Inadequate Control Research Articles

The effect of intraoperative methadone on postoperative opioid requirements in children undergoing orchiopexy: A randomized clinical trial.

Children undergoing outpatient surgery are at risk of inadequate postoperative pain control. Methadone has a long duration of action and an intraoperative dose may provide stable analgesia throughout the postoperative period. Intraoperative methadone has been shown to improve pain control in adolescents but its use for postoperative pain in pediatric patients undergoing outpatient surgery has not been studied before. Therefore, we conducted a double-blind randomized placebo-controlled trial to investigate the effects of a single dose of intraoperative methadone in children aged less than 5 years undergoing orchiopexy for undescended testis. A total of 68 children were randomized to receive either methadone (0.1 mg/kg) or isotonic saline following induction of anesthesia. Exclusion criteria included preterm birth, previous scrotal surgery, and parents' inability to consent. Primary outcomes were opioid requirements (first primary outcome) and pain intensity in the post-anesthesia care unit. Secondary outcomes included episodes of desaturation and time until readiness to discharge from the post-anesthesia care unit, sleep on the first postoperative night, pain intensity, and opioid requirements at home until the evening on the first postoperative day. Follow-up was 4 days. Sixty children completed the study (age, mean ± SD, 26.2 ± 13.9 months), 29 children received methadone, and 31 children received placebo. Eighteen children required opioids in the post-anesthesia care unit, five children in the methadone group (proportion = 0.17, 95% confidence interval (CI): 0.07, 0.36) compared to thirteen patients in the placebo group (0.42, 95% CI: 0.26, 0.60) (mean difference = -0.24 and 95% CI: -0.03, -0.47) (p = 0.037). Five children in the methadone group (0.17, 95% CI: 0.03, 0.31) versus ten in the placebo group (0.32, 95% CI: 0.16, 0.49) had a face, legs, activity, cry, consolability score of ≥5 in the post-anesthesia care unit (mean difference = -0.15, 95% CI: -0.36, 0.06) (p = .179). More children in the placebo group woke up due to pain the first night following surgery (seven children vs. one child). The methadone group had a longer stay in the post-anesthesia care unit. There were no differences between the two groups regarding the other secondary outcomes. A single dose of intraoperative methadone reduces short-term postoperative opioid requirements in children after orchiopexy for nondescended testes but prolongs the duration of their stay in the post-anesthesia care unit.

Hypertension control and risk of age-associated dementia in people with hiv infection.

Hypertension is a major risk factor for dementia, but sustained blood pressure control is difficult to achieve. We evaluated whether inadequately controlled hypertension may contribute to excess dementia risk among people with HIV. Retrospective cohort study. We studied demographically matched people with and without HIV between 7/1/2013 and 12/31/2021 who were ≥50 years old and had a hypertension diagnosis but no dementia diagnosis. Hypertension control was calculated using a disease management index (DMI) which captured degree and duration above the hypertension treatment goals of systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg. DMI values ranged from 0% to 100% (perfect control); hypertension was considered "inadequately controlled" if DMI<80% (i.e., in control for <80% of the time). Annual, time-updated DMI was calculated for SBP and DBP. Associations of SPB and DPB control with incident dementia were evaluated using extended Cox regression models. The study included 3,099 hypertensive people with HIV (mean age: 58.3 years, 90.2% men) and 66,016 people without HIV. Each year of inadequate SBP control was associated with greater dementia risk in both people with HIV (adjusted hazard ratio [aHR] = 1.26, 0.92-1.64) and people without HIV (aHR = 1.27 (1.21-1.33); p-interaction = 0.85). Similarly, inadequate DBP control was associated with greater dementia risk in both people with HIV (aHR = 1.43, 0.90-1.95) and people without HIV (aHR = 1.71, 1.50-1.93; p-interaction = 0.57). Findings suggest the association of inadequate hypertension control with greater dementia risk is similar by HIV status. Stronger associations of DBP control with dementia merits further investigation.

