January June Research Articles

The Long Shadow of Exposure to Early-Life Adversity

The Long Shadow of Exposure to Early-Life Adversity

Response of Soursop (Annona muricata L.) to Clonal Multiplication through Budding and Rootstock Compatibility

A research trial was carried out at the College of Horticulture, Mysuru, University of Horticultural Sciences, Bagalkot, Karnataka, India during January–June 2021 to study the effect of different environmental conditions and rootstocks on success and survival of soursop budlings. There were 6 treatment combinations consisting of different rootstocks of Annona sp. (Annona muricata and Annona squamosa) along with growing conditions (polyhouse, 50% shade net and open condition) were replicated thrice in factorial completely randomized design. The results of the study indicated that soursop scion budded on its own rootstock (A. muricata) and placed under polyhouse condition had significantly affected on days taken to bud sprout (34.96 days), success (91.60%), survival percentage (85.30%) and growth parameters like number of leaves (3.81, 6.56 and 13.67), length of sprouted shoot (3.58 cm, 8.19 cm and 15.42 cm), girth of sprouted shoot (1.35 mm, 1.86 mm and 2.08 mm), number of nodes (3.52 , 6.11 and 11.67) and length of internode (1.20 cm, 1.47 cm and 1.73 cm) at 60, 90 and 120 days after budding whereas A. muricata scion budded on A. squamosa rootstock kept under open condition recorded more number of days for sprouting (37.86), least success (37.86%), survival percentage (85%) and growth parameters like number of leaves (2.33, 4.44 and 11.11), shoot length (2.78 cm, 5.51 cm and 11.13 cm), diameter of shoot (0.70 mm, 1.01 mm and 1.24 mm), number of nodes (2.11, 4.33 and 10.22) and node length (0.84 cm, 1.01 cm and 1.42 cm).

Pneumococcal vaccination status among cirrhotic patients in Italy: a neglected topic.

To date, few reports have evaluated the pneumococcal vaccination status in cirrhotic patients. No data are available for European countries. We have explored this topic and the potential independent predictors motivating lack of vaccination in Italy. Between January 1st and June 30th 2022, 1419 cirrhotic patients of any etiology were consecutively enrolled in an observational, prospective study at 8 referral centers in Italy. Adjusted odds ratios (ORs) for the association with lack of vaccination were evaluated by multiple logistic regression analysis. Overall vaccine coverage was 17.9% (8.9% in patients < 65 years of age and 27.1% in those aged ≥ 65 years; p < 0.001). Among the 1165 unvaccinated patients, 1068 (91.7%) reported lack of information regarding vaccination as the reason for not having undergone vaccination. Independent predictors associated with lack of vaccination were age < 65 years (OR 3.39, CI 95% 2.41-4.76) and a higher number of schooling years (OR 2.14, CI 95% 1.58-2.91); alcoholic etiology resulted only marginally associated (OR 1.91, CI 95% 1.03-3.52). These findings establish evidence on how pneumococcal vaccination status in Italy is largely suboptimal among cirrhotic patients. These results raise concern, considering the severe outcomes of pneumococcal infection in patients with chronic liver diseases.

Spontaneous reporting of adverse reactions related to proton pump inhibitors.

Proton pump inhibitors (PPIs) are widely prescribed in all age groups, and their use is increasing. However, their safety profile has been frequently questioned. The aim of this study was to analyze the characteristics of PPI-related adverse drug reactions (ADRs) reported to the Italian spontaneous reporting system (SRS) database and relative to an Italian region (Sicily). A 20-year observational, retrospective study was conducted, evaluating PPI-related ADR reports from Sicily between January 1st, 2001, and June 30th, 2021. The factors associated with ADR seriousness were investigated. A total of 148 spontaneous reports of ADRs related to PPIs were analyzed. Lansoprazole was the drug with the highest number of associated reports (30.87%). The most frequently reported ADRs were cutaneous (24.56%) and/or gastrointestinal manifestations (18.10%), the latter especially in the case of lansoprazole-related ADRs (p<0.006). The great majority of ADR reports were relative to on-label prescriptions. Serious ADRs were 39 (26.35%). Serious ADRs were more common in reports including omeprazole than in reports containing other PPIs (p<0.008) and in reports presenting PPIs combined with other drugs than in reports with PPI single therapies (p<0.001). Most PPI-related ADRs are non-serious. Omeprazole and combination therapy seem to be associated with ADR seriousness.

