Global Healthcare Systems Research Articles

A review on the crisis of antibiotic resistance and the strategies to combat resistance

Abstract The discovery of antibiotics has caused a huge impact on the history of the entire health-care system. The irrational and excessive use of antibiotics has become futile and has given rise to another serious issue known as antibiotic resistance, which is now a threat to the health-care sector. Due to this, millions of deaths are occurring worldwide every year as infections are becoming difficult to treat as a result of resistance to the antibiotics that are used to treat them. Thus, the confidence of the global health-care system is ruined. The WHO has recognized antibiotic resistance as a serious issue that needs to be addressed and has declared tackling it a high priority. Even though complete eradication of antibiotic resistance is not possible, the spread and the incidence of resistance can be reduced by taking adequate measures. Combating antimicrobial resistance is, therefore, a prime need of the and various strategies have been adopted globally. This article primarily focuses on the phenomenon of antibiotic resistance, the mechanisms of resistance, various reasons that contribute to it, and the strategies adopted to combat the global crisis. Here, we have reviewed articles on antibiotic resistance from scientific websites such as PubMed Central, NCBI, Science Direct, and Google Scholar, and the strategies have been taken from the official website of the WHO, Indian Council of Medical Research, and the guidelines issued on this by the Ministry of Health and Family Welfare Government of India and Government of Kerala.

The Relationship Between Anemia and Parathyroid Hormone Levels in Patients With Kidney Failure Undergoing Hemodialysis Treatment in Georgia.

Chronic kidney disease (CKD) and its associated complications, such as anemia and secondary hyperparathyroidism (SHPT), pose significant challenges to global healthcare systems. This study explores the demographic and clinical characteristics of 284 kidney failure (KF) patients undergoing hemodialysis, in an effort to shed light on the possible association between anemia and SHPT. A proven connection between the two could theoretically influence the management plans for CKD patients, with the hopes of achieving lower morbidity and/or mortality in this patient group. A retrospective, cross-sectional, real-world data analytical study was conducted at a hemodialysis center in Tbilisi, Georgia, encompassing a sample size of n = 284 patients on maintenance hemodialysis. The data analyzed was extracted from patients' medical records. According to our results, the prevalence of anemia was strikingly high at 82.04%, underlining its substantial burden within this patient population.Our analysis revealed a notable systemic association between anemia and SHPT, particularly when considering hemodialysis vintage. However, our final analysis model revealed no statistically significant association between anemia and intact parathyroid hormone (iPTH) levels. Conclusion:Our study revealed a significant systemic relationship between anemia and SHPTwhen hemodialysis duration was considered, despite initial analyses showing no direct association. Future research should focus on longitudinal and multi-center studies to better understand this relationship, aiming to enhance the care and management of CKD patients on hemodialysis.

Analysis of anatomic location of burns inpatients in China from 2009 to 2018

BackgroundBurns cause serious physical and psychological harm to patients, placing a heavy burden on the global healthcare system. Our previous study detailed the epidemiological characteristics of burn injuries in Chinese inpatients from 2009 to 2018. Interestingly, the anatomic locations of burn injuries vary by gender, age, provinces, and outcomes among different causes. Therefore, this current study aims to analyze the characteristics of burn injuries in inpatients with various burn sites by collecting data in China from 2009 to 2018. This analysis will inform future healthcare system decisions and provide effective strategies.MethodsBurns inpatients from 196 hospitals across 31 provinces in China were included in the study, covering the period from 2009 to 2018. The data collected encompassed information on gender, age, etiology, regions, clinical outcomes, and anatomical locations of the injuries. Data analysis was conducted using Microsoft Excel 2007.ResultsFrom 2009 to 2018, a total of 333,995 burns inpatients were recorded. The most vulnerable parts to burns were multiple burn sites (230,090, 68.89%). Women were more susceptible to lower limb burns (15,608, 14%), while men were more prone to eye injuries (8,387, 3.37%) and hand burns (6,119, 2.75%). The age group of 0–10 years was the most vulnerable to burns across all body areas, including internal organs. In China, individuals aged 20–50 years were at a higher risk of head and neck burns compared to other age groups. The Han population showed increased vulnerability to eye injuries (2.12 times higher than minorities), respiratory tract issues (2.09 times higher than minorities), and trunk burns (1.83 times higher than minorities), while being less susceptible to internal organ injuries (0.23 times fewer than minorities) and lower limb burns (0.78 times fewer than minorities). The southwest region had the highest proportion of burns inpatients with burns affecting single body parts, whereas the eastern area had the highest rates of respiratory tract burns (0.85%) and multiple burn sites (80.64%). Scalding was identified as the most common cause of burns, while flame burns (769, 55.81%) and chemical burns (438, 47.35%) were the main causes of respiratory tract and internal organ injuries, respectively.ConclusionsThis study provides an initial description of characteristics of burns inpatients with various anatomic locations of burns in China over the past decade. Our findings will contribute to the most up-to-date clinical evidence database for healthcare planning and prevention initiatives in both China and other countries.

