Gap Of Evidence Research Articles

Feeding Approach to Optimizing Nutrition in Infants with Congenital Heart Disease

Congenital heart disease (CHD) affects 1% of live births globally. Infants with CHD often experience growth faltering and malnutrition due to increased metabolic demands, malabsorption, and feeding intolerance, further worsened by surgical interventions and frequent hospitalizations. Malnutrition in this population is linked to higher morbidity, extended hospital stays, and poor neurodevelopmental outcomes. The physiological diversity among CHD types presents significant challenges in developing a universal feeding strategy to optimize nutrition. This narrative review explores the interplay between CHD physiology and nutritional management. CHD types could be categorized into three hemodynamic groups—systemic hypoperfusion, global hypoxia, and pulmonary overcirculation—which help to consider a feeding approach based on such physiology. Nutritional management in these infants could be further tailored based on the disease severity, co-morbidities, and evolving hemodynamic changes. Based on clinical opinions, this review proposes a hemodynamic-focused risk-stratified feeding approach, considering ways that may enhance growth while possibly minimizing complications such as necrotizing enterocolitis (NEC), pulmonary overload, and worsening heart failure. This approach may help individualize nutritional management to address the complex needs of infants with CHD. Further quality improvement studies are needed to assess this approach. Beyond meeting macronutrient needs, micronutrients, including zinc, thiamine, magnesium, vitamin A, and calcium, potentially play a role in cardiovascular health. Given the complexity of nutritional management in these infants, a multidisciplinary team may be needed to optimize care, including cardiologists, neonatologists, pediatricians, dietitians, speech therapists, and pharmacists. With the current knowledge gap and lack of strong evidence, research should focus on nutritional interventions and study their potential impact on infant outcomes with CHDs.

Investigating heart rate responses of children to active travel: a mixed effects modeling analysis

BackgroundThe active travel concept has gained recognition as an effective method to enhance physical activity in children’s everyday mobility. Yet, there is a notable gap of quantitative evidence on its direct impacts, especially regarding physiological outcomes that can concretely demonstrate its influences on physical intensity and overall health of children.MethodsThis study investigates the effects of active travel on children, focusing on trip-level physiological responses, specifically heart rate. Through a mixed survey design, we obtained a repeated-measures dataset from a cohort of 73 children (average age 13) across three Austrian secondary schools, each observed for 7 days. By applying mixed effects modelling approach, both fixed and random effects to children’s heart rates were explored.ResultsAccording to results from developed mixed linear models (maximum R2 = 0.22), it revealed a significant positive association between active travel mode(s) engagement and heightened physiological responses (Low, Medium and High active level of trip compare to None: β = 1.81, 5.01 and 8.34, t-value = 4.70, 10.29 and 21.34), indicating that increased usage of active travel modes led to elevated heart rate values. Additionally, subjective perceptions also played an important role in influencing children’s physiological responses. Feelings of exhausted, anxiety, and stress contributing to a higher heart rate (β = 14.79, 16.69 and 1.99, t-value = 20.42, 5.67 and 3.0), while unhappiness was associated with a lower heart rate (β = -5.96, t-value = -14.62). Effects of social interactions were also found during the trip. The presence of adults was associated with a calming effect (β = -1.92, t-value = -5.72), whereas solo travel resulted in lower heart rate compared to travel with peers (β = -1.95, t-value = -6.59).ConclusionOur article innovatively employs mixed survey methods and heart rate data to quantitatively demonstrate the positive association between engagement in active travel modes and heightened physiological responses in children, elucidating the intricate interplay of subjective perceptions and social interactions during trips, thus offering valuable insights into the health implications of active travel at a trip level. Future research will keep on leveraging survey and experimental methods.

