International Medical Organizations Research Articles

Heart failure with preserved ejection fraction management: a systematic review of clinical practice guidelines and recommendations.

Multiple guidelines exist for the diagnosis and management of heart failure with preserved ejection fraction (HFpEF). We systematically reviewed current guidelines and recommendations, developed by national and international medical organizations, on the management of HFpEF in adults to aid clinical decision-making. We searched MEDLINE and EMBASE on 28 February 2024 for publications over the last 10 years as well as websites of organizations relevant to guideline development. Of the ten guidelines and recommendations retrieved, seven showed considerable rigour of development and were subsequently retained for analysis. There was consensus on the definition of HFpEF and the diagnostic role of serum natriuretic peptides and resting transthoracic echocardiography. Discrepancies were identified in the thresholds of serum natriuretic peptides and transthoracic echocardiography parameters used to diagnose HFpEF. There was agreement on the general pharmacological and supportive management of acute and chronic HFpEF. However, differences exist in strategies to identify and address specific phenotypes. Contemporary guidelines for HFpEF management agree on measures to avoid its development and the consideration of cardiac transplantation in advanced disease. There were discrepancies in recommended frequency of surveillance for patients with HFpEF and sparse recommendations on screening for HFpEF in the general population, use of diagnostic scoring systems, and the role of newly emerging therapies.

Screening for lung cancer using thin-slice low-dose computed tomography in southwestern China: a population-based real-world study.

Lung cancer is one of the most common malignant tumors threatening human life and health. At present, low-dose computed tomography (LDCT) screening for the high-risk population to achieve early diagnosis and treatment of lung cancer has become the first choice recommended by many authoritative international medical organizations. To further optimize the lung cancer screening method, we conducted a real-world study of LDCT lung cancer screening in a large sample of a healthy physical examination population, comparing differences in lung nodules and lung cancer detection between thin and thick-slice LDCT scanning. A total of 29 296 subjects who underwent low-dose thick-slice CT scanning (5 mm thickness) from January 2015 to December 2015 and 28 058 subjects who underwent low-dose thin-slice CT scanning (1 mm thickness) from January 2018 to December 2018 in West China Hospital were included. The positive detection rate, detection rate of lung cancer, pathological stage of lung cancer, and mortality rate of lung cancer were analyzed and compared between the two groups. The positive rate of LDCT screening in the thin-slice scanning group was significantly higher than that in the thick-slice scanning group (20.1% vs. 14.4%, p < 0.001). In addition, the lung cancer detection rate in the thin-slice LDCT screening positive group was significantly higher than that in the thick-slice scanning group (78.0% vs. 52.9%, p < 0.001). The screening positive rate of low-dose thin-slice CT scanning is higher and more early-stage lung cancer (IA1 stage) can be detected in the screen-positive group.

National medical eligibility criteria for contraceptive use 2023: review

Individual sexual and reproductive life management has been сonfirmed by medical and state communities since 1990s. Every citizen officially received rights for access to appropriate goods and services. Such international agreements as 1994 International Conference on Population and Development (ICPD, Cairo, Egypt) and 2004 WHO Reproductive health strategy, estimated reproductive health and family planning as priorities. Worldwide agreement on the 2005 summit declares achieving of female reproductive health before year 2015 as worldwide progress.WHO created complex of international eligibility criteria for male and female contraception with the aim of medical aid improvement. According to WHO plan, those criteria should be used by countries considering policy, needs, priorities and resources of national healthcare programs. For example, USA, United Kingdom, Russia etc. have successfully adopted medical eligibility criteria for contraception on the national level.The present review is summary product created by interdisciplinary expert group including representers of federal and regional healthcare establishments, medical universities, and international medical organizations.

Prevalence of vitamin D deficiency in exclusively breastfed infants at Charoenkrung Pracharak Hospital.