On the turbulent heat fluxes: A comparison among satellite-based estimates, atmospheric reanalyses, and in-situ observations during the winter climate over Arctic sea ice

The surface energy budget is crucial for Arctic sea ice mass balance calculation and climate systems, among which turbulent heat fluxes significantly affect the air–sea exchanges of heat and moisture in the atmospheric boundary layer. Satellite observations (e.g. CERES and APP-X) and atmospheric reanalyses (e.g., ERA5) are often used to represent components of the energy budget at regional and pan-Arctic scales. However, the uncertainties of the satellite-based turbulent heat fluxes are largely unknown, and cross-comparisons with reanalysis data and in-situ observations are limited. In this study, satellite-based turbulent heat fluxes were assessed against in-situ observations from the N-ICE2015 drifting ice station (north of Svalbard, January–June 2015) and ERA5 reanalysis. The turbulent heat fluxes were calculated by two approaches using the satellite-based ice surface temperature and radiative fluxes, surface atmospheric parameters from ERA5, and snow/sea ice thickness from the pan-Arctic Ice Ocean Modeling and Assimilation System (PIOMAS). We found that the bulk-aerodynamic formula based results could better capture the variations of turbulent heat fluxes, while the maximum entropy production based estimates are comparable with ERA5 in terms of root-mean-square error (RMSE). CERES-based estimates outperform the APP-X-based ones but ERA5 performs the best in all seasons (RMSE of 18 and 7 W m−2 for sensible and latent heat flux, respectively). The air–ice temperature/humidity differences and the surface radiation budget were found the primary driving factors in the bulk-formula method and maximum entropy production (MEP) method, respectively. Furthermore, errors in the surface and near-surface temperature and humidity explain almost 50% of the uncertainties in the estimates based on the bulk-formula, whereas errors in the net radiative fluxes explain more than 50% of the uncertainties in the MEP-based results.

Assessing the hidden burden and costs of COVID-19 pandemic in South Asia: Implications for health and well-being of women, children and adolescents.

The COVID-19 pandemic has disproportionately affected vulnerable populations. With its intensity expected to be cyclical over the foreseeable future, and much of the impact estimates still modeled, it is imperative that we accurately assess the impact to date, to help with the process of targeted rebuilding of services. We collected data from administrative health information systems in six South Asian countries (Afghanistan, Bangladesh, Nepal, India, Pakistan and Sri Lanka), to determine essential health services coverage disruptions between January-December 2020, and January-June 2021, compared to the same calendar months in 2019, and estimated the impact of this disruption on maternal and child mortality using the Lives Saved Tool. We also modelled impact of prolonged school closures on continued enrollment, as well as potential sequelae for the cohort of girls who have likely dropped out. Coverage of key maternal and child health interventions, including antenatal care and immunizations, decreased by up to 60%, with the largest disruptions observed between April and June 2020. This was followed by a period of recovery from July 2020 to March 2021, but a reversal of most of these gains in April/May 2021, likely due to the delta variant-fueled surge in South Asia at the same time. We estimated that disruption of essential health services between January 2020 and June 2021 potentially resulted in an additional 19,000 maternal and 317,000 child deaths, an increase of 19% and 13% respectively, compared to 2019. Extended school closures likely resulted in 9 million adolescents dropping out permanently, with 40% likely being from poorest households, resulting in decreased lifetime earnings. A projected increase in early marriages for girls who dropped out could result in an additional 500,000 adolescent pregnancies, 153,000 low birthweight births, and 27,000 additional children becoming stunted by age two years. To date, the increase in maternal and child mortality due to health services disruption has likely exceeded the overall number of COVID-19 deaths in South Asia. The indirect effects of the pandemic were disproportionately borne by the most vulnerable populations, and effects are likely to be long-lasting, permanent and in some cases inter-generational, unless policies aimed at alleviating these impacts are instituted at scale and targeted to reach the poorest of the poor. There are also implications for future pandemic preparedness.