Hormonal suppression in premenopausal patients with estrogen receptor-positive breast cancer: a randomized trial comparing monthly versus trimonthly GnRH analogs

Background: Currently the standard of care for premenopausal women with estrogen receptor-positive breast cancer is the combined use of a gonadotropin-releasing hormone (GnRH) analog with either tamoxifen or an aromatase inhibitor in patients at high risk for relapse or when it is deemed necessary to optimize ovarian function suppression. Monthly GnRH analogs have been used for years but, recently, longer-acting formulations have been gaining approval. Yet, there is still a gap of evidence regarding the use of longer-acting formulations; only a few studies exist that examine their efficacy in breast cancer and compare them to the monthly formulations. It is the investigators’ hypothesis that trimonthly injections, which are more convenient for the patient and ensure better compliance, are better suited for use in breast cancer patients and may induce equally effective estrogen suppression as the monthly injections. Aim: A comparison of trimonthly versus monthly GnRH analogs in eliciting ovarian function suppression in premenopausal patients with estrogen receptor-positive breast cancer. Methodology: This is a prospective randomized open-label trial involving 25 premenopausal patients that were randomized to receive either a monthly or a trimonthly GnRH analog. Estrogen (E2) levels, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels were measured on day 0 and on week 12. Patients, also, completed a questionnaire regarding exhibiting amenorrhea and other side-effects of the analogs. Results: All patients (N=25; 100%) from both groups achieved ovarian function suppression according to the criteria set by the researchers, which are E2 levels <30 pg/mL and amenorrhea. Both groups exhibited a statistically significant decrease (almost by 50%) in E2 levels by week 12 (monthly group: E2 levels’ decrease equal to -18.5 pg/mL, p=0.00293; trimonthly group: E2 levels’ decrease equal to -13.9 pg/mL, p=0.0002441). On the contrary, FSH and LH levels did not show a statistically significant difference in either group. Moreover, when the two groups were compared, there was no statistically significant difference in the variation of all hormone levels between day 0 and week 12. All patients developed amenorrhea. There were no statistically significant differences in the number of side-effects between the two groups, even though the trimonthly group had fewer (in absolute number) side-effects than the monthly. Conclusion: This study demonstrates that the trimonthly formulations of GnRH analogs are equally effective in eliciting ovarian function suppression and present a similar percentage of side-effects as the monthly formulations, with the added benefit that patients need not undergo monthly injections.

Mitral Annular Plane Systolic Excursion (MAPSE): A Review of a Simple and Forgotten Parameter for Assessing Left Ventricle Function.

Mitral annular plane systolic excursion (MAPSE) was a widely used and simple M-mode echocardiographic parameter for determining the left ventricle (LV) longitudinal systolic function. The purpose of this review is to analyze the use of MAPSE as a simple LV systolic function marker in different clinical scenarios, especially given the recent paradox of choices in ultrasound markers assessing cardiac performance. Recent data on the use of MAPSE in the assessment of LV function in different settings seem to be relatively scarce, given the wide variety of possible causes of cardiovascular pathology. There remain significant possible clinical applications of MAPSE utilization. This review included all major articles on the topic of mitral annular plane systolic excursion published and indexed in the PubMed, Google Scholar, and Scopus databases. We analyzed the potential implications of using simpler ultrasonographical tools in heart failure diagnosis, prediction, and treatment. MAPSE is a dependable, robust, and easy-to-use parameter compared to ejection fraction (EF) or global longitudinal strain (GLS) for the quick assessment of LV systolic function in various clinical settings. However, there may be a gap of evidence in certain scenarios such as conventional cardiac pacing.

A Propensity Score-Based Comparison regarding Renal, Functional, and Surgical Outcome of Continent Cutaneous Urinary Diversions in Patients with Benign Chronic Bladder Diseases and Patients with Bladder Cancer.

Continent cutaneous urinary diversion post-cystectomy is an established approach addressing both oncological and functional indications. However, there is a noticeable gap of evidence when it comes to comparing outcomes between these indications, especially concerning the technique of Mainz pouch I (MPI). This study aimed to close the gap by analyzing the long-term functional and renal outcomes of patients with MPI after cystectomy due to both benign and malign bladder pathologies. In this retrospective study, we examined 173 patients, who underwent MPI surgery between 2000 and 2022. Patients were categorized into a study group (benign conditions, n = 26) and a control group (bladder cancer, n = 52) using propensity score matching. Clinical demographics, surgical outcomes, and functional/renal parameters were analyzed using unpaired t tests and χ2 tests. Patients undergoing cystectomy with MPI due to benign bladder pathologies were significantly younger and had a lower comorbidity burden compared to those with bladder cancer. In contrast to a significantly higher incidence of chemotherapy in the oncological cohort, the long-term renal function was comparable between both populations. Surgical outcomes, revisions, and postoperative complications did not differ significantly between both groups. Nearly 90% of patients in both groups showed full continence. This study demonstrates the efficacy and safety of MPI surgery in both benign and malignant conditions, proving favorable long-term renal and functional outcomes.