Vitamin D deficiency is a common problem in exclusively breastfed infants, with supplementation recommended by various international medical organizations. However, in Thailand, no advice for routine vitamin D supplementation is available. Thus, this study investigated the prevalence of vitamin D deficiency and its associated factors in exclusively breastfed infants in Bangkok, Thailand. To investigated the prevalence of vitamin D deficiency and its associated factors in exclusively breastfed infants in Bangkok, Thailand. This descriptive observational cross-sectional study assessed 109 4-month-old infants at Charoenkrung Pracharak Hospital from May 2020 to April 2021. The 25-OH vitamin D level of the infants was measured using an electrochemiluminescence binding assay. Vitamin D deficiency was defined as 25-OH level < 20 ng/mL, with vitamin D insufficiency 20-30 ng/mL. The sun index and maternal vitamin D supplementation data were collected and analyzed using the independent t-test, univariate logistic regression, and multivariate logistic regression to identify the associated factors. The prevalences of vitamin D deficiency and vitamin D insufficiency were 35.78% and 33.03%, respectively with mean serum 25-OH vitamin D levels in these two groups 14.37 ± 3.36 and 24.44 ± 3.29 ng/mL. Multivariate logistic regression showed that the main factors associated with vitamin D status were maternal vitamin D supplementation and birth weight, with crude odds ratios 0.26 (0.08-0.82) and 0.08 (0.01-0.45), respectively. The sun index showed no correlation with the 25-OH vitamin D level in exclusively breastfed infants (r = -0.002, P = 0.984). Two-thirds of healthy exclusively breastfed infants had hypovitaminosis D. Vitamin D supplementation prevented this condition and was recommended for both lactating women and their babies.

Reducing the Risks of Nuclear War— the Role of Health Professionals

Reducing the Risks of Nuclear War— the Role of Health Professionals

ANCA-associated vasculitis: overview and practical issues of diagnosis and therapy from a European perspective

Abstract Antineutrophil cytoplasmic antibodies (ANCA)–associated vasculitis (AAV) is a heterogeneous group of rare diseases characterized by necrotizing inflammation predominantly of small vessels and the presence of these circulating antibodies. AAV comprises three important diseases, namely granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis, which affect multiple organ systems, significantly affecting patients' quality of life and survival. The diagnosis is established according to the clinical manifestations, detectable ANCA, and histopathology findings. Primary treatment strategies are adapted to the severity of the disease and based on immunosuppression with corticosteroids and cyclophosphamide, with increasing adoption of new, less toxic agents aimed at sustained remission of the disease, such as rituximab, methotrexate, and mycophenolate mofetil. Several international medical organizations have proposed recommendations for diagnosing and managing these diseases to standardize the procedures. In this study, we provide an up-to-date European perspective on AAV management, compiling current and relevant information regarding its epidemiology, symptoms, diagnosis, treatment strategies, and prognosis.

Structural characteristic of the model of early detection and primary pre-vention of cerebral stroke among the adult population

In the article, based on the analysis of world literary sources, official statistical data, and the work of international medical organizations, a systematic analysis and generalization of modern world experience regarding the possibilities of improving the system of early detection and primary prevention of brain strokes among the adult population was carried out. Based on this, an optimized model of early detection and primary prevention of brain strokes among the adult population was developed and scientifically substantiated. The optimized model takes into account the existing medical and social problems of people with brain strokes, the existing shortcomings in the measures of early detection and primary prevention of brain strokes among the adult population, and global achievements and developments. The proposed optimized model of early detection and primary prevention of brain strokes was developed on the basis of own research, careful and thorough study and analysis of modern models of work of domestic health care institutions and best practices of other countries. The optimized model consists of six main interconnected and interdependent main activity apparatuses (structural components of the model): conceptual and categorical apparatus (purpose, tasks, principles, priorities, approaches, properties); strategic and operational apparatus (management levels: strategic, tactical, operational); rule-making apparatus (existing legal framework, formation of new rule-making acts); information and communication apparatus (collection and processing of information, formation of a data bank); functional and organizational apparatus (individual, family, group and population level); practical-implementation apparatus (resource-action and subject-object guidelines, achievement of expected results, verification of effective and corrective measures (if necessary)). Keywords: measures of early detection and primary prevention, stroke pathology, optimized model, functional devices.