Enhancing hospital emergency response based on the experience of COVID-19

ABSTRACT Introduction The COVID-19 pandemic required a significant response from global healthcare systems. In Belgium, the crisis began in March 2020, prompting quick action in hospitals. This study assesses the effectiveness of Belgium’s hospital emergency plans and compares them with global standards for potential enhancements. Methodology An online survey targeting CEOs of 60 Flemish general hospitals evaluated the deployment of hospital emergency coordination cells during the pandemic’s first and fourth waves, utilizing various statistical analyses. Results Findings indicate a high establishment rate of COVID-19 coordination cells before the government’s deadline. Despite this readiness, differences in leadership, involvement, and communication strategies were noted among hospitals. There was a notable shift towards hybrid meetings and an evolving role for coordination cells, highlighting the need for a more structured crisis management approach. Conclusion The study concludes that while Flemish hospitals were quick to respond, the lack of a standardized framework suggests the potential for adopting models like the Hospital Incident Command System (HICS) for improved crisis management. Future research should examine the long-term effects of these strategies and the integration of comprehensive emergency management systems in Belgium’s healthcare.

Emerging biotechnologies for screening electromechanical signals of cardiomyocytes

AbstractCardiac diseases threaten human health and burden the global healthcare system. Cardiomyocytes (CMs) are considered the ideal model for studying the signal transduction and regulation of cardiac systems. Based on the principle of the rhythmical beating process (excitation‒contraction coupling mechanism of CMs), investigating the mechanical and electrophysiological signals offered new hope for cardiac disease detection, prevention, and treatment. Considerable technological success has been achieved in electromechanical signal recording. However, most drug assessment platforms attach importance to high‐throughput and dynamic monitoring of mechanical or electrical signals while overlooking the measuring principles and physiological significance of the signal. In this review, the development of biosensing platforms for CMs, sensing principles, key measured parameters, measurement accuracy, and limitations are discussed. Additionally, various approaches for the stimulation and measurement of CMs in vitro are discussed to further elucidate the response of these cells to external stimuli. Furthermore, disease modeling and drug screening are used as examples to intuitively demonstrate the contribution of in vitro CM measurement platforms to the biomedical field, thereby further illustrating the challenges and prospects of these sensing platforms.

Navigating the COVID-19 Pandemic with DPLD: Insights from a Case Report for Healthcare Providers

The COVID-19 pandemic brought significant challenges to global healthcare systems, particularly for individuals with underlying health conditions. This article reports a case of a 65-year-old man with a medical history of diabetes mellitus, hypertension, and diffuse parenchymal lung disease (DPLD), who succumbed to severe COVID-19 infection. He presented to the Medicine inpatient of a tertiary care hospital, with fever and extreme lethargy during the second wave of the COVID-19 pandemic early in 2021. Upon presentation, his oxygen saturation (SPO2) was 31%. High-resolution computed tomography (HRCT) chest findings revealed extensive ground glass opacity, and his nasal swabs tested positive for COVID-19 via reverse transcription-polymerase chain reaction (RT-PCR). He was diagnosed with type 1 respiratory failure and was subsequently admitted to the intensive care unit (ICU), where his condition rapidly deteriorated and he passed away.This case highlights the heightened vulnerability of individuals with pre-existing comorbidities to severe COVID-19 complications and thus intensifies the importance of early recognition and intervention in such high-risk populations.

Calcium Modulating Effect of Polycyclic Cages: A Suitable Therapeutic Approach Against Excitotoxic-induced Neurodegeneration.