Individual and social determinants of COVID-19 vaccine hesitancy and uptake in Northwest Syria

IntroductionThe COVID-19 outbreak devastated the fragmented health system in Syria, a war-torn country, and exaggerated the demands for humanitarian assistance. COVID-19 vaccination was rolled out in Northwest Syria, an area out of government control, in May 2021. However, vaccine acceptance rates are still minimal, which is reflected in the meager percentage of vaccinated people. The study aims to investigate the effectiveness of the humanitarian actors’ plans to address the COVID-19 vaccine hesitancy and conclude practical strategies for boosting vaccine uptake in Northwest Syria.Methods and materialsTwo questionnaires were developed to collect data from humanitarian organizations involved in the COVID-19 vaccination campaign and people from northwest Syria. Data analysis was performed using SPSS 22 data analysis program.ResultsAccording to the findings, 55.5% of people refused the COVID-19 vaccine. The results showed a knowledge gap and lack of evidence regarding humanitarian actors’ strategies to address the vaccine’s low uptake. Besides, it was found that doctors and medical workers were reliable sources of information about the vaccine. However, they were not systematically engaged in community mobilization and risk communication to promote people’s perspectives on the vaccine.ConclusionRisk communication and community engagement programs were not significantly associated with increasing the COVID-19 acceptance rate. Humanitarian actors must reconsider their strategies to address vaccine hesitancy in Northwest Syria. These strategies should engage medical professionals through dialogue sessions on the realities of the pandemic and vaccine development mechanism based on a compelling and evidence-based approach.

Outcomes of cardiac resynchronization therapy in congenital heart disease: A meta-analysis and systematic review.

Cardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure with reduced ejection fraction. However, there is still a gap of evidence in congenital heart disease (CHD) patients regarding resynchronization therapy. We performed a meta-analysis and systematic review of CHD patients who received CRT implantation. We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to June 2023. Studies that reported response rate to CRT, total mortality rate, change in QRS duration, change in left ventricular ejection fraction, and change in New York Heart Association functional class were included. A total of 14 studies were included in the study. There were 10 studies that reported response rates after implantation. The overall response rate to CRT in CHD patients was 68% (95% confidence interval [CI] 61%-75%, I2 32%). The response rates in patients with systemic right ventricle (RV), systemic left ventricle (LV), and single ventricle were 58% (95% CI 46%-70%, I2 0%), 80% (95% CI 74%-86% I2 14%), and 67% (95% CI 49%-80% I2 0%). Response to CRT in systemic RV was inferior to systemic LV with an odds ratio of 0.38 (95% CI 0.15-0.95, I2 38%). The total mortality rate from sevenstudies was 12% (95% CI 8%-18%, I2 55%). The parameters which represented ventricular dyssynchrony improved after CRT implantation. The overall response rate to CRT in CHD was 68%. Patients with systemic RV had a lower response rate to CRT when compared to patients with systemic LV. The total mortality rate after CRT implantation was 12%.

Current concepts of treatment for left ventricular thrombus: A sys-tematic meta-analysis comparing direct oral anticoagulants versus vitamin K-antagonists