#4112 IMPACT OF ADD-ON EXTRACORPOREAL MEMBRANE OXYGENATION ON THE OUTCOME OF CRITICALLY ILL COVID-19 POSITIVE PATIENTS

Abstract Background and Aims Growing reports arguing the value of extracorporeal membrane oxygenation (ECMO) support on COVID-19 survival. The earliest studies reported prohibitively high mortality in small cohorts. International medical organizations still recommended, early in the pandemic, that ECMO should be considered if conventional treatment was not successful. To evaluate the impact of add-on ECMO on the outcome of critically ill COVID-19 patients. Method An observational study recruited critically ill COVID-19 patients necessitating ECMO support during their stay in governmental hospitals of Kuwait from March 2020 to December 2021. Socio-demographic characters (age, sex, smoking history, comorbidities), clinico-laboratory parameters (days of mechanical ventilation before ECMO, routine investigations, LDH, ferritin, D-dimer, arterial blood gases &amp;reporting any positive cultures; sputum, blood &amp;/or others), chest radiological findings, and different lines of management (steroids, antivirals, antibiotics, biological therapy and anticoagulants) were recorded for all patients. Moreover, various complications and acute events during ECMO were reported with special stress on bleeding or thrombotic event, RBCs or platelet transfusion in addition to acute kidney injury (AKI) on ECMO. Final outcome was recorded regarding ECMO duration, ICU stay, mortality, and need for ventilatory support post discharge. Results Most of the studied patients (n = 135) were males (61.48%), non-smokers (80%) in their middle age (41.28±9.88 years). DM was the most prevalent comorbidity (24%). The reported survival rate was 58.5%. Non-survivors were older (43.6± 8.7 vs. 38.92 ±8.75 years, p = 0.01), predominantly males (p = 0.046), had higher mean platelet volume (21.78±7.55 vs. 13.47±8.19, p = 0.02), median D-dimer (4312±2146 vs. 2795±1545, p = 0.04) and mean CO2 (65.1±25.69 vs. 52.45±24.05, p = 0.01). Most of non-survivors (56.9%) had computed tomography (CT) chest findings consistent with COVID-19 (vs. 35.7% among COVID-19unmatched CT) (p = 0.028). Moreover, non-survivors were more likely to be shocked and supported with vasopressors (50 out of 56 patients) or developed AKI while on ECMO (44 out of 56 patients), (p &amp;lt;0.001, 0.012 respectively). Most patients who were managed by biological agents survived compared to those who did not receive it (75% vs. 49.5% respectively, p = 0.038). We found a significant positive correlation between ECMO duration, age (p = 0.012), and LDH (p = 0.041); a significant positive correlation between LDH and ICU stay (p&amp;lt;0.001); a significant positive correlation between D-dimer, CRP (p = 0.006) and PaC02 (p = 0.015). We found that post-discharge ventilatory support among survivors was needed in 48.1% and 11.4% (as O2 supplementation or CPAP, respectively). Conclusion ECMO should be considered for critically ill COVID-19 patients who develop refractory respiratory failure despite standard care.

Career development of international medical graduates in Canada: status of the unmatched

With limited residency positions, the majority of international medical graduates living in Canada and other developed countries cannot work as physicians. The educational experience and career development of unmatched international medical graduates (those who are not matched to a residency position) residing in Canada have never been studied. Through an innovative collaboration of provincial international medical graduate organizations, we launched an online survey targeting the career development of unmatched international medical graduates, with 356 survey responses entering data analysis. Respondents reported that at the early career planning stage, close to a third had not had adequate knowledge of their career prospects in Canada. Although official resources are available, most respondents found that the information did not match well with reality. After arriving in Canada, educational resources for unmatched international medical graduates are scarce. The majority of them work in healthcare-related fields but reported significant difficulties finding these positions, and there were limited career training opportunities. Among respondents who were no longer pursuing residency positions and had moved on to alternate career paths, we found, unexpectedly, that 69% of them reported previous residency application experience did not contribute to their current occupation, and most were not satisfied with their current career status and continuing education opportunities. In conclusion, the unmatched international medical graduates could serve as a vital reservoir of skilled medical professionals to serve the community, especially during public health crises. Continuing education and career support of unmatched international medical graduates are crucial for their career development and should be an area of priority for policymakers. Career support, especially for alternative career paths, can be built on the current services that exist in most provinces in Canada. In addition, novel online and social media tools can be utilized to increase the outreach of these programs.