Global prevalence of hepatitis B or hepatitis C infection among patients with tuberculosis disease: systematic review and meta-analysis

There is a substantial overlap in the epidemiology of chronic hepatitis B (HBV), hepatitis C (HCV) and tuberculosis (TB) due to overlapping risk factors. Testing for viral hepatitis is not widely recommended for patients with TB. The aim of this systematic review was to evaluate the global prevalence of chronic viral hepatitis infection among patients with TB. MEDLINE, EMBASE, Web of Science, Cochrane Library, African Journals Online, LILACS, and country TB reports were searched for studies published between January 1st, 2011 and June 17th 2021. Random-effects meta-analyses for proportions were conducted to obtain pooled prevalences. The prevalence of chronic HBV/HCV infection among patients with TB was also compared to that in the general population. The protocol was registered on PROSPERO (CRD42021276468). This analysis included 127 studies (83 for both HBV and HCV, 28 for HBV only, and 25 for HCV only) and data from 94,936 patients. The global pooled seroprevalence was 5.8% (95% CI 5.0-6.8) for HBs-antigen and 10.3% (95% CI 8.4-12.3) for HCV-antibodies. Pooled prevalence was highest in the WHO African Region for HBV at 7.8% (95% CI 5.2-10.9) and in the WHO European Region at 17.5% (95% CI 12.2-23.5) for HCV. In studies among TB patients who inject drugs, HCV prevalence was 92.5% (95% CI 80.8-99.0). Pooled HCV-antibody seroprevalence among patients with TB was higher than in the general population in all six WHO regions while HBs-antigen seroprevalence was higher in 3/6 regions. This review highlights the syndemicity of chronic viral hepatitis and TB and suggests that routine testing for hepatitis upon TB diagnosis may be justified. The prevalence of chronic HBV and HCV infections was higher among patients with TB than in the general population. This study was study was funded by the Global Tuberculosis Programme, World Health Organization.

Wind Forecast at Medium Voltage Distribution Networks

Due to the intermittent and variable nature of wind, Wind Power Generation Forecast (WPGF) has become an essential task for power system operators who are looking for reliable wind penetration into the electric grid. Since there is a need to forecast wind power generation accurately, the main contribution of this paper is the development, implementation, and comparison of WPGF methods in a framework to be used by distribution system operators (DSOs). The methodology applied comprised five stages: pre-processing, feature selection, forecasting models, post-processing, and validation, using the historical wind power generation data (measured at secondary substations) of 20 wind farms connected to the medium voltage (MV) distribution network in Portugal. After comparing the accuracy of eight different models in terms of their relative root mean square error (RRMSE), extreme gradient boosting (XGBOOST) appeared as the best-suited forecasting method for wind power generation. The best average RRMSE achieved by the proposed XGBOOST model for 1-year training (January–December of 2020) and 6 months forecast (January–June of 2021) corresponds to 13.48%, outperforming the predictions of the Portuguese DSO by 20%.

The Collateral Benefit of COVID Pandemic: Improved Pharmacological Venous Thromboembolism Prophylaxis Practices in Non-COVID Patients.

COVID-19 creates a hypercoagulable state with a wide spectrum of clinical manifestations. Of those, venous thromboembolism (VTE) is prevalent, and numerous studies have highlighted the importance of VTE prophylaxis. Pre-pandemic VTE prophylaxis practices have already been poor, despite guidelines. We hypothesized that the gap between guidelines and practices might have been closed due to increased awareness. Non-COVID-19 patients hospitalized in the internal medicine ward of a university hospital between January 1st, 2021, and June 30th, 2021, were assessed. VTE risk and thromboprophylaxis requirements were assessed using the Padua Prediction Score (PPS). The results were compared with the findings of the study conducted in the same setting before the pandemic. A total of 267 patients were included, and 81 patients (30.3%) received prophylaxis. A total of 128 patients' (47.9%) PPS was ≥ 4, and 69 patients (53.9%) received prophylaxis; 12 low-risk patients (8.6%) received prophylaxis although it was not indicated. Compared to the pre-pandemic figures, both appropriate prophylaxis use and overuse rates have risen. While the increment rate of appropriate prophylaxis was statistically significant, the increment rate of overuse did not reach statistical significance. Patients hospitalized for infectious diseases and respiratory failure were more likely to receive appropriate prophylaxis. We have demonstrated a significant increase in appropriate pharmacologic prophylaxis rates among high-risk patients. Besides all the collateral damage the pandemic has created, it might also have brought collateral benefits with regards to VTE prophylaxis.

COVID-19 vaccination among cirrhotics in Italy: High coverage and effectiveness of 3 doses versus 2 in preventing breakthrough infection and hospitalization.