Abstract Background/Introduction Left ventricular thrombus (LVT) is a dreaded complication after myocardial infarction (MI) and is traditionally treated with Vitamin K antagonists (VKAs) for 3-6 months. Despite a gap of evidence, the broad use of direct oral anticoagulants (DOACs) for other thromboembolic disorders has triggered an increasing off-label use for DOACs in LVTs and has stimulated for expanding research focusing on DOAC´s utility for patients with LVT. Purpose To assess the safety and efficacy of DOACs versus VKAs for the treatment of LVT with a systematic meta-analysis. Methods We conducted a systematic search according to the PRISMA guidelines to identify all existing studies comparing DOACs and VKAs for the treatment of LVT. Forest plots and pooled odds ratios have been calculated for major bleeding events, strokes and systemic embolism, and for thrombus resolution. Results We have included a total of 13 studies with a pooled sample size of 2243 patients. 601 patients (26.8%) were treated with DOACs and 1642 patients (73.2%) with VKAs. The mean age was 55 and 59 years in the DOACs and VKAs group and sex was equally distributed with a male predominance of 81% in both groups. As underlying heart disease, most patients suffered from acute or chronic ischemic cardiomyopathy and presented with a mean left ventricular ejection fraction (LVEF) of 32% at admission. Baseline characteristics of patients included in each primary study are summarized in table 1. The pooled odds ratio of stroke or systemic embolism in patients treated with DOACs versus VKAs was 0.84 (95% CI 0.59-1.19) (p= 0.32). Compared to VKAs, we suggest that the use of DOACs may be associated with a reduced risk for major bleeding incidents without reaching statistical significance (OR 0.63 (95% CI 0.39-1.04) (p = 0.07). LVT resolution was similar and independent of the antithrombotic regimen (OR 0.91 (95% CI 0.7-1.19), p=0.50). Conclusions Based on our meta-analysis we conclude that DOACs seem to be non-inferior to VKAs for the treatment of LVT in terms of thrombus resolution, stroke and systemic embolism, and bleeding incidents. Despite these promising findings, several important aspects such as the duration of anticoagulation, and the type and dosing of the DOAC agent are still poorly understood. To close the lack of evidence for DOACs in LVTs, an adequately powered, randomized trial is needed.

Review: Linking animal health measures in dairy cows to farm-level economic outcomes: a systematic literature mapping.

Farm animal health is an area of increasing interest to both the public and industry stakeholders. There is an ongoing debate on whether improving animal health, and thereby increasing welfare, is profitable or not. Improving animal health often requires investments in the farm or increases labour costs. As a result, the impact of animal health on farm economy is particularly interesting. This study systematically maps and assesses the available evidence in the published scientific literature regarding the link between farms' economic outcomes on dairy cow health, with the aim of identifying knowledge gaps in this field of research. In total, 59 peer-reviewed articles were included using a broad range of animal health variables and economic outcomes. We found a heterogeneous body of evidence in terms of both methods, animal health measures (AHMs) and economic outcome measures used. None of the included studies makes explicit causal claims between AHMs and economic outcomes. The results suggest that common production diseases such as clinical mastitis and lameness, which are painful and affect cow health and welfare, are costly for farmers. We found a knowledge gap and lack of evidence on the impact of animal health interventions on farms' economic outcomes, as well as the long-term effects of such interventions. Future research should aim to investigate the causal links between animal health and economic outcomes.

Prediction of conversion to dementia disorders based on timed up and go dual-task test verbal and motor outcomes: a five-year prospective memory-clinic-based study

BackgroundWhile assessment tools can increase the detection of cognitive impairment, there is currently insufficient evidence regarding clinical outcomes based on screening for cognitive impairment in older adults.MethodsThe study purpose was to investigate whether Timed Up and Go dual-task test (TUGdt) results, based on TUG combined with two different verbal tasks (name different animals, TUGdt-NA, and recite months in reverse order, TUGdt-MB), predicted dementia incidence over a period of five years among patients (N = 186, mean = 70.7 years; 45.7% female) diagnosed with Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI) following assessment at two memory clinics. Associations between TUG parameters and dementia incidence were examined in Cox regression models.ResultsDuring follow-up time (median (range) 3.7 (0.1–6.1) years) 98 participants converted to dementia. Novel findings indicated that the TUGdt parameter words/time, after adjustment for age, gender, and education, can be used for the prediction of conversion to dementia in participants with SCI or MCI over a period of five years. Among the TUG-related parameters investigated, words/time showed the best predictive capacity, while time scores of TUG and TUGdt as well as TUGdt cost did not produce significant predictive results. Results further showed that the step parameter step length during TUGdt predicts conversion to dementia before adjustment for age, gender, and education. Optimal TUGdt cutoffs for predicting dementia at 2- and 4-year follow-up based on words/time were calculated. The sensitivity of the TUGdt cutoffs was high at 2-year follow-up: TUGdt-NA words/time, 0.79; TUGdt-MB words/time, 0.71; reducing respectively to 0.64 and 0.65 at 4-year follow-up.ConclusionsTUGdt words/time parameters have potential as cost-efficient tools for conversion-to-dementia risk assessment, useful for research and clinical purposes. These parameters may be able to bridge the gap of insufficient evidence for such clinical outcomes.Trial registrationClinicalTrials.gov Identifier: NCT05893524: https://www.clinicaltrials.gov/study/NCT05893524?id=NCT05893524&rank=1.