Luigi Mongeri: A reformist and expert on "Oriental Insanity" in the Nineteenth-Century Ottoman Empire

This article focuses on the early career of Luigi Mongeri, who was appointed as the chief physician to the Süleymaniye Mental Asylum in 1856 to treat mental illness and improve the living conditions of mentally ill patients in the nineteenth-century Ottoman Empire. It focuses on Mongeri's early career in Italy, investigates his involvement in Ottoman imperial patronage networks and their subsequent effects on his career, and finally explores the reform program he implemented at Süleymaniye. While in the Ottoman Empire, Mongeri appeared as a reformist who claimed to improve the living conditions and treatment of patients by the use medical statistics, abolishing the use of shackles, etc. At the same time in Europe—and especially in France, which was one of the important centers of alienist medicine at the time— he presented himself as an expert on "oriental insanity,” a claim which gained him access to international medical circles and organizations.

The Implication of Time-in-Range for the Management of Diabetes in India: A Narrative Review

Introduction: In recent times, traditional self-monitoring of blood glucose (SMBG) using fingerstick capillary samples is moving to continuous glucose monitoring (CGM) due to inherent limitations of the traditional methods. CGM displays current glucose level, trends, rate of change, time-in-range (TIR), and glucose variability (GV) over a period of several days. It detects episodes of hyperglycemia and hypoglycemia, which allows immediate response to prevent these episodes. It also allows physicians to provide a personalized glycemic response to the patients. Materials and methods: Though CGM systems have been available for more than 20 years, their use is quite low. It is challenging for clinicians to invest time in learning and understanding the diverse reports of the various CGM devices. Moreover, there is a lack of consensus on the frequency of TIR measurement. Hence. a review of the literature was performed and existing guidelines from India and abroad were reviewed for a need for CGM and its frequency of measurements in DM patients. Results: TIR is inversely correlated to the risk of microvascular and macrovascular complications. CGM is recommended by expert clinician consensus and national and international medical organizations. For the patients use of CGMs involves cost. Besides, there is the discomfort and inconvenience of wearing the device. Hence, defining the implications of using CGM in practice is important. According to the 2020 recommendations by the Research Society for the Study of Diabetes in India (RSSDI) — Endocrine Society of India (ESI) and the 2019 recommendations by an expert group of endocrinologists and diabetologists, in the Indian context, CGM could be suggested for patients with Type 2 Diabetes who encounter severe hyperglycemia or hypoglycemia, repeated hypoglycemia, asymptomatic hypoglycemia, nocturnal hypoglycemia, refractory hyperglycemia, or large blood glucose excursions. Conclusions: The role of CGM to achieve better glycemic control and prevention of complications in T1D and T2D is well established. Significant education and awareness on CGM needs to be provided to physicians as well as patients with high GV and those on insulin therapy.

797-P: Usability and Satisfaction of a New Affordable Insulin Pen for All: Positive Outcomes of Two Usability Studies

Globally, 13 million people (4 million in USA) inject insulin with single use disposable syringes daily. Compared to syringe and vials, pens are known to increase adherence and diabetes control and to reduce healthcare utilization costs. Yet, pens are largely unavailable to low-income groups, due to prohibitive cost. GO-Pen has designed a new affordable pen for use with vial insulin and conducted usability testing in collaboration with Médecins Sans Frontières (MSF) , an international medical humanitarian organization working to improve diabetes care for people living in difficult circumstances. Here we report the results of two usability studies conducted among insulin pen users (n=19, f/m: 11/8, age: 23-64) and syringe users (n=20, f/m: 10/10, age: 24-70) in refugee populations in Malaysia and Jordan. A convenience sample of the first 20 to accept enrollment was set up after informed consent. After a short introduction, participants were asked to demonstrate the use of the insulin pen in front of a camera, without revealing their faces or any identifying information, while an interviewer noted their correct use and confidence level. Injection was simulated in a sponge. 100% (n=19) of pen users and 75% (n=15) of syringe users performed &amp;gt;90% of the tasks correctly. Among pen users, the most common failed tasks were priming the needle (n=4) . Among syringe users, the most common failed tasks were failing to check the vial label (n=9) and priming the needle (n=6) . 5% (n=1) of pen users preferred the new insulin pen over the pen they were already familiar with. 75% (n=15) of syringe users preferred the new insulin pen over syringes. The most common complaint among pen users was that there were too many steps in the process. In conclusion, we find current pen users require little training and prefer the pen they are already familiar with. Syringe users who are unfamiliar with pen usage require more training than pen users, however, they have largely favorable attitudes towards this new insulin pen. Disclosure O.K.Nielsen: Stock/Shareholder; GO-Pen ApS. G.Huisman: None. J.A.Qasem: None. C.Eng: None. A.F.Jørgensen: None. M.Torrone: None. B.S.Larsen: None. A.Reddy: None.