Correlation of Vitamin D Levels with Severity of Asthma in Children Between 6 to 12 Years

Background: Millions of children worldwide suffer from chronic asthma, a serious respiratory disease that has a major influence on everyday living and health outcomes. There are significant public health concerns regarding the estimated 10-15% frequency of asthma in children in India. Vitamin D, which is recognized for its immunomodulatory qualities, according to recent studies reduces the severity. In this study, children aged 6 to 12 years old's vitamin D levels and the severity of their asthma were examined. Materials and Methods: At a tertiary care teaching hospital, 100 children between the ages of 6 and 12 who were presenting with acute exacerbations of bronchial asthma were the subjects of a prospective cohort study from August 2021 to August 2022. ELISA was used to evaluate serum 25-hydroxyvitamin D levels, and the GINA recommendations were used to determine the severity of asthma. Based on their levels of vitamin D, the kids were divided into three groups: sufficient (&gt;30 ng/mL), insufficient (20–30 ng/mL), and deficient (&lt;20 ng/mL). Children who were deficient in vitamin D were given supplements and monitored for three months. With SPSS 27, statistical analysis was carried out. Findings: The results of the study showed a strong correlation between increased asthma severity and inadequate asthma control and reduced vitamin D levels. Children with the most acute and uncontrollably asthmatic episodes were those with low vitamin D levels (&lt;20 ng/mL). Significant improvements in asthma control, decreased activity limits, and decreased need for rescue medication were noted after three months of vitamin D administration. Conclusion: This study shows a clear link between children's asthma control issues and higher asthma severity when there is a vitamin D Deficiency. Supplementing with vitamin D significantly improved asthma outcomes, indicating a possible therapeutic role for this nutrient. Future studies with larger sample sizes and longer follow-up periods are recommended to validate these findings and further elucidate the underlying mechanisms.

Imported Malaria Cases and Fatality in East Africa: A Review

Malaria remains a critical public health challenge in East Africa, with endemic transmission in many regions. Recent trends, however, show an alarming rise in imported malaria cases—wherein individuals contract malaria in endemic areas and transport it to regions with lower or no endemicity. This review examines the epidemiology of imported malaria in East Africa, with a focus on contributing factors such as international travel, migration, and inadequate vector control. The fatality rates associated with imported malaria, often driven by delayed diagnosis, drug resistance, and limited healthcare resources, are explored in depth. The review highlights the risk factors for imported malaria, including the role of expatriates, tourists, refugees, and migrants in the cross-border transmission of malaria. In particular, non-immune individuals such as travelers are highly susceptible to severe disease, often leading to fatalities when treatment is delayed. In addition, the review discusses the complex transmission dynamics that arise from overlapping malaria transmission zones within East Africa, further complicating efforts to distinguish domestic from imported cases. Management strategies to combat imported malaria, including strengthening surveillance systems at entry points, enhancing diagnostic capabilities, and ensuring access to effective treatments, are outlined. The importance of cross-border collaboration between East African nations to harmonize malaria control strategies is emphasized. Additionally, the review identifies future research directions, including the need for more detailed epidemiological studies, ongoing drug resistance monitoring, and policy development to address the complexities of imported malaria. This comprehensive analysis underscores the significance of addressing imported malaria as a critical element in the broader fight against the disease, highlighting the need for tailored strategies to mitigate its impact on healthcare systems and prevent further transmission in East Africa. Keywords: Imported Malaria, Cases, Fatality, East Africa.

Analysis of Pharmaceutical Sciences and Public Health Applications

Growing in frequency in both rural and urban parts of India, growing percentage of people at risk of diabetes, Indian population's genetic susceptibility to diabetes risk factors related to the environment, Globalisation causing a decline in physical exercise Some of the challenges that the disease poses in India are low patient awareness of hypertension, undiagnosed hypertension due to a variety of factors such as low healthcare facilities and economic status, inadequate disease control, and an increasing incidence of complications related to hypertension. Although there are solutions, the healthcare team will need to work in tandem with the clinician who is battling the illness on an individual basis. This will prevent the patient from receiving the proper care, the clinician from being able to listen to the patient's problems and find solutions, the patient from receiving the psychological support they need for a chronic illness, and the nation from suffering from economic hardship after the patient's illness. The purpose of this study was to identify the services provided by pharmaceutical care and evaluate the barriers to pharmaceutical care in various settings in order to provide relevant recommendations.