Neurodegenerative disorders pose a significant challenge to global healthcare systems due to their progressive nature and the resulting loss of neuronal cells and functions. Excitotoxicity, characterized by calcium overload, plays a critical role in the pathophysiology of these disorders. In this review article, we explore the involvement of calcium dysregulation in neurodegeneration and neurodegenerative disorders. A promising therapeutic strategy to counter calcium dysregulation involves the use of calcium modulators, particularly polycyclic cage compounds. These compounds, structurally related to amantadine and memantine, exhibit neuroprotective properties by attenuating calcium influx into neuronal cells. Notably, the pentacycloundecylamine NGP1-01, a cage-like structure, has shown efficacy in inhibiting both N-methyl-D-aspartate (NMDA) receptors and voltage- gated calcium channels (VGCCs), making it a potential candidate for neuroprotection against excitotoxic-induced neurodegenerative disorders. The structure-activity relationship of polycyclic cage compounds is discussed in detail, highlighting their calcium-inhibitory activities. Various closed, open, and rearranged cage compounds have demonstrated inhibitory effects on calcium influx through NMDA receptors and VGCCs. Additionally, these compounds have exhibited neuroprotective properties, including free radical scavenging, attenuation of neurotoxicities, and reduction of neuroinflammation. Although the calcium modulatory activities of polycyclic cage compounds have been extensively studied, apart from amantadine and memantine, none have undergone clinical trials. Further in vitro and in vivo studies and subsequent clinical trials are required to establish the efficacy and safety of these compounds. The development of polycyclic cages as potential multifunctional agents for treating complex neurodegenerative diseases holds great promise.

AI in Medical

Abstract: Artificial Intelligence (AI) stands as a transformative influence in the realm of medicine, poised to reshape healthcare delivery and elevate patient outcomes. This summary offers an overview of AI's impact on medical applications, with key technologies such as machine learning, natural language processing, and computer vision playing pivotal roles across various healthcare domains, from diagnostics to treatment planning and patientcare. A notable stride in this evolution is the integration of AI-driven telemedicine solutions, effectively expanding access to healthcare services, particularly in underserved regions. Telehealth platforms leverage sophisticated AI algorithms for remote monitoring, facilitating real-time analysis of patient data and enabling prompt interventions.However, despite the immense potential, challenges persist. Issues surrounding data privacy, regulatory complexities, and the continual need for validating and refining AI models present hurdles to seamless integration. Addressing these challenges is imperative to fully capitalize on the benefits of AI in healthcare. In summary, the incorporation of AI into medicine holds the potential to deliver healthcare that is more tailored, efficient, and accessible, ultimately leading to enhanced patient outcomes and reduced healthcare costs. As the field advances, overcoming challenges and effectively harnessing AI's capabilities becomes crucial for the continued progression of global healthcare systems. Keyword: Artificial Intelligence, Machine Learning,Disease Detection, Medical Data Analytics, Early Di

One-step synthesized multisize AuAg alloy nanoparticles with high SERS sensitivity in directly detecting SARS-CoV-2 spike protein

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in widespread disease transmission, challenging the stability of global healthcare systems. Surface-enhanced Raman scattering (SERS) as an easy operation, fast, and low-cost technology illustrates a good potential in detecting SARS-CoV-2. In the study, one-step fabrication of gold-silver alloy nanoparticles (AuAgNPs) with adjustable metal proportions and diameters is employed as SERS substrates. The angiotensin-converting enzyme 2 (ACE2) functionalized AuAgNPs are applied as sensor surfaces to detect SARS-CoV-2 S protein. By optimizing the SERS substrates, ACE2/Au35Ag65NPs illustrate higher performance in detecting the SARS-CoV-2 S protein with a limit of detection (LOD) of 10 fg/mL in both phosphate-buffered saline (PBS) and pharyngeal swabs solution (PSS). It also provides excellent reproducibility with a relative standard deviation (RSD) of 7.7 % and 7.9 %, respectively. This easily preparable and highly reproducible SERS substrate has good potential in the practical application of detecting SARS-CoV-2.

Assessing post-COVID-19 respiratory dynamics: a comprehensive analysis of pulmonary function, bronchial hyperresponsiveness and bronchodilator response.