Proposed digital marketing strategy: A case of multinational mask producer in indonesia

Triple Nexguard Indonesia, as one of the multinational mask manufacturers in Indonesia, is looking for a large market growth opportunity from this condition. On the other hand, there are several challenges faced by Triple Nexguard Indonesia in dealing with black swan conditions and intense competition, such as product allocation and priority from global market supply, inability to produce locally with acceptable time-to-market. From the research, it is concluded that Triple Nexguard is positioned as the highest protective mask that provides quality assurance with advanced quality screening and strong brand equity with international medical organization patents, with the main target market of people who are very worried and worried about their masks. behavior of the wearer during a pandemic situation. According to this research, the Triple Nexguard Indonesia digital marketing strategy project stream is divided into two major activities that can be carried out in parallel. The first activity is a content marketing strategy that emphasizes strengthening product information content to build brand awareness. Then, the e-commerce strategy focuses on transactional processes. Both strategies stem from consumer behavior that can influence customer paths and journeys.

Reflections on mental healthcare for an asylum seeker population caught in limbo on the Greek island of Samos.

A psychiatry trainee reflects on a period of work on the Greek island of Samos with the international medical non-governmental organisation Medécins Sans Frontières/Doctors Without Borders, providing mental health and psychosocial support to asylum seekers. The clinic provided services to asylum seekers who were living in a crowded refugee camp, many of whom were experiencing symptoms of severe mental illness. The author reflects on the nature and severity of these presentations, and questions the role of psychiatry in treating mental illness that is clearly exacerbated by circumstances resulting from European asylum policies.

COVID-19 Vaccinations: Summary Guidance for Cancer Patients in 28 Languages: Breaking Barriers to Cancer Patient Information.

BackgroundCovid-19 vaccination has started in the majority of the countries at the global level. Cancer patients are at high risk for infection, serious illness, and death from COVID-19 and need vaccination guidance and support.Guidance availability in the English language only is a major limit for recommendations’ delivery and their application in the world’s population and generates information inequalities across the different populations.Methods Most of the available COVID-19 vaccination guidance for cancer patients was screened and scrutinized by the European Cancer Patients Coalition (ECPC) and an international oncology panel of 52 physicians from 33 countries. ResultsA summary guidance was developed and provided in 28 languages in order to reach more than 70 percent of the global population.ConclusionLanguage barrier and e-guidance availability in the native language are the most important barriers when communicating with patients. E-guidance availability in various native languages should be considered a major priority by international medical and health organizations that are communicating with patients at the global level.

МЕДИКО-СОЦІАЛЬНІ АСПЕКТИ ПІДТРИМКИ УКРАЇНИ МІЖНАРОДНИМ СПІВТОВАРИСТВОМ НА ТЛІ ЗБРОЙНОЇ АГРЕСІЇ РОСІЇ

The article analyzes the medical and social aspects of international aid to Ukraine in conditions of Russia's armed aggression. The urgency of the problem is due to the need to highlight the most urgent areas of interaction between international governmental and non-governmental medical and social organizations and representatives of the Ukrainian medical community, taking into account the most urgent problems in the field of health care in the conditions of a full-scale war. The extremely difficult humanitarian situation in Ukraine is emphasized, especially regarding medical assistance to children. The modern capabilities and algorithm of medical evacuation of wounded servicemen and civilian victims of war for treatment and rehabilitation to European countries, Canada, the USA and the role of governmental and non-governmental organizations in their organization are disclosed. The high effectiveness of the current humanitarian and medical initiatives of the Canada-Ukraine Foundation, in particular the International program #HelpUkraineNow; The Ukraine Humanitarian Appeal program; medical and educational program of the Canada Ukraine Surgical Aid Program (CUSAP) and the "Help Displaced Ukrainians in Canada" Appeal. Other international medical programs are briefly described. The author revealed the peculiarities of assistance to refugees and temporarily displaced persons from Ukraine in various European countries, as well as Canada, the USA. The article notes the importance of organizing rehabilitation measures for wounded servicemen and civilians at the state level both with the participation of international organizations and within Ukraine. It was emphasized the need to develop domestic medical programs, taking into account the large number of wounded people who need long-term treatment. The article focuses on the modern problems and challenges regarding international medical and social cooperation against the background of Russia's armed aggression.