All-cause and cause-specific mortality risk and loss in life expectancy associated with incident type 2 diabetes onset age and duration.

Evidence on type 2 diabetes onset age and duration on mortality risk has been limited by short follow-up, inadequate control for confounding, missing repeated measurements, and inability to cover the full range of onset age, duration, and major causes of death. Moreover, scarce data dissect how type 2 diabetes onset age and duration shape life expectancy. We evaluate prospectively these topics based on 270,075 eligible participants in the Nurses' Health Studies and Health Professionals Follow-up Study, leveraging repeated measurements throughout up to 40 years of follow-up. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). In fully adjusted analyses, incident early onset type 2 diabetes (diagnosed <40 years of age) was associated with significantly higher mortality from all-causes (HR, 95% CI was 3.16, 2.64-3.79; vs. individuals without type 2 diabetes), cardiovascular disease (6.56, 4.27-10.1), respiratory disease (3.43, 1.38-8.51), neurodegenerative disease (5.13, 2.09-12.6), and kidney disease (8.55, 1.98-36.9). The relative risk elevations declined dramatically with each higher decade of age at diagnosis for deaths from most of these causes, though the absolute risk difference increased continuously. A substantially higher cumulative incidence of mortality and a greater loss in life expectancy were associated with younger age at type 2 diabetes diagnosis. Longer disease duration was associated with generally higher relative and absolute risk of mortality. Early onset of type 2 diabetes and longer disease duration are associated with substantially increased risk of all-cause and cause-specific mortality and greater loss in life expectancy.

The synergistic effect of triglyceride-glucose index and HbA1c on blood pressure control in patients with hypertension: a retrospective cohort study

Triglyceride-Glucose Index (TyG index) and HbA1c are metabolic risk factors associated with insulin resistance (IR), which have been confirmed to be independently correlated with the incidence of hypertension. However, there is limited research specifically focusing on the interaction between these two metabolic risk factors in hypertensive populations. Currently, it remains unclear how the metabolic indicators TyG index and HbA1c affect BP control in individuals with hypertension. This study aims to investigate the value and interaction of TyG index and HbA1c in blood pressure (BP) control among hypertensive patients. The results are conducive to enhancing the effectiveness of clinical BP control for individuals with hypertension. This cohort study included 99,336 adults diagnosed with hypertension. Participants were grouped according to the median of TyG index and HbA1c. The main endpoint is inadequate BP control. Multivariable-adjusted risk ratios and multivariable Cox regression analysis were used to represent the relationship between BP control levels and metabolic risk factors. Finally, we evaluated the interaction between TyG index and HbA1c in the population with inadequate BP control. This study confirmed that TyG index and HbA1c, as metabolic risk factors, are independently associated with poor BP control (P < 0.05). In multivariable Cox regression analysis, it was found that TyG index and HbA1c were significantly associated with poor BP control. In the male elderly population, HbA1c was significantly associated with poor BP control (P = 0.029).

Assessment of glycemic control and correlation of HbA1c level with lipid profile and duration of diabetes in type 2 diabetes mellitus patients