Role of Doxycycline as an Osteoarthritis Disease-Modifying Drug.

Doxycycline is a drug that has been proposed to modify osteoarthritis (OA) progression, in addition to its role as an antibiotic. However, available evidence thus far comprises sporadic reports, with no consensus on its benefits. Hence, this review attempts to analyze the evidence available thus far on the role of doxycycline as a disease-modifying osteoarthritis drug (DMOAD) in knee osteoarthritis. The earliest evidence of doxycycline in OA appeared in 1991 when doxycycline was found to inhibit the type XI collagenolytic activity of extracts from the human osteoarthritic cartilage, and gelatinase and tetracycline were found to inhibit this metalloproteinase activity in articular cartilage in vivo, which could modify cartilage breakdown in osteoarthritis. Apart from the inhibition of cartilage damage by metalloproteinases (MMPs) and other cartilage-related mechanisms, doxycycline also affects the bone and interferes with many enzyme systems. The most significant finding after reviewing various studies was that doxycycline has a definitive role in structural changes in osteoarthritis progression and radiological joint space width, but its role in the improvement of clinical outcomes as a DMOAD has not been established. However, there is much of a gap and lack of evidence in this regard. Doxycycline, as an MMP inhibitor, has theoretical advantages for clinical outcomes, but the present studies reveal only beneficial structural changes in osteoarthritis and very minimal or nonexistent advantages in clinical outcomes. Current evidence does not favor the regular use of doxycycline for the treatment of osteoarthritis as an individual treatment option or in combination with others. However, multicenter large cohort studies are warranted to determine the long-term benefits of doxycycline.

HOST FACTORS AND RISK OF PIN SITE INFECTION IN EXTERNAL FIXATION: A LITERATURE REVIEW EXAMINING AGE, BODY MASS INDEX, SMOKING, AND COMORBIDITIES INCLUDING DIABETES

An international Consensus Group has by a Delphi approach identified the topic of host factors affecting pin site infection to be one of the top 10 priorities in external fixator management. The aim of this study was to report the frequency of studies reporting on specific host factors as a significant association with pin site infection. Host factors to be assessed was: age, smoking, BMI and any comorbidity, diabetes, in particular. The intention was an ethological review, data was extracted if feasible, however no meta-analysis was performed.A systematic literature search was performed according to the PRISMA-guidelines. The protocol was registered before data extraction in PROSPERO. The search string was based on the PICO criterias. A logic grid with key concept and index terms was made. A search string was built assisted by a librarian. The literature search was executed in three electronic bibliographic databases, including Embase MEDLINE (1111 hits) and CINAHL (2066 hits) via Ovid and Cochrane Library CENTRAL (387 hits). Inclusion criteria: external fixation, >1 pin site infection, host factor of interest, peer-reviewed journal. Exclusion criteria: Not written in English, German, Danish, Swedish, or Norwegian, animal or cadaveric studies, location on head, neck, spine, cranium or thorax, editorials or conference abstract. The screening process was done using Covidence.A total of 3564 titles found. 3162 excluded by title and abstract screening. 140 assessed for full text eligibility. 11 studies included for data extraction. The included studies all had a retrospective design. Three identified as case-control studies. Generally the included studies was assessed to have a high risk of bias. A significant associations between pin site infection for following host factors: a) increased HbA1C level in diabetic patients; b) congestive heart failure in diabetic patients; c) less co-morbidity; d) preoperative osteomyelitis was found individually.This systematic literature search identified a surprisingly low number of studies examining for risk of pin site infection and host factors. Thus, this review most of all serves to demonstrate a gap of evidence about correlation between host factors and risk of pin site infection, and further studies are warranted.