Being an excellent scientist is not enough to succeed! Soft skills for medical physicists

PurposeTo provide a review of the literature and commentary regarding soft skills for Medical Physicists. MethodA comprehensive search in PubMed was carried out using the searchwords ‘medical physics’ coupled separately (‘AND’, both in Title) with each of the following terms: leadership, teamwork, communication, pedagog*, teach*, marketing, conflict resolution, negotiat*, qualitative research, organizational psychology. ResultsThe total number of PubMed references was extremely low (total 6 relevant articles for all of leadership, communication, pedagog*, teach*, with the rest of the searchwords giving zero hits) which is quite disturbing. For an improved perspective, we compared the search for ‘leadership AND medical physics’ to ‘leadership AND medical’ and ‘leadership AND nursing’ we only had 4 hits for Medical Physics as opposed to 564 for ‘leadership AND medical’ and 1419 for ‘leadership AND nursing’. ConclusionsIt seems that Medical Physicists give an extremely low priority to soft skills as opposed to scientific skills. In a world of austerity economics and sometimes over commoditization such a situation is not only disturbing it is actually very risky for the profession. Medical Physicists must learn to provide strategic and robust leadership, be able to market their profession to all stakeholders (in particular to decision makers, other health care professions and the general public), be able to communicate their role, negotiate effectively for their profession, and boost their abilities for teambuilding and conflict resolution. The setting up of education programmes to overcome this soft skill deficit among medical physicists by national, regional and international medical physics organizations must be given priority.

Epidemiological aspects of echinococcosis of the liver and other organs in the Republic of Uzbekistan

IntroductionRecently, in international medical organizations, more and more interest is shown towards diseases in humans, among which the cystic form of echinococcosis (CE) is given special importance. As a zoonotic parasitic disease caused by the larval stage of cestodes belonging to the genus Echinococcus and the Taeniidae family, CE in 2014 was recognized globally by the UN Food and Agriculture Organization (FAO) and WHO as the second most important foodborne parasitic pathology. In the 2018, the European Food Safety Authority (EFSA) considered CE among the food-borne parasites of highest relevance in Europe. Purposeto study the actual epidemiology of human echinococcosis lesion in the Republic of Uzbekistan for 2015–2019 to highlight the mean annual incidence of this pathology in all regions of the country, as well as the extensive value of the proportion of echinococcosis of the liver (EL), lungs (LE) and other localizations. Material and methodsThe officially registered data for all regions of the country for 2015–2019 were studied. An ultrasound screening of the abdominal organs of the population of the Khorezm region was carried out during 2019 to determine the effectiveness of early diagnosis of EL. A total of 104,284 inhabitants were examined, of which 38,660 were children and 65,624 were adults. ResultsAccording to the processed statistical data for all regions of the Republic of Uzbekistan for 2015–2019 on average, 2105.0 ± 43.3 patients with echinococcosis of various localizations were diagnosed. The mean annual incidence was 6.5 ± 0.09 per 100,000 inhabitants. The extensive value of the EL share was 79.4 ± 0.9% (1672.2 ± 35.6 on average per year), high-level rate - 5.2 ± 0.08 per 100,000 inhabitants; the proportion of LE was 14.0 ± 0.8% (295.2 ± 17.8), the prevalence was 0.9 ± 0.06 per 100,000 inhabitants; the proportion of echinococcosis of other localizations was 6.5 ± 0.5% (137.6 ± 13.4), the high-level value was 0.4 ± 0.03 per 100,000 inhabitants. The frequency of detection of the liver or other abdominal organs echinococcosis during screening ultrasound in the Khorezm region was 0.009%, in turn, the examination of family members of these patients increased this indicator to 0.011%.