Few reports, all retrospective, have evaluated vaccine coverage against COVID-19 infection in cirrhotic subjects. No data are available for European Countries. We aimed to explore this topic and potential independent predictors of lack of vaccination. Between January 1st and June 30th 2022, 1512 cirrhotic subjects of any etiology were consecutively enrolled in an observational - prospective study in 8 referral centers in Italy. Adjusted Odds Ratios (O.R.) for the association with lack of vaccination and with occurrence of breakthrough infection were evaluated by multiple logistic regression analysis. Overall vaccine coverage was 89.7% (80% among people born abroad). Among the 1358 vaccinated people, 178 (13.1%) had a breakthrough infection; of them 12 (6.7%) were hospitalized, but none died. Independent predictors associated with lack of vaccination were birth abroad, age <65 years and lower years of schooling. Child stage B/C was the only independent predictor of breakthrough infection. Occurrence of breakthrough infection was more likely reported in subjects who received 2 doses of vaccine than in those who received 3 doses (33.9% versus 9.0%; P<0.001). High vaccine coverage against COVID-19 infection is observed among cirrhotic subjects in Italy. Vaccine is effective in preventing severe outcomes. Three doses are more effective than two, even in cirrhotic subjects. This large cohort study evidenced high vaccine coverage against COVID-19 infection among cirrhotic subjects in a European country and the effectiveness of vaccine in preventing severe outcomes. Three doses of vaccine are more effective than two in preventing breakthrough infection and hospitalization. Informative campaigns targeting people younger than 65 years of age and those with lower years of schooling may increase these excellent results.

Spatial interpolation of regional PM2.5 concentrations in China during COVID-19 incorporating multivariate data

During specific periods when the PM2.5 variation pattern is unusual, such as during the coronavirus disease 2019 (COVID-19) outbreak, epidemic PM2.5 regional interpolation models have been relatively little investigated, and little consideration has been given to the residuals of optimized models and changes in model interpolation accuracy for the PM2.5 concentration under the influence of epidemic phenomena. Therefore, this paper mainly introduces four interpolation methods (kriging, empirical Bayesian kriging, tensor spline function and complete regular spline function), constructs geographically weighted regression (GWR) models of the PM2.5 concentration in Chinese regions for the periods from January–June 2019 and January–June 2020 by considering multiple factors, and optimizes the GWR regression residuals using these four interpolation methods, thus achieving the purpose of enhancing the model accuracy. The PM2.5 concentrations in many regions of China showed a downward trend during the same period before and after the COVID-19 outbreak. Atmospheric pollutants, meteorological factors, elevation, zenith wet delay (ZWD), normalized difference vegetation index (NDVI) and population maintained a certain relationship with the PM2.5 concentration in terms of linear spatial relationships, which could explain why the PM2.5 concentration changed to a certain extent. By evaluating the model accuracy from two perspectives, i.e., the overall interpolation effect and the validation set interpolation effect, the results showed that all four interpolation methods could improve the numerical accuracy of GWR to different degrees, among which the tensor spline function and the fully regular spline function achieved the most stable effect on the correction of GWR residuals, followed by kriging and empirical Bayesian kriging.

Evaluation of quality of life in the elderly who have fallen

Background/Aim: Approximately 30% of older adults fall at least once per year; consequently, falls are a significant public health concern in the elderly. The most common outcomes are fractures, immobility, high morbidity, and mortality rates. In recent years, quality of life (QoL) is used as a criterion to guide social policies for the elderly. The high prevalence of falls can have serious consequences on the QoL of older people, resulting in prolonged hospitalization, institutionalization, need for care, social isolation, anxiety, and depression. Therefore, it is essential to understand the effect of falls on QoL and influencing factors. In light of this study’s results, it is intended to provide recommendations for social policy that will protect the elderly from falls and maintain their high QoL. This study aimed to determine the QoL and the factors affecting the elderly who have fallen. Methods: The research was a cross-sectional study. The study sample consisted of 90 elderly individuals who applied to the hospital due to falls. The inclusion criteria were being 65 years of age or older, applying to the hospital's emergency department, orthopedic or orthopedic surgery clinic due to a fall, not having passed 6 months from the date of discharge, and agreeing to participate in the study voluntarily. Data were collected through face-to-face interviews in January–June 2021 using the purposive sampling method. The Elderly Introduction Form was used to obtain sociodemographic data of the participants, as well as data on falls and their experiences after falls. The Quality of Life Scale for the Elderly was used to determine QoL. The student’s t-test was used to compare two categorical variables. ANOVA was used for more than two variables, and logistic regression analysis was also applied. Results: QoL levels were classified as poor, fair, and good, and 58.9% of the participants were found to have a fair QoL. In addition, according to the scale’s total score average of 3.17 (0.473), the general quality of life was found to be fair for all participants. According to the t-test and ANOVA results, the QoL was higher for those with higher education levels and those living with their spouses (P˂0.05). The QoL was low in those who had fractures, had surgery, were hospitalized for more than 4 days, and had chronic diseases (P˂0.05). In the regression analysis model, age, economic status, and the number of drugs used were effective on QoL. Conclusion: The quality of life was poor in the elderly who experienced fractures and were hospitalized. Balance-enhancing exercises in the elderly can prevent falls and associated complications. Low education level, chronic illness, and drug use reduced the quality of life. For education, literacy courses and lifelong learning programs can be applied to the elderly. For diseases, healthy aging policies can be implemented.