Coronavirus disease 2019 (COVID-19) has a considerable impact on the global healthcare system. Individuals who have recovered from COVID often experience chronic respiratory symptoms that affect their daily lives. This study aimed to assess respiratory dynamics such as airway hyperresponsiveness (AHR) and bronchodilator response in post-COVID patients. This study included 282 adults with respiratory symptoms who underwent provocation tests. The demographic details, clinical symptoms and medical histories were recorded. Baseline spirometry, methacholine challenge tests (MCT) and post-bronchodilator spirometry were performed. Patients were divided into the following four groups: Group 1: non-COVID-19 and negative MCT; Group 2: post-COVID-19 and negative MCT; Group 3: non-COVID-19 and positive MCT; and Group 4: post-COVID-19 and positive MCT. Most post-COVID-19 patients (43.7%) experienced AHR, and wheezing was more common. Patients in Group 4 exhibited increased intensities of dyspnoea, cough and wheezing with the lowest pulmonary function test (PFT) parameters at baseline. Moreover, significant decreases in PFT parameters after the MCT were observed in these patients. Although the prevalence of a low forced expiratory volume in 1 s to forced vital capacity ratio (<70%) was initially 2% in Group 4, it increased to 29% after MCT. No significant differences in allergic history or underlying diseases were observed between the groups. These findings provide comprehensive insights into the AHR and respiratory symptoms of post-COVID-19 individuals, highlighting the characteristics and potential exacerbations in patients with positive MCT results. This emphasises the need of MCT to address respiratory dynamics in post-COVID-19 individuals.

Chemopreventive Agents from Nature: A Review of Apigenin, Rosmarinic Acid, and Thymoquinone.

Cancer, a major challenge to global health and healthcare systems, requires the study of alternative and supportive treatments due to the limitations of conventional therapies. This review examines the chemopreventive potential of three natural compounds: rosmarinic acid, apigenin, and thymoquinone. Derived from various plants, these compounds have demonstrated promising chemopreventive properties in in vitro, in vivo, and in silico studies. Specifically, they have been shown to inhibit cancer cell growth, induce apoptosis, and modulate key signaling pathways involved in cancer progression. The aim of this review is to provide a comprehensive overview of the current research on these phytochemicals, elucidating their mechanisms of action, therapeutic efficacy, and potential as adjuncts to traditional cancer therapies. This information serves as a valuable resource for researchers and healthcare providers interested in expanding their knowledge within the field of alternative cancer therapies.

Drug Diversion: Could be a Serious Concern in Global Healthcare System

Prescription drug diversion is a significant $25 billion-a-year problem in the US. Diversion can occur at any stage of the medicine delivery process, from manufacturing to the patient. Common diversion methods include illegal selling by doctors/pharmacists, “doctor shopping,” theft/forgery of prescriptions, and burglaries/thefts. Emerging diversion methods include theft by healthcare workers, fraud involving insurance, and theft from medicine cabinets. The main sources of diverted medications are at the practitioner-patient level, such as through “doctor shopping” and friends/family sharing prescriptions. Diversion from healthcare settings like hospitals accounts for a smaller proportion, though the exact extent is difficult to quantify. Some diversion occurs through theft from pharmacies, manufacturers, and supply chain points, but this makes up a relatively small percentage. Healthcare providers who engage in drug diversion have been linked to infectious disease outbreaks in hospitals, exposing patients to pathogens like hepatitis C. Intelligent systems and machine learning can help rapidly detect diversion anomalies. Comprehensive solutions are needed, including policy reforms, communication strategies, and a public health approach.

Antibacterial activity and mechanism of luteolin isolated from Lophatherum gracile Brongn. against multidrug-resistant Escherichia coli.

Infections caused by multidrug-resistant (MDR) bacteria have become a major challenge for global healthcare systems. The search for antibacterial compounds from plants has received increasing attention in the fight against MDR bacteria. As a medicinal and edible plant, Lophatherum gracile Brongn. (L. gracile) has favorable antibacterial effect. However, the main antibacterial active compound and its antimicrobial mechanism are not clear. Here, our study first identified the key active compound from L. gracile as luteolin. Meanwhile, the antibacterial effect of luteolin was detected by using the broth microdilution method and time-kill curve analysis. Luteolin can also cause morphological structure degeneration and content leakage, cell wall/membrane damage, ATP synthesis reduction, and downregulation of mRNA expression levels of sulfonamide and quinolones resistance genes in multidrug-resistant Escherichia coli (MDR E. coli). Furthermore, untargeted UPLC/Q-TOF-MS-based metabolomics analysis of the bacterial metabolites revealed that luteolin significantly changed riboflavin energy metabolism, bacterial chemotaxis cell process and glycerophospholipid metabolism of MDR E. coli. This study suggests that luteolin could be a potential new food additive or preservative for controlling MDR E. coli infection and spread.