Background &amp; Objectives: The prevalence of Type 2 diabetes mellitus, or Type 2 DM, is rising globally. A periodic estimation of HbA1c has been recommended to track the state of glycemic control of Type 2 DM patients, in order to control the diabetes associated disorders. The main consequence and cause of death in Type 2 diabetes has been identified as cardiovascular disease (CVD).Optimization of glycemic status along with decreasing CVD risk factors are critical to preventing morbidity and mortality in patients with Type 2 DM. Since there is a lack of data on these CVD risk factors, in Madhesh Province, Nepal, we aimed to evaluate the glycemic status, estimate the lipid profile, and ascertain their correlation, including duration of Type 2 DM among patients in tertiary care hospitals in Madhesh Province, Nepal. Materials and Methods: The tertiary care hospital based cross-sectional study was conducted on 139 Type 2 DM patients, in Madhesh Province, Nepal. In order to gather information of the participants, a systematic questionnaire was introduced. A physical and clinical examination was performed, and an appropriate volume of blood was drawn with prior written consent. The lipid profile parameters, HbA1C, Fasting and post prandial serum glucose were estimated. Results: In 84 (60.3%) and 106 (76.3%) cases, there was an increased fasting and postprandial blood sugar. The mean±SD HbA1c level was 8.40±0.8%. More than half (52.5%) of the patients had poor glycemic control, while 22.3% had inadequate glycemic control, in reference to HbA1c &gt;8% and 7 to 8%, respectively. A substantial increased level of LDL-C, triglycerides and total cholesterol was observed in 122 patients and 85.6% had reduced HDL-C. A significant strong positive association was found between HbA1c level and total cholesterol and triglycerides, in contrast, no discernible association with duration of disease observed. Conclusion: Glycemic control was inadequate. Triglycerides and total cholesterol were significantly positively correlated with HbA1c, but not with HDL-C, LDL-C, or the course of diabetes.

THE SUITABILITY OF ACTIVITIES IN THE TRADE SUB-ZONE (THE CORRIDOR OF LETDA SUJONO ROAD, MEDAN TEMBUNG SUB-DISTRICT, MEDAN CITY)

The development of population and infrastructure in cities can enhance the local economy, as seen in the Letda Sujono Road corridor. This area, located between Medan City and Deli Serdang Regency and near the Bandar Selamat Toll Gate, has seen significant growth in trade and service activities. This growth has spurred the development of housing, public services, commercial spaces, warehousing, and industry, increased land demand and causing potential land-use conflicts and traffic issues. Inappropriate space utilization can lead to urban sprawl, often due to inadequate spatial planning control. The Medan City Detailed Spatial Plan (DSP or Rencana Detail Tata Ruang (RDTR)) designates the Letda Sujono Road corridor as a Trade Sub-zone, with zoning regulations limiting some activities to 10% of the block area. Aims: The objective of this study was to study the suitability of existing activities with the zoning plan which has been regulated in the Medan City Detailed Spatial Plan as a space control content in order to create safe, comfortable and sustainable spatial planning. Methodology and results: This study uses a qualitative descriptive method with spatial analysis to assess the alignment of current activities with the DSP zoning plan. Conclusion, significance and impact study: The findings reveal that 60.84% of the activities are suitable, while 39.16% are not. Some blocks, particularly Block 17-07-01 (Tembung), have exceeded the 10% activity limit, indicating that zoning plans have not been fully realized, with unauthorized activities such as integrated schools and vehicle-related services still present.

Cybersecurity vulnerabilities and solutions in Ethiopian university websites

This study investigates the causes and countermeasures of cybercrime vulnerabilities, specifically focusing on selected 16 Ethiopian university websites. This study uses a cybersecurity awareness survey, and automated vulnerability assessment and penetration testing (VAPT) technique tools, namely, Nmap, Nessus, and Vega, to identify potential security threats and vulnerabilities. The assessment was performed according to the ISO/IEC 27001 series of standards, ensuring a comprehensive and globally recognized approach to information security. The results of this study provide valuable insights into the current state of cybersecurity in Ethiopian universities and reveals a range of issues, from outdated software and poor password management to a lack of encryption and inadequate access control. Vega vulnerability assessment reports 11,286 total findings, and Nessus identified a total of 1749 vulnerabilities across all the websites of the institutions examined. Based on these findings, the study proposes counteractive measures tailored to the specific needs of each identified defect. These recommendations aim to strengthen the security posture of the university websites, thereby protecting sensitive data and maintaining the trust of students, staff, and other stakeholders. The study emphasizes the need for proactive cybersecurity measures in the realm of higher education and presents a strategic plan for universities to improve their digital security.

Aloperine Inhibits ASFV via Regulating PRLR/JAK2 Signaling Pathway In Vitro.