Relationship between Tumor Budding and Partial Epithelial–Mesenchymal Transition in Head and Neck Cancer

Tumor budding (TB), a microscopic finding in the stroma ahead of the invasive fronts of tumors, has been well investigated and reported as a prognostic marker in head and neck squamous cell carcinoma (HNSCC). Epithelial-mesenchymal transition (EMT) is a crucial step in tumor progression and metastasis, and its status cannot be distinguished from TB. The current understanding of partial EMT (p-EMT), the so-called halfway step of EMT, focuses on the tumor microenvironment (TME). Although this evidence has been investigated, the clinicopathological and biological relationship between TB and p-EMT remains debatable. At the invasion front, previous research suggested that cancer-associated fibroblasts (CAFs) are important for tumor progression, metastasis, p-EMT, and TB formation in the TME. Although there is biological evidence of TB drivers, no report has focused on their organized functional relationships. Understanding the mechanism of TB onset and the relationship between p-EMTs may facilitate the development of novel diagnostic and prognostic methods, and targeted therapies for the prevention of metastasis in epithelial cancer. Thus far, major pieces of evidence have been established from colorectal cancer (CRC), due to a large number of patients with the disease. Herein, we review the current understanding of p-EMT and TME dynamics and discuss the relationship between TB development and p-EMT, focusing on CAFs, hypoxia, tumor-associated macrophages, laminin-integrin crosstalk, membrane stiffness, enzymes, and viral infections in cancers, and clarify the gap of evidence between HNSCC and CRC.

The Dutch chronic lower limb-threatening ischemia registry (THRILLER): A study protocol for popliteal and infrapopliteal endovascular interventions.

Chronic limb-threatening ischemia (CLTI) is the end stage of peripheral arterial disease (PAD) and is associated with high amputation rates, mortality and disease-related health care costs. In infrapopliteal arterial disease (IPAD), endovascular revascularization should be considered for the majority of anatomical and clinical subgroups of CLTI. However, a gap of high-quality evidence exists in this field. The aim of the Dutch Chronic Lower Limb-Threatening Ischemia Registry (THRILLER) is to collect real world data on popliteal and infrapopliteal endovascular interventions. THRILLER is a clinician-driven, prospective, multicenter, observational registry including all consecutive patients that undergo a popliteal or infrapopliteal endovascular intervention in seven Dutch hospitals. We estimate that THRILLER will include 400-500 interventions annually. Standardized follow-up visits with wound monitoring, toe pressure measurement and duplex ultrasonography will be scheduled at 6-8 weeks and 12 months after the intervention. The independent primary endpoints are primary patency, limb salvage and amputation free survival. Patients must give informed consent before participation and will be included according to predefined reporting standards. A data log of patients who meet the inclusion criteria but are not included in the registry will be maintained. We intend to conduct the first interim analysis two years after the start of inclusion. The results will be published in a scientific journal. Despite innovations in medical therapy and revascularization techniques, patients with CLTI undergoing endovascular revascularization still have a moderate prognosis. Previous prospective cohort studies were hampered by small sample sizes or heterogeneous reporting. Randomized controlled trials (RCTs) have high costs, potential conflicts of interest and give a limited reflection of daily practice. THRILLER aims to provide the largest prospective well phenotyped up-to-date dataset on treatment outcomes in CLTI patients to answer multiple underexplored research questions regarding diagnostics, medication, patient selection, treatment strategies and post intervention follow-up.

Cardiopulmonary Fitness among Nursing Students of Mid-Western Nepal: A Descriptive Cross-Sectional Study

Background Cardiopulmonary fitness in terms of maximum aerobic capacity (VO2 max) reflects the total physical fitness of a person. Nursing students, who are the future health care workers and a role model, are more likely to encourage their patients to adopt healthy habits. However, there is a gap of evidence about nursing student’s physical fitness. Thus, this study aimed to assess the cardiopulmonary fitness in terms of VO2 max among the nursing students of Nepalgunj Nursing campus, Banke, Nepal. Methods A cross sectional study was conducted to assess the cardiopulmonary fitness among the nursing students enrolled in Nepalgunj Nursing Campus using a non-probability purposive sampling technique. Queen’s College Step test was conducted along with anthropometric measurements. Descriptive analysis, and chi square test was done using SPSS v20. Ethical approval was taken from the Institutional Review Committee, Institute of Medicine, Tribhuvan University (Ref-99(6-11) 077/078). Results Total 189 female nursing students participated whose mean age was 21.06±3.41 years. Thirty-six (19%) were overweight and 11 (5.8%) were obese. Out of total, 56 (29.6%) had a high-risk waist hip ratio. Almost half (42.9%) of the respondents had superior level of VO2 max with mean VO2 max value of 43.605±10.686. There was a significant association between VO2 max and BMI (X2 =18.856, p=0.016). Conclusion There is superior level of cardiopulmonary fitness among the young nursing adults. Since BMI is associated with VO2 max, one should be aware of maintaining a normal BMI.