Integrated-electrochemical Approaches Powered by Photovoltaic Energy for Detecting and Treating Hydroxychloroquine in Water

Hydroxychloroquine (HCQ), a derivative of 4-aminoquinolone, is prescribed as an antimalarial prevention drug and to treat diseases such as rheumatoid arthritis, and systemic lupus erythematosus. Recently, the treatment of Coronavirus (COVID-19) was authorized by national and international medical organizations in certain hospitalized patients by chloroquine and hydroxychloroquine. However, its use for treating COVID-19 is only an unproven hypothesis still being investigated. Consequently, the high risk of natural water contamination due to the large production and utilization of HCQ is a key issue to overcome urgently. For this reason, the monitoring its concentration in water and the treatment of polluted effluents with HCQ are needed to minimize its hazardous effects. Then, in this study, an electrochemical measuring device and electrochemical water treatment are integrated for their environmental application on HCQ control. In the former, raw cork-graphite electrochemical sensor was prepared and a simple differential pulse voltammetric (DPV) method was developed for the quantitative determination of HQC. Meanwhile, the degradation of HCQ was carried out with BDD anode by applying 15, 30, and 60 mA cm-2 over 90 min of treatment, in the latter. The decay and degradation of HCQ were monitored by DPV, and HPLC measurements. Results indicated that, the electrochemical device exhibited a clear current response, allowing to quantify the analyte in the 2.5–25 ppm range. Alternatively, BDD-electrolysis demonstrated to be an efficient process for removing organic matter from the drug compound effluent via the production of strong oxidizing species. Lower HCQ concentrations were detected, using the electrochemical sensor, when higher current densities and sulfate concentrations were used in BDD-electrolysis, demonstrating the applicability of integrated-technologies. The evolution of short-carboxylic acids (oxalic, formic, oxamic, maleic, acetic, and glycoxylic) was observed at 15 mA cm-2 but all of them were eliminated after 120 min. Inorganic ions (NH4 + and NO3 -) were also detected under these experimental conditions, confirming that the pollutant was mineralized. Finally, lower energy requirements were estimated for all experimental conditions; however, solar photovoltaic (PV) renewable energy has been utilized to power these electrochemical technologies, decreasing the investment cost.

Vitamin D status in full-term exclusively breastfed infants versus full-term breastfed infants receiving vitamin D supplementation in Thailand: a randomized controlled trial

BackgroundMany international medical organizations recommend vitamin D supplementation for infants, especially exclusively breastfed infants. In Thailand, however, data regarding the vitamin D status in Thai infants are lacking. Such data would help to support physician decisions and guide medical practice.MethodsFull-term, exclusively breastfed infants were randomized into two groups at 2 months of age to continue exclusive breastfeeding either without vitamin D supplementation (control group, n = 44) or with vitamin D3 supplementation at 400 IU/day (intervention group, n = 43) until 6 months of age. At 6 months, the serum vitamin D (25OHD) of the infants and their mothers, serum bone marker, and infants’ growth parameters were compared between the two groups.ResultsThe infants’ serum 25OHD concentration was lower in the control group than intervention group (20.57 ± 12.66 vs. 46.01 ± 16.42 ng/mL, p < 0.01). More infants had vitamin D sufficiency (25OHD of > 20 ng/mL) in the intervention group than control group (93.0% vs. 43.2%, p < 0.01). There were no significant differences in the maternal 25OHD concentrations between the control and intervention groups (25.08 ± 7.75 vs. 23.75 ± 7.64 ng/mL, p = 0.42). Serum calcium, phosphorus, intact parathyroid hormone, alkaline phosphatase, and infants’ growth parameters were comparable between the two groups. After adjustment for the confounding factors, 25OHD concentration in the intervention group was 25.66 ng/mL higher than the control group (95% confidence interval, 19.07–32.25; p < 0.001). Vitamin D supplement contributed to an 88.7% decrease in the prevalence of vitamin D insufficiency/deficiency (relative risk, 0.11; 95% confidence interval, 0.04–0.35; p < 0.01).ConclusionsMost full-term, exclusively breastfed Thai infants have serum vitamin D concentration below sufficiency level at 6 months of age. However, vitamin D supplementation (400 IU/day) improves their vitamin D status and prevents vitamin D deficiency.Trial registrationThe study was pre-registered in the Thai Clinical Trials Registry (TCTR20190622001) on 22/06/2019.