African swine fever (ASF) has become a global pandemic due to inadequate prevention and control measures, posing a significant threat to the swine industry. Despite the approval of a single vaccine in Vietnam, no antiviral drugs against the ASF virus (ASFV) are currently available. Aloperine (ALO), a quinolizidine alkaloid extracted from the seeds and leaves of bitter beans, exhibits various biological functions, including anti-inflammatory, anti-cancer, and antiviral activities. In this study, we found that ALO could inhibit ASFV replication in MA-104, PK-15, 3D4/21, and WSL cells in a dose-dependent manner without cytotoxicity at 100 μM. Furthermore, it was verified that ALO acted on the co- and post-infection stages of ASFV by time-of-addition assay, and inhibited viral internalization rather than directly inactivating the virus. Notably, RT-qPCR analysis indicated that ALO did not exert anti-inflammatory activity during ASFV infection. Additionally, gene ontology (GO) and KEGG pathway enrichment analyses of transcriptomic data revealed that ALO could inhibit ASFV replication via the PRLR/JAK2 signaling pathway. Together, these findings suggest that ALO effectively inhibits ASFV replication in vitro and provides a potential new target for developing anti-ASFV drugs.

Antarctic Streptomyces: Promising biocontrol agents for combating Fusarium oxysporum f. sp. cubense

Fusarium wilt of Banana (FWB) caused by Fusarium oxysporum f. sp. cubense (Foc) poses a significant threat to the banana industry, with current inadequate control measures. This study evaluated the antifungal potential of nine Streptomyces strains isolated from Antarctic soil samples, using Casein-Starch media to stimulate the production of antifungal compounds. The inhibition spectrum against Foc was assessed under laboratory conditions using the well diffusion on Mueller-Hinton agar, with antifungal activity measured in arbitrary units (AU/mL) and minimum inhibitory concentration (MIC) tested using ethyl acetate extracts. Among the nine isolates, K6 and E7 were closely related to Streptomyces polyrhachis and Streptomyces fildesensis, exhibited significant antifungal activity, with K6 and E7 showing 320 and 80 AU/mL, and MIC values of 250 and >500 ppm, respectively. These findings highlight K6 and E7 as potential biocontrol agents against Foc, offering new avenues for sustainable Fusarium wilt management in banana cultivation.

Source Control and Antibiotics in Intra-Abdominal Infections.

Intra-abdominal infections (IAIs) account for a major cause of morbidity and mortality, representing the second most common sepsis-related death with a hospital mortality of 23-38%. Prompt identification of sepsis source, appropriate resuscitation, and early treatment with the shortest delay possible are the cornerstones of management of IAIs and are associated with a more favorable clinical outcome. The aim of source control is to reduce microbial load by removing the infection source and it is achievable by using a wide range of procedures, such as definitive surgical removal of anatomic infectious foci, percutaneous drainage and toilette of infected collections, decompression, and debridement of infected and necrotic tissue or device removal, providing for the restoration of anatomy and function. Damage control surgery may be an option in selected septic patients. Intra-abdominal infections can be classified as uncomplicated or complicated causing localized or diffuse peritonitis. Early clinical evaluation is mandatory in order to optimize diagnostic testing and establish a therapeutic plan. Prognostic scores could serve as helpful tools in medical settings for evaluating both the seriousness and future outlook of a condition. The patient's conditions and the potential progression of the disease determine when to initiate source control. Patients can be classified into three groups based on disease severity, the origin of infection, and the patient's overall physical health, as well as any existing comorbidities. In recent decades, antibiotic resistance has become a global health threat caused by inappropriate antibiotic regimens, inadequate control measures, and infection prevention. The sepsis prevention and infection control protocols combined with optimizing antibiotic administration are crucial to improve outcome and should be encouraged in surgical departments. Antibiotic and antifungal regimens in patients with IAIs should be based on the resistance epidemiology, clinical conditions, and risk for multidrug resistance (MDR) and Candida spp. infections. Several challenges still exist regarding the effectiveness, timing, and patient stratification, as well as the procedures for source control. Antibiotic choice, optimal dosing, and duration of therapy are essential to achieve the best treatment. Promoting standard of care in the management of IAIs improves clinical outcomes worldwide. Further trials and stronger evidence are required to achieve optimal management with the least morbidity in the clinical care of critically ill patients with intra-abdominal sepsis.

