS OF SURGICAL SITE INFECTIONS IN A TEACHING HOSPITAL IN HYDERABAD

Background: Surgical site infections are one of the most common healthcare associated infections which results in a delay in patient recovery. These infections being the most common HAI in our area, the present study was conducted to know the incidence of SSIs and to detect the risk factors associated with SSIs. Material and methods: A prospective study on SSIs was conducted over a period of seven months involving 1211 patients. History was taken from these patients regarding the risk factors of SSIs. Pus and wound swabs collected from these patients were subjected to culture. The culture isolates were identified by standard biochemical tests. Antibiotic sensitivity testing was performed using standard protocol. The incidence of SSIs was determined. Results: SSI rate was 6.6 %.The most common risk factors associated with SSIs were age &gt;60 years, diabetes followed by obesity and prolonged duration of surgery. There was no association with smoking, malnutrition, immunosuppression, skin colonization at the time of surgery, presence of skin diseases at the incision site, peripheral vascular disease and anaemia. Majority of isolates were gram negative isolates. Klebsiella and Escherichia coli were the most common isolates. There was maximum sensitivity of isolates to carbapenems and combination drugs. Conclusion: Age&gt;60 years, diabetics, obesity, and prolonged duration of therapy were the major risk factors associated with SSIs. Decreased incidence of SSIs &amp; decreased isolation of exogenous pathogens in SSI, high sensitivity of gram negative bacilli in our study suggests good infection control practices in our hospital area.

P063 Host-mycobiome interactions during the resolution of inflammation in experimental colitis

Abstract Background Recent studies have documented the complexity of the intestinal fungal community (‘mycobiome’) in mice, and clinical and experimental observations have shown that the mycobiome influences both gut health and disease, e.g., IBD. In fact, prior studies have shown that CD patients, compared to healthy controls, harbor higher levels of intestinal Candida tropicalis (Ct), which is the major fungal species detected in the colons of colitic mice after dextran sodium sulfate (DSS) challenge. Moreover, proteins encoded by genes within IBD susceptibility loci, such as the pattern recognition receptor (PRR), NOD2, are known not only to recognize bacterial components, but also a fungal cell wall element, chitin. In fact, the role of PRRs in regulating immunity against intestinal fungi, and how fungi influence IBD remains poorly defined. Methods We challenged DSS colitic wildtype (WT) and Nod2-/- mice with Ct 2 days before DSS administration and subsequently on day 0, 3 and 6. Bone marrow-derived macrophages (BMDMs) from untreated mice were administered chitin in vitro. Results Our data confirms previous studies that Ct challenge does not exacerbate colitis in DSS-treated C57BL/6 WT mice, however, Ct-infected Nod2-/- mice possess a higher fungal burden and exhibit worse colitis symptoms, such as weight loss, decreased stool consistency, and presence of blood in stools, vs. Ct-infected WT mice, indicating an essential and protective role for NOD2 during colitis recovery after Ct challenge. Our results also show that Ct-infected Nod2-/- mice display a marked reduction in colonic Il22 and Il17, which are cytokines previously reported to be important in maintaining epithelial barrier integrity during DSS colitis. These data were confirmed in colons of Ct infected DSS challenged, ileitis prone SAMP1/YitFc (SAMP) mice NOD2 deficient. Moreover, our in vitro data show, a decrease in Il1ß and Il23 in BMDM from SAMP Nod2-/- mice compared to WT after 2h of exposure to chitin. IL-17+ innate lymphoid cells (ILCs) are also known to control fungal burden during opportunistic fungal infections, and interestingly, our findings indicate that Ct infection of Nod2-/- vs. WT mice results in a decreased frequency of mesenteric lymph node–derived type 3 ILCs (ILC3s), suggesting that delay in fungal clearance and recovery in Nod2-/-mice may be due to the inability to mount protective type 3 immune responses. Conclusion Taken together, the data collected suggests that NOD2 is essential to maintain gut mycobiome homeostasis and drives protective innate immune responses, via a macrophage-mediated ILC3 recruitment and IL-17 mechanism, by preventing the overgrowth of opportunistic fungi that may contribute to chronic intestinal inflammation, such as that observed in CD.