Aligning HE Pedagogical Innovation with VET, Industry, and Research Partnerships: Insights on the Demola Portugal Initiative

Academia–industry collaboration has been around for some time, but there has been a shift in both the education and workforce settings to work closely together, coordinating initiatives across all sectors, namely higher education (HE), vocational education and training (VET), and industry, in an attempt to mutually drive innovation, provide opportunities to go from concept to action, encourage entrepreneurship, improve ICT use, and other equally important hard and soft skills, aiming to bridge the existing gap between the teaching–learning arena and the business world. Aware that the VET sector, HE, the government, and industry should be devoted to forging partnerships considered key to the development of research, leading to quality, more business, and ultimately, the economic and social well-being of society, a Consortium of 14 Portuguese Polytechnic Institutions engaged in an innovative pedagogical training program, “Learning based on co-creation processes,” a project within the Demola Portugal Initiative (2021–2023), and at the Polytechnic Institute of Viseu (IPV) with reference No. POCH-04-5267-FSE-000818. This training program, with its active methodologies, is then put into practice through the “Link Me Up—1000 Ideias” project. In our study, we will focus on the needs, expectations, and experiences of the IPV teaching staff and the vocational schoolteachers that participated in the training course. Through the analysis of questionnaires and e-portfolios of the participants in the first two editions (January–June 2021 and September 2021–February 2022), we intend to answer the following questions: (i) Which facilitation skills can be meaningfully used by the teachers participating in the (Demola) Pedagogical Innovation Training course at IPV? (ii) Which tools/platforms can enhance the students’ learning and collaboration among different team members, company representatives, and trainees/facilitators? The data collected confirm that the Demola Portugal Initiative provides an effective approach to bring HE closer to the labor market and keep pace with progress and innovation.

Pfizer-BioNTech Coronavirus Disease 2019 Vaccine Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Long-term Care Facility Staff With and Without Prior Infection in New York City, January-June 2021.

Evidence is accumulating of coronavirus disease 2019 (COVID-19) vaccine effectiveness among persons with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We evaluated the effect against incident SARS-CoV-2 infection of (1) prior infection without vaccination, (2) vaccination (2 doses of Pfizer-BioNTech COVID-19 vaccine) without prior infection, and (3) vaccination after prior infection, all compared with unvaccinated persons without prior infection. We included long-term care facility staff in New York City aged <65 years with weekly SARS-CoV-2 testing from 21 January to 5 June 2021. Test results were obtained from state-mandated laboratory reporting. Vaccination status was obtained from the Citywide Immunization Registry. Cox proportional hazards models adjusted for confounding with inverse probability of treatment weights. Compared with unvaccinated persons without prior infection, incident SARS-CoV-2 infection risk was lower in all groups: 54.6% (95% confidence interval, 38.0%-66.8%) lower among unvaccinated, previously infected persons; 80.0% (67.6%-87.7%) lower among fully vaccinated persons without prior infection; and 82.4% (70.8%-89.3%) lower among persons fully vaccinated after prior infection. Two doses of Pfizer-BioNTech COVID-19 vaccine reduced SARS-CoV-2 infection risk by ≥80% and, for those with prior infection, increased protection from prior infection alone. These findings support recommendations that all eligible persons, regardless of prior infection, be vaccinated against COVID-19.

Multicenter Case–Control Study of COVID-19–Associated Mucormycosis Outbreak, India

Abstract We performed a case–control study across 25 hospitals in India for the period of January–June 2021 to evaluate the reasons for an COVID-19–associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004–1.007) and zinc supplementation (OR 2.76, 95% CI 2.24–3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002–1.006), host factors (renal transplantation [OR 7.58, 95% CI 3.31–17.40], diabetes mellitus [OR 6.72, 95% CI 5.45–8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03–9.60]), and rural residence (OR 2.88, 95% CI 2.12–3.79), significantly associated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM.