Physicochemical characterization, antioxidant, anti-inflammatory, and wound healing potential of cytocompatible Gum Arabic-Curcumin-Cerium oxide Nanocomposites

Global healthcare systems face an enormous economic burden related to oxidative stress diseases and chronic wound treatments. Exploring therapies that regulate reactive oxygen species (ROS) within a non-toxic range could be promising in treating chronic wounds. Hence, this study synthesized the cerium oxide nanoparticles (CeO2 NPs) using endophytic Penicillium radiatolobatum. Further, the gum arabic-curcumin-CeO2 nanocomposites (GA-CU-CeO2 NCs) were prepared, characterized, and tested for enhanced antioxidant, anti-inflammatory, and wound healing effects. X-ray diffraction analysis revealed the cubic fluorite structure of GA-CU-CeO2 NCs. FT-IR analysis confirmed the presence of GA and CU in the GA-CU-CeO2 NCs. In TEM analysis, GA-CU-CeO2 NCs appeared in an average size of ∼25 nm with spherical and oval anisotropic structural distribution. DLS and ELS analysis indicated an average particle size and zeta charge of GA-CU-CeO2 NCs as 202 nm and −22.1 mV, respectively. The GA-CU-CeO2 NCs scavenged ABTS and DPPH radicals with an IC50 of 16.4 μg/mL and 56.0 μg/mL, respectively. Besides, GA-CU-CeO2 NCs did not induce apparent toxicity in NIH3T3 and RAW264.7 cells. GA-CU-CeO2 NCs attenuated the ROS-level and associated nucleus damage in H2O2-stressed RAW264.7 cells. GA-CU-CeO2 NCs indicated ∼90 % of wound gap closure of NIH3T3 cells within 36 h activity while being non-toxic to erythrocytes.

Supporting Individuals With an Acquired Brain Injury: An Interpretative Phenomenological Study Exploring the Everyday Lives of Caregivers.

Acquired brain injury (ABI) is one of the most common causes of disability and death globally. Support from informal caregivers is critical to the well-being and quality of life of people with ABI and supports the sustainability of global health and social care systems. This study presents an in-depth qualitative analysis of the experiences of eight British informal caregivers supporting someone with ABI. Semi-structured interviews were conducted with narratives transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Three superordinate themes were generated: making sense of brain injury; being consumed by caregiving; and, the changing self. These data highlight the impact of caregiving on the caregiver's illness perceptions and sense of self. By identifying negative and positive changes in the caregiver's sense of self, and dilemmas regarding the care recipient's behaviour, we address less understood aspects of caregiver experiences. Caregiving can pose both challenges to the caregiver's sense of identity and an opportunity for self-growth. Some caregivers exhibit resilience throughout their journey, with post-traumatic growth more apparent in the later stages of caregiving. Illness perceptions shape caregiver well-being and family dynamics and indicate the need to address stigmatisation and discrimination faced by ABI survivors and caregivers. Although some caregivers acquired positive meaning and enrichment from their caregiving, previously described challenges of ABI caregiving are supported. Overall, our findings support the need for timely psychological/mental health support for caregivers, caregiver education, and the provision of short breaks from caregiving.

MASLD-Related HCC: A Comprehensive Review of the Trends, Pathophysiology, Tumor Microenvironment, Surveillance, and Treatment Options.