Effects of explosion-venting interlayer within utility tunnels on the characteristics of natural gas explosions

With the rapid expansion of the national economy and strategic adjustments to the energy structure, natural gas, a crucial clean energy source, encounters significant safety challenges during transportation in utility tunnels, owing to its flammable and explosive nature. To effectively address the current issues in response technologies for gas explosions in utility tunnels, such as inadequate control over the flame propagation range, limited attenuation of overpressure, and the mechanical impact damage effects on the internal structures of the utility tunnels and surrounding buildings, a small-scale experimental platform was constructed independently. This platform is designed to explore how the area and position of vents affect the characteristics of methane explosions within tunnels, utilizing the explosion venting mechanism. The results indicate that, for the same venting position, the maximum flame propagation distance, speed, and peak overpressure all decrease as the venting area increases. When the vent is located at position 1 in each compartment, the reduction in maximum flame propagation distance and speed is the most significant. The maximum decrease in peak overpressure occurs at venting position 2. When the venting position is closer to the ignition source, the rate of explosion overpressure rise and the explosion index both decrease with an increase in venting area, with the most significant reduction occurring at venting position 1. Conversely, when the venting position is farther from the ignition source, the rate of explosion overpressure rise and the explosion index actually increase, with the most significant increase occurring at venting position 4. The research findings offer a theoretical foundation and scientific guidance for developing new technologies aimed at mitigating gas explosion disasters in utility tunnels through internal venting.

SDS-protein and 18S rRNA gene, and phylogeny-based identification of hydatid cysts in human and animal samples

Hydatid disease is a significant and widespread infectious disease prevalent in many countries where there is inadequate control of the adult tapeworm; Echinococcus spp, in dogs, which are the definite hosts. The disease is caused by the presence of hydatid cysts in intermediate hosts, such as humans and some farm animals. In Iraq, infected dogs are highly likely to transmit the infection to humans and some farm animals. The study aimed to identify the presence of hydatid cysts in human and animal samples. The research involved collecting thirty hydatid cysts from human livers and ovaries, as well as from animal livers and lungs. The samples were subjected to SDS-based protein detection, PCR, and gene sequencing of the 18S rRNA gene. The SDS-Coomassie-blue findings demonstrated a 100% (15/15) positive identification of the cystic protein of all specimens. The PCR results confirmed the identity of the parasite with 100% accuracy. Sequencing and phylogenetic analysis of 10 PCR products from both human and animal samples revealed close nucleotide identity to global isolates previously deposited in GeneBank. These findings indicate a high occurrence of hydatid cysts in the examined humans and animals, which have evolved or exhibit close genetic similarity to global strains.

Quackery: A Major Persisting Issue in the Dental Profession of Nepal

Background: Quackery in the dental profession is a significant and persistent issue in Nepal, particularly in urban areas like Hetauda city. This practice involves the provision of dental services by individuals lacking formal education, training, or licensing, posing serious risks to patient health and safety. Objective: This study aims to assess the prevalence of quackery in Hetauda city, Nepal, and its implications for dental care quality and patient safety. It also seeks to understand the reasons behind patients’ continued use of unlicensed dental practitioners and to provide recommendations for addressing this issue. Methods: A cross-sectional study was conducted in 25 dental clinics across Hetauda city. Data collection included structured interviews with licensed dental practitioners, patient surveys, and observational assessments of clinic operations and infection control practices. Quantitative data were analyzed using descriptive statistics, while qualitative data from interviews were thematically analyzed. Results: The study found that 28% of the surveyed clinics employed unlicensed practitioners. Clinics with quacks exhibited significantly lower standards of care, including inadequate infection control and improper procedures. Only 30% of patients were aware of their dental care providers' qualifications, with many opting for quacks due to affordability and accessibility. A higher incidence of complications and adverse outcomes were reported among patients treated by unlicensed practitioners. Qualitative findings highlighted patient trust in quacks, frustrations of licensed practitioners, and regulatory gaps. Conclusion: Quackery remains a major issue in the dental profession in Hetauda city, Nepal. Addressing this problem requires a multifaceted approach, including improved regulation, increased public awareness, and stringent enforcement of licensing standards. Ensuring that all dental practitioners are properly qualified and licensed is essential for protecting patient safety and maintaining the credibility of the dental profession in Nepal.