Variations in atrial fibrillation screening after ischemic stroke or transient ischemic attack in Sweden

Abstract Background/Introduction The risk of recurrent stroke and mortality is high among patients with ischemic stroke or transient ischemic attack (TIA) and untreated atrial fibrillation (AF). Hence, AF screening after an event has high priority in national and international guidelines. Despite the abundance of evidence on AF detection using different AF screening modalities, there is still no evidence on a prognostic benefit of ECG monitoring post ischemic stroke. There is a risk for variations in clinical practice for AF screening after ischemic cerebrovascular events due to this gap of evidence. Purpose The aim of this study was to investigate the clinical practice of AF screening after TIA or ischemic stroke at Swedish stroke units. Methods In collaboration with the stakeholders of the Swedish stroke register (Riksstroke) important fields to study were identified, e.g. AF screening method, first choice of method (multiple answers possible), monitoring duration, clinical follow-up etc. A draft for a digital survey was constructed and then tested and revised by 5 stroke consultants. The survey consisted of 18 multiple choice questions with free text comments and was sent by e-mail to the medical supervisors at all stroke units in Sweden in November 2021. Results All 72 stroke units in Sweden responded to the survey. Almost all (69/72) stroke units reported that ≥75% of ischemic stroke patients are screened for AF. Of the stroke units 81% had inpatient telemetry as their first choice of AF screening method (Figure 1), but 7% had no access to inpatient telemetry. In case of inpatient telemetry, 30% reported 0–24 hours and 54% reported 24–48 hours as their standard monitoring time. Most had the attending physician at the stroke unit as the primary ECG reader, some with access to support from cardiologist. Different standard monitoring durations for Holter were used (Figure 2) and 17% reported Holter as their first choice of AF screening method. Approximately 85% reported repeated ECG monitoring if high suspicion of cardiac embolization, preferably with repeated Holter (73%) or handheld ECG (49%). Implantable loop recorder (6%), event loop recorder (14%) and 2 weeks registration with ECG-patch (3%) was more infrequently used for this purpose. Conclusions Clinical practice for AF screening after ischemic stroke or TIA at Swedish stroke units showed considerable variations with a range of different AF screening methods and monitoring durations. Further, the standards and quality of inpatient ECG monitoring is unknown. There is an urgent need for evidence and evidence-based recommendations in this field, the present situation also implies inequality in care. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Stiftelsen Hjartat

Host Factors and Risk of Pin Site Infection in External Fixation

Introduction: Host factors affecting pin site infections were selected by The Pin site Consensus Group, using a modified Delphi approach, to be one of the top 10 priorities to investigate how to reduce rates of pin site infections, improve clinical management, and inform research. The aim of this study was to perform a systematic literature review of the association between host factors and pin site infection, focused on age, smoking, body mass index, and comorbidities, in particular diabetes. Materials and Methods: The literature search strategy was developed as advised in the Cochrane Handbook for Systematic Reviews of Interventions following the PRISMA guidelines with the help from a scientific librarian. The protocol was registered in the International Register of Systematic Reviews, PROSPERO (ID: CRD42021273305). The literature search was executed in three electronic bibliographic databases, including Embase MEDLINE (1111 hits) and CINAHL (2066 hits) through Ovid and Cochrane Library CENTRAL (387 hits). Results: A total of 3564 titles were found. 3162 records were excluded by title and abstract screening. 140 studies were assessed for full-text eligibility. All excluded studies were not reporting specific numbers of patients with pin site infection and the associations of interest. 11 studies were included for data extraction. The included studies were all designed retrospective, and the risk of bias assessment was done using Joanna Briggs Institute risk appraisal tool. The extracted data are presented as results in tabular summaries. This review reveals an increased risk of pin site infection associated with increased HbA1C level in diabetic patients and congestive heart failure in diabetic patients. An increased risk of pin site infection was associated with a lower ASA score. None of the included studies found any association between pin site infection and smoking, age, or body mass index. Conclusion: This systematic literature search identified a surprisingly low number of studies examining the association between pin site infection and the specific host factors. Thus, this review most of all serves to demonstrate a gap of evidence about the correlation between host factors and risk of pin site infection, and further studies are warranted.