Hepatocellular carcinoma (HCC) represents a significant burden on global healthcare systems due to its considerable incidence and mortality rates. Recent trends indicate an increase in the worldwide incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) and a shift in the etiology of HCC, with MASLD replacing the hepatitis B virus as the primary contributor to new cases of HCC. MASLD-related HCC exhibits distinct characteristics compared to viral HCC, including unique immune cell profiles resulting in an overall more immunosuppressive or exhausted tumor microenvironment. Furthermore, MASLD-related HCC is frequently identified in older age groups and among individuals with cardiometabolic comorbidities. Additionally, a greater percentage of MASLD-related HCC cases occur in noncirrhotic patients compared to those with viral etiologies, hindering early detection. However, the current clinical practice guidelines lack specific recommendations for the screening of HCC in MASLD patients. The evolving landscape of HCC management offers a spectrum of therapeutic options, ranging from surgical interventions and locoregional therapies to systemic treatments, for patients across various stages of the disease. Despite ongoing debates, the current evidence does not support differences in optimal treatment modalities based on etiology. In this study, we aimed to provide a comprehensive overview of the current literature on the trends, characteristics, clinical implications, and treatment modalities for MASLD-related HCC.

Surface modified niosomal quercetin with cationic lipid: an appropriate drug delivery system against Pseudomonas aeruginosa Infections

The Increase in infections caused by resistant strains of Pseudomonas aeruginosa poses a formidable challenge to global healthcare systems. P. aeruginosa is capable of causing severe human infections across diverse anatomical sites, presenting considerable therapeutic obstacles due to its heightened drug resistance. Niosomal drug delivery systems offer enhanced pharmaceutical potential for loaded contents due to their desirable properties, mainly providing a controlled-release profile. This study aimed to formulate an optimized niosomal drug delivery system incorporating stearylamine (SA) to augment the anti-bacterial and anti-biofilm activities of quercetin (QCT) against both standard and clinical strains of P. aeruginosa. QCT-loaded niosome (QCT-niosome) and QCT-loaded SA- niosome (QCT-SA- niosome) were synthesized by the thin-film hydration technique, and their physicochemical characteristics were evaluated by field emission scanning electron microscopy (FE-SEM), zeta potential measurement, entrapment efficacy (EE%), and in vitro release profile. The anti-P. aeruginosa activity of synthesized niosomes was assessed using minimum inhibitory and bactericidal concentrations (MICs/MBCs) and compared with free QCT. Additionally, the minimum biofilm inhibitory and eradication concentrations (MBICs/MBECs) were carried out to analyze the ability of QCT-niosome and QCT-SA-niosome against P. aeruginosa biofilms. Furthermore, the cytotoxicity assay was conducted on the L929 mouse fibroblasts cell line to evaluate the biocompatibility of the formulated niosomes. FE-SEM analysis revealed that both synthesized niosomal formulations exhibited spherical morphology with different sizes (57.4 nm for QCT-niosome and 178.9 nm for QCT-SA-niosome). The EE% for cationic and standard niosomal formulations was reported at 75.9% and 59.6%, respectively. Both formulations showed an in vitro sustained-release profile, and QCT-SA-niosome exhibited greater stability during a 4-month storage time compared to QCT-niosome. Microbial experiments indicated that both prepared formulations had higher anti-bacterial and anti-biofilm activities than free QCT. Also, the QCT-SA-niosome exhibited greater reductions in MIC, MBC, MBIC, and MBEC values compared to the QCT-niosome at equivalent concentrations. This study supports the potential of QCT-niosome and QCT-SA-niosome as effective agents against P. aeruginosa infections, manifesting significant anti-bacterial and anti-biofilm efficacy alongside biocompatibility with L929 cell lines. Furthermore, our results suggest that optimized QCT-niosome with cationic lipids could efficiently target P. aeruginosa cells with negligible cytotoxic effect.