Glycemic Control and Cardiometabolic Risk in Black Zimbabweans with Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) frequently presents with modified cardiometabolic risk profiles, indicative of an elevated susceptibility to cardiovascular disease (CVD). Cardiometabolic risk factors such as obesity, hyperglycemia, hypertension, insulin resistance and dyslipidemia are known contributors to increased CVD hazard in individuals with T2DM. This study evaluated the glycemic control-based cardiometabolic risk profiles of black Zimbabweans with T2DM. A cross-sectional study of 116 T2DM patients recruited from diabetic clinics at Parirenyatwa and Sally Mugabe Hospitals, Harare, Zimbabwe, was conducted. Blood samples were collected for glycated hemoglobin (HbA1c) and lipid profile assessment. The Framingham risk scores (FRS) based on body mass index (BMI) and lipid profile were used to determine CVD risk. Parametric variables were analyzed using one-way analysis of variance (ANOVA) with post hoc Bonferroni correction, while non-parametric variables were compared using the Kruskal-Wallis test with post hoc Dunn test for multiple comparisons. The overall frequency of dyslipidemia was 83.6% (n=97) and hypoalphalipoproteinemia was the most prevalent dyslipidemia (79.3%). Median HDLC levels were significantly lower in participants with poor glycemic control (1.12 mmol/L) compared to those with good glycemic control group (1.37 mmol/L) (p=0.011). Despite lack of significant variations in Framingham Risk Scores, there was a trend towards lower FRS-BMI in the good control group (29.8%) compared to the inadequate control (35.4%) and poor control (32.7%) groups (p=0.078). Duration since DM diagnosis was observed to be an important risk factor for poor glycemic control being significantly shorter in those with good glycemic control compared to those with inadequate and poor control. Overall, there was no significant difference in HbA1c status by age but individuals with poor glycemic control were significantly older than those with good control. The most prevalent dyslipidemia among the study participants was hypoalphalipoproteinemia which is reportedly associated with genetic predisposition, warranting further investigations.

Chemical gasification: An alternative approach to invitro maturation of bovine oocytes.

This study aimed to evaluate the effect of chemical gasification and HEPES as alternative systems to pH control during invitro maturation on bovine oocytes competence. Groups of 20 bovine cumulus oocytes complexes (COCs) were randomly distributed and cultured for 24 h in one of the following experimental groups: (i) chemical reaction (ChRG) system: CO2 generated from sodium bicarbonate and citric acid reaction (ii) culture media TCM-HEPES (HEPES-G); and (iii) control group (CNTG) in conventional incubator. After invitro maturation (IVM), the COCs were invitro fertilized (IVF), and invitro cultivated (IVC) in a conventional incubator. We evaluated oocyte nuclear maturation, cleavage and blastocyst rates, in addition to the relative mRNA expression of BAX, BMP-15, AREG and EREG genes in oocytes and cumulus cells. The proportion of oocytes in metaphase II was higher in CNTG and ChRG (77.57% and 77.06%) than in the HEPES-G (65.32%; p = .0408 and .0492, respectively). The blastocyst production was similar between CNTG and ChRG (26.20% and 28.47%; p = .4232) and lower (p = .001) in the HEPES-G (18.71%). The relative mRNA expression of BAX gene in cumulus cells was significantly higher (p = .0190) in the HEPES-G compared to the CNTG. Additionally, the relative mRNA expression of BMP-15 gene was lower (p = .03) in oocytes from HEPES-G compared to the CNTG. In conclusion, inadequate atmosphere control has a detrimental effect on oocyte maturation. Yet, the use of chemical gasification can be an efficient alternative to bovine COCs cultivation.

Extracorporeal Shockwave Therapy for Greater Trochanteric Pain Syndrome: A Systematic Review with Meta-Analysis of Randomized Clinical Trials.