Effects on heart rate from direct current block of the stimulated rat vagus nerve

Objective. Although electrical vagus nerve stimulation has been shown to augment parasympathetic control of the heart, the effects of electrical conduction block have been less rigorously characterized. Previous experiments have demonstrated that direct current (DC) nerve block can be applied safely and effectively in the autonomic system, but additional information about the system dynamics need to be characterized to successfully deploy DC nerve block to clinical practice. Approach. The dynamics of the heart rate (HR) from DC nerve block of the vagus nerve were measured by stimulating the vagus nerve to lower the HR, and then applying DC block to restore normal rate. DC block achieved rapid, complete block, as well as partial block at lower amplitudes. Main Results. Complete block was also achieved using lower amplitudes, but with a slower induction time. The time for DC to induce complete block was significantly predicted by the amplitude; specifically, the amplitude expressed as a percentage of the current required for a rapid, 60 s induction time. Recovery times after the cessation of DC block could occur both instantly, and after a significant delay. Both blocking duration and injected charge were significant in predicting the delay in recovery to normal conduction. Significance. While these data show that broad features such as induction and recovery can be described well by the DC parameters, more precise features of the HR, such as the exact path of the induction and recoveries, are still undefined. These findings show promise for control of the cardiac autonomic nervous system, with potential to expand to the sympathetic inputs as well.

Postexercise Oxygen Uptake Recovery Delay Among Patients with Heart Failure: A Systematic Review

Background: Peak oxygen uptake (VO2) is often the focal point of cardiopulmonary exercise testing among patients with heart failure (HF). Breath-by-breath VO2 kinetic patterns at exercise onset, during low-level and submaximal exercise, and during recovery may provide incremental insight into HF severity and etiologies of exercise limitation. Objective: The aim of this systematic review was to explore VO2 recovery delay (VO2RD) across the spectrum of left ventricular function. Methods: A systematic review was conducted using several online databases (EMBASE, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science). Steps outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Search terms included VO2RD OR VO2 off kinetics AND HF, peak VO2 AND recovery. All articles were uploaded to Covidence. Results: Four studies met the inclusion criteria. The definition of VO2RD varied across studies. Recovery delay was consistently observed in HF patients compared to controls indicating VO2RD discriminates between those with and without HF. Control groups showed VO2 decline almost immediately after exercise. VO2RD had a significant positive linear relationship to N-terminal prohormone of brain natriuretic and Doppler echo E/e' while demonstrating an inverse relationship with peak cardiac output and survival duration. Conclusions: VO2RD, unlike peak VO2, is relatively cardiospecific. Oxygen recovery kinetics offer insight into disease severity and discrimination of healthy participants from those with HF.

Magnitude of undernutrition and its association with dietary diversity among older persons in Ethiopia: a systematic review and meta-analysis, 2023.

Undernutrition in elders remains under-detected, under-treated, and under-resourced and leads to further weight loss, increased infections, and delay in recovery from illness as well as increased hospital admissions and length of stay. The reports of the findings were fragmented and inconsistent in Ethiopia. Therefore, the main objective of this meta-analysis was to estimate the pooled prevalence of undernutrition and its association with dietary diversity among older persons in Ethiopia. Online databases (Medline, PubMed, Scopus, and Science Direct), Google, Google Scholar, and other grey literature were used to search articles until the date of publication. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The random effect model was used to estimate the pooled prevalence; whereas subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity using Stata version 14.0 software. Out of 522 studies accessed, 14 met our criteria and were included in the study. A total of 7218 older people (aged above 60 years old) were included in the study. The pooled proportion of undernutrition among older persons in Ethiopia was 20⋅6% (95% CI 17⋅3, 23⋅8). Elders who consumed low dietary diversity scores were strongly associated with undernutrition among older persons. Therefore, promoting appropriate intervention strategies for elders to improve dietary diversity practices and nutritional status is crucial.