Complementary and alternative system of medicine for type 2 diabetes mellitus and its complications: A scoping review

Background: This review aims to map the evidence on the effectiveness of Complementary and Alternative Medicine (CAM) for Type 2 Diabetes Mellitus (T2DM) and its associated complications and identify research gaps in key outcomes and CAMs. Methods: We followed the Johanna Briggs Institute guidelines to undertake this scoping review. We carried out a comprehensive search from inception to March 2020 in electronic databases and registers. Forward and backward citations of included studies were also searched. The randomized controlled trials (RCTs) and non-randomized studies with intervention and control arm were mapped based on the effectiveness of various CAM (Yoga, Ayurveda, Homeopathy, Siddha, Naturopathy, Unani, and Sowa-rigpa) on outcomes among individuals with prediabetes or metabolic syndrome, T2DM with and without any comorbidities. Results: A total of 249 studies were included after screening 3798 citations. Most of the included studies were conducted in India and Iran. Most frequently studied CAM interventions include Yoga, Ayurveda, and herbal products as compared to other CAM therapies. Conclusion: Although we identified a lot of literature on the effectiveness of CAMs for T2DM, there is a lack of standardization of preparation of these medicines and the interventional modalities. To validate the potential benefits of CAM, robust research with high-quality RCTs and systematic reviews are needed to bridge the gap of evidence in CAM therapies. Future investments for research in CAM may focus on assessing the quality of existing trials and finding out an optimal dose, frequency, and duration of CAM, both as an alternative and complementary approach.

Determinants of Leaky Gut and Gut Microbiota Differences in Children With Autism Spectrum Disorder and Their Siblings.

Leaky gut hypothesis is one of the well-known theory which tries to explain etiology of Autism Spectrum Disorder (ASD). Unfortunately there is still a gap of evidence to investigate the corner points of the hypothesis. The aim of this study was to investigate the determinants of leaky gut in children with ASD, their siblings and healthy controls. Intestinal microbiota was found to be similar between ASD and sibling groups. Biological markers of bacterial translocation showed a significant difference in the sibling group, whereas the marker indicating local inflammation was not different between the groups. The findings from this study did not support the role of Gut microbiota or leaky gut on the etiology of autism.

Four in one-Combination therapy using live Lactococcus lactis expressing three therapeutic proteins for the treatment of chronic non-healing wounds.

Diabetes mellitus is one of the major concerns for health care systems, affecting 382 million people worldwide. Among the different complications of diabetes, lower limbs chronic ulceration is a common, severe and costly cause of morbidity. Diabetic foot ulcers are a leading cause of hospitalization in diabetic patients and its rate exceed the ones of congestive heart failure, depression or renal disease. Diabetic non-healing ulcers account for more than 60% of all non-traumatic lower limb amputations and the five-year mortality after amputation is higher than 50%, being equal to several types of advanced cancer. The primary management goals for an existing diabetic foot ulcer are to achieve primary healing as expeditiously as possible and to achieve a reduction of the amputation rate in the patients. Unfortunately, approximately a quarter of patients do not partially or fully respond to the standard of care. Advanced therapies for chronic wounds are existing, however, recent guidelines including the latest reviews and meta-analyses of the scientific and clinical evidence available from current treatment strategies and new therapeutic agents revealed that there is a lack of clinical data and persistent gap of evidence for many of the advanced therapeutic approaches. In addition, no pharmacological wound healing product has gained authority approval for more than 10 years in both US and EU, constituting a highly unmet medical need. In this publication we present data from a live biopharmaceutical product AUP1602-C designed as a single pharmaceutical entity based on the non-pathogenic, food-grade lactic acid bacterium Lactococcus lactis subsp. cremoris that has been genetically engineered to produce human fibroblast growth factor 2,interleukin4 and colony stimulating factor 1. Designed to address different aspects of wound healing (i.e. fibroblast proliferation, angiogenesis and immune cell activation) and currently in phase I clinical study, we show how the combination of the individual components on the wound micro-environment initiates and improves the wound healing in chronic wounds.