Role of Melatonin in Management of COVID-19: A Systematic Review

Background: the COVID-19 pandemic has significantly impacted global healthcare and economic systems. The clinical manifestation of the disease varies from flu-like symptoms to severe pneumonia and, in some cases, death. Melatonin and its metabolites play a crucial role in immunomodulation and possess anti-oxidative properties, capable of directly and indirectly scavenging reactive oxygen species. Objective: the aim of the present systematic review was to assess the effectiveness of melatonin in the management of COVID-19 patients and its role in expediting the return of patients to their baseline health. Methodology: the literature review was conducted up to August 2022, resulting in the identification of 533 articles after sorting them by authors and year of publication. Following the removal of 223 duplicate articles, 310 abstracts were screened, leading to the exclusion of 281. Subsequently, 29 full-text studies were evaluated for eligibility, with 22 being excluded. Finally, seven studies met the inclusion criteria and were included for further qualitative and quantitative analyses. Results: the findings revealed a noteworthy reduction in hospital stay among patients who received melatonin compared to those who received a placebo (standardized mean difference: -0.50, Standard error: 0.15, 95% CI: -0.80, -0.20, P value: 0.001). Melatonin was associated with a significant decrease in mortality in COVID-19 patients when compared to the placebo (Pooled RR: 0.21, 95% CI: 0.08, 0.56, P value: 0.002). However, there were no significant differences between melatonin and placebo regarding the need for hospitalization, ICU admission, artificial ventilation, and the requirement for oxygen therapy. Conclusion: melatonin may decrease the mortality rate among patients with COVID-19. Melatonin may reduce the duration of hospital stay in patients with COVID-19. Melatonin had no effect on the following outcomes in COVID-19 patients: the need for hospitalization, ICU admission, artificial ventilation and the need for oxygen therapy.

Cancer research funding in South Asia

BackgroundThe rising burden of cancer significantly influences the global economy and healthcare systems. While local and contextual cancer research is crucial, it is often limited by the availability of funds. In South Asia, with 1.7 million new cancer cases and 1.1 million deaths due to cancer in 2020, understanding cancer research funding trends is pivotal. MethodsWe reviewed funded cancer studies conducted between January 1, 2003, and Dec 31, 2022, using ClinicalTrials.gov, International Cancer Research Partnership (ICRP) Database, NIH World RePORT, and WHO International Clinical Trials Registry Platform (ICTRP). We included funded studies related to all cancer types, conducted in South Asian countries, namely Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. ResultsWe identified 6561 funded cancer studies from South Asia between 2003 and 2022, increasing from 400 studies in 2003‐2007 to 3909 studies in 2018–2022. India had the highest number of funded cancer studies, while Afghanistan, Bhutan, and the Maldives had minimal or no funded cancer research output. Interventional studies (67.3%) were the most common study type funded. The most common cancer sites funded were breast (17.8%), lung (9.9%), oropharyngeal (6.2%), and cervical (5.0%) cancers. On the WHO ICTRP, international funding agencies contributed to a majority of studies (57.5%), except in India where local funding agencies (58.2%) funded more studies. ConclusionThis study identified gaps in research funding distribution across cancer types and geographic areas in South Asia. This data can be used to optimize the distribution of cancer research funding in South Asia, fostering equitable advancement in cancer research.

Infection Prevention Strategies for Otorhinolaryngology and Head-and-Neck Surgery During the COVID-19 Pandemic: A Systematic Review

Background: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has significantly impacted global healthcare systems, necessitating stringent infection control measures to safeguard patients and healthcare workers. Otorhinolaryngology and head-and-neck surgery, due to their close proximity to the respiratory tract and frequent aerosol-generating procedures, face elevated risks of COVID-19 transmission. Understanding infection control measures in these specialties is paramount to optimize safety protocols and mitigate transmission risks. Aim: The review aims to examine infection control measures in otorhinolaryngology and head-and-neck surgery during the COVID-19 pandemic, addressing specific risks, effectiveness of safety measures, adaptations to evolving knowledge, implementation challenges, and future directions for research and policy. Review Summary: A systematic literature search was conducted from December 2019 to present, focusing on infection control practices in these specialties during the pandemic. Studies addressing infection control measures, risks, and adaptations in otorhinolaryngology and head-and-neck surgery were included. Key findings were synthesized qualitatively, emphasizing trends, common themes, and discrepancies in data. Future Implications: Insights from the review provide actionable guidance for optimizing infection control measures in otorhinolaryngology and head-and-neck surgery, enhancing safety for patients and healthcare providers during current and future pandemics. Areas for future research include ongoing surveillance, adaptation of protocols, and development of innovative safety strategies. Clinical Policy and Development: Recommendations include comprehensive use of personal protective equipment, modifications to patient handling and surgical procedures, telemedicine integration, and adherence to strict infection control protocols. These measures aim to minimize COVID-19 transmission risks while maintaining essential healthcare services. Keywords: COVID-19, Otorhinolaryngology, Head-And-Neck Surgery, Infection Control, Aerosol-Generating Procedures