Greater trochanteric pain syndrome (GTPS) affects 17.6% of adults aged 50 to 79 years, particularly women. While exercise therapy and corticosteroid injections (CSIs) are common treatments, their limitations include inadequate pain control and potential tendon weakening. Extracorporeal shockwave therapy (ESWT) is an emerging alternative for GTPS. This systematic review assessed ESWT's efficacy in GTPS by evaluating pain and functional outcomes at different follow-up intervals. A literature search of PubMed, Embase, and Web of Science for randomized clinical trials (RCTs) was conducted comparing ESWT with other GTPS treatments up to March 1, 2024. Two reviewers independently extracted data, assessing study quality using the Cochrane risk-of-bias tool. A random-effects pairwise meta-analysis compared ESWT with other treatments. Eight RCTs involving 754 patients (169 male, 585 female patients) were included. Seven RCTs were deemed high risk of bias, and 1 RCT had some concerns. Five RCTs investigated focused on focused ESWT, and 3 examined radial ESWT. ESWT provided significantly lower pain scores than other treatments at 2 to 4 months (standardized mean difference = -0.431; 95% confidence interval [CI], -0.82 to -0.039; I2 = 83%). Functional improvement (Lower Extremity Functional Scale) was significantly higher at 6 months (weighted mean difference = 6.68; 95% CI, 3.11-10.25; I2 = 0%) but did not exceed the minimal clinically important difference. Focused ESWT provided greater pain reduction than radial ESWT. Three weekly ESWT sessions offer short-term pain relief at 2 to 4 months for patients with GTPS, especially with focused ESWT. Functional improvements at 6 months were notable but not clinically significant. These findings suggest ESWT may complement or serve as an alternative to CSIs and exercise. However, caution is needed when interpreting these results due to high risk of bias with the included RCTs and heterogeneity across the studies. Further high-quality trials are needed to confirm ESWT's long-term benefits over other treatments. Level II. See Instructions for Authors for a complete description of levels of evidence.

Epilepsy in inmate patients seen in a high complexity reference hospital in Colombia: A cross-sectional study.

To describe the sociodemographic and clinical characteristics of imprisoned patients with epilepsy seen at Samaritana University Hospital (HUS) in Bogotá D.C., between January 2017 and November 2020. Cross-sectional cohort study of inmate patients over 18 years of age seen at HUS between January 2017 and November 2020, with a discharge diagnosis of epilepsy. A descriptive univariate analysis of patient sociodemographic and clinical characteristics was carried out. Overall, 92 patients were included, 95.7% were males with a median age of 32 years (IQR: 26-44); 65% were assessed in the outpatient clinic; median hospital length of stay was 2 days (IQR: 0) and 7.6% required admission to the intensive care unit; 75% had focal onset epilepsy, 63.04% with undetermined etiology 31.52% with structural causes. Polytherapy was found in 53.3%, valproic acid being the most frequently used antiseizure medication in 59.78%; lack of adherence was reported in 15.22% and inadequate seizure control in 81.52%; status epilepticus occurred in 5.34%. A total of 31 EEG recordings and 53 brain images were performed, of which, 29% and 39.62%, respectively, were abnormal. Non-epileptic paroxysmal events were diagnosed in 5.34%, while organic or psychiatric comorbidities were found in 25%, and the use of psychoactive substances was documented in 17.39%. Upon discharge, 93.47% had no disability, and only 45.65% returned for outpatient follow-up. The clinical profile was of men in the fourth decade of life with focal onset epilepsy characterized by high seizure frequency, most of whom were receiving antiseizure medication, with a high proportion of polytherapy. The results are a point of departure for prospective studies designed to identify points to intervene and improve healthcare for inmates with epilepsy. Inmates are a vulnerable proportion of persons with epilepsy. In this group there are significant differences compared to the general population, especially with greater psychiatric comorbidity and worse control of epileptic seizures due to difficulties in accessing medical care, antiseizure medication and diagnostic tests. We found that the most characteristic population is made up of men in the fourth decade of life with a high frequency of seizures, most of whom were receiving multiple antiseizure medication This study is the first of its kind in Latin America and it is an initial approach to epilepsy in inmates.