Epidemiological burden, risk factors, and recent therapeutic advances in chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that is certainly preventable and treatable and is caused due to the continuous exposure to noxious substances and toxic gases and is characterized by airflow limitation and chronic inflammation in the lungs coupled with persistent symptoms in the respiratory tract leading to obstructive bronchiolitis and parenchymal emphysema. The incidence and progression of COPD is a complicated pathological phenomenon and the overall severity is due to its exacerbations and comorbidities in individuals. Further, COPD is a major contributor to the global years of life lost and by 2030 it would be the third leading causes of mortality in the world. Also, knowledge on COPD, its associated conditions and the clinical understanding of the disease date back to the 16th century. The prevalence, morbidity and mortality may vary across the globe based on their exposure to smoking, tobacco, occupational pollutants, indoor pollution, outdoor air pollution, gender, age and genetic inheritance. Considering the continuous exposure to toxic substances and aging of the general population, the burden and prevalence of COPD are estimated to increase substantially in the coming years. Furthermore, COVID-19 patients with pre-existing COPD conditions suffer from severe disease progression and delay in recovery.

The Effects of Dexmedetomidine on Postoperative Sleep in Elderly Patients: A Systematic Review and Meta-Analysis

Background: Postoperative sleep disorders in elderly patients may increase the risk of postoperative delirium or cognitive dysfunction and delay recovery. Therefore, it is imperative to develop innovative approaches to prevent and treat postoperative sleep disorders.Objective: This study aims to systematically evaluate the effects of perioperative use of dexmedetomidine on postoperative sleep in elderly patients.Methods: We searched for randomized controlled trials (RCTs) in Embase, PubMed, The Cochrane library, Web of Science, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and Google Scholar databases from the establishment of the database to November 2020. Two researchers independently screened the literature, extracted information, and assessed bias risk. They cross-checked their findings .Any discrepancies were resolved through discussion or consultation with a third party. The risk of bias in the included studies was evaluated using RevMan 5.3, and meta-analysis, sensitivity analysis, and publication bias analysis were conducted using Stata 13.0.Results: A total of 23 studies involving 2,969 patients were included in the meta-analysis. The results of the meta-analysis showed that the subjective sleep quality score of the dexmedetomidine group was lower than that of the control group on the first day after surgery, with statistical significance [SMD = −1.29, 95%CI (−1.60, −0.98), P < 0.001, I2 = 89.7%]. The incidence of postoperative sleep disorders in the dexmedetomidine group was lower than that in the control group [RR = 0.49, 95% CI (0.30, 0.79), P = 0.003, I2 = 36.2%]. The duration of ICU stay and hospitalization in the dexmedetomidine group was also shorter than that in the control group [ICU stay: SMD = −0.98, 95% CI (−1.76, −0.19), P = 0.015, I2 = 88.8%; Hospitalization: SMD = −0.56, 95% CI (−0.95, -0.16), P = 0.006, I2 = 92.7%]. In terms of adverse events, the number of patients with postoperative bradycardia in the dexmedetomidine group was higher than that in the control group [RR = 1.629, 95% CI (1.291, 2.054), P < 0. 001, I2 = 0.0%]. The number of patients with postoperative hypotension was also higher in the dexmedetomidine group than in the control group [RR = 1.328, 95% CI (1.087, 1.622), P = 0. 003, I2 =2.1%]. On the other hand, the incidence of postoperative agitation was lower in the dexmedetomidine group than that in the control group [RR =0.193, 95% CI (0.075, 0.500), P = 0. 001, I2 = 0.0%], as was the incidence of postoperative tachycardia [RR = 0.486, 95% CI (0.348, 0.678), P < 0. 001, I2 = 0.0%].Conclusion: The perioperative use of dexmedetomidine in elderly patients can effectively improve subjective postoperative sleep quality, reduce the incidence of postoperative sleep disorders, shorten ICU and hospital stay, and has favorable safety.