Recognizing the variation of bioavailable organic phosphorus in sediment and its significance between high and low risk periods for algal blooms in Lake Erhai

The sediment-bound organic phosphorus (Po) is increasingly recognized as a critical internal source for the lake eutrophication process due to its potential bioavailability for organisms. However, limited recognition about the bioavailability variations of sediment Po impeded the in-depth understanding upon the biogeochemical process of Po, especially the differences between high and low risk-periods of algal blooms (HRP-ABs and LRP-ABs). Primarily, significant difference between HRP-ABs (July–December) and LRP-ABs (January–June) was discerned by Mann-Kendall tests of TP, Chla and algal biomass. Biochemical and molecular characterizations, e.g., enzymatic hydrolysis with Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS), were combined to discern the bioavailability variation of sequential extracted sediment Po in HRP-ABs and LRP-ABs. The contents of enzymatically hydrolysable Po decreased in the following order: NaOH-Po > NaHCO3-Po > H2O-Po. The concentrations of bioavailable Po, including labile phosphate monoester (Labile Mono-P) and phosphodiester (Diester-P) were 21.8–58.4 mg/kg (averagely 44.3 mg/kg) and 19.5–35.8 mg/kg (averagely 28.2 mg/kg) in HRP-ABs and LRP-ABs, respectively. Notably, the amounts of bioavailable H2O-Po and NaHCO3-Po in HRP-ABs (13.4–33.3 mg/kg) were nearly 2–3 times of that in LRP-ABs (3.9–14 mg/kg), while no significant NaOH-Po differences were observed. Similarly, contrasting the HRP-ABs with LRP-ABs, more P-containing formulas were assigned in H2O-Po (2526 vs 1884) and NaHCO3-Po (1554 vs 863), with similar abundance in NaOH-Po. Furthermore, the molecular composition of bioavailable Po (Bio-Po, H/C > 1.2 O/C > 0.5), especially Bio-Po containing two P atoms (Bio-2Po) displayed significant variation in H2O-Po (308 vs 391, 217 vs 316) and NaHCO3-Po (114 vs 208, 40 vs 145) between HRP-ABs and LRP-ABs. This was largely attributed to its high bioavailability in Bio-2Po (>50% lipids, proteins and carbohydrates-like). Our findings upon the internally activated accumulation and transformation process interpretation of sediment bioavailable Po are of great significance for lake eutrophication control.

Impact of restricted access to, and low awareness of, mexiletine on people with myotonia: a real-world European survey

Although mexiletine effectively treats myotonia, supply disruptions affected Europe between 2008–2018. MyoPath was a mixed-methods, cross-sectional, market research survey conducted January–June 2018 to evaluate consequences of limited access to/awareness of mexiletine in people with myotonia. Part A: qualitative structured interviews (clinicians; advocates for adult patients); Part B: quantitative online questionnaire completed by people with self-reported history of myotonia. Part A: Interviews (clinicians, n=12; patient advocates, n=5; 12 countries) indicated poor mexiletine awareness among general neurologists. Patients chose between living with myotonia (other treatments were generally unsatisfactory) or importing mexiletine. Part B: Questionnaire respondents, myotonic dystrophy (DM)1, n=213; DM2, n=128; non-dystrophic myotonia (NDM), n=41; other n=8; (11 countries). Of the respondents, 76/390 (20%) people with awareness of/access to mexiletine described profound improvements in myotonia and health-related quality of life following treatment. Respondents with NDM had greatest mexiletine experience (n=28/41). Mexiletine was associated with fewer falls, less muscle stiffness, increased mobility. Treatment interruptions worsened myotonia and were associated with fatigue, pain, dysphagia, breathing difficulty, impaired digestion, poor sleep. However, 36/54 (67%) of currently treated people expressed anxiety about mexiletine's availability: this finding was expected (MyoPath was undertaken before mexiletine's approval in NDM). MyoPath provides the largest European exploration of patients’ views regarding impact of mexiletine on myotonia. Anticipated effects of mexiletine differ between people with different myotonic disorders: myotonia is the main symptom in NDM but one of many potential symptoms affecting those with DM. Nevertheless, findings indicate substantial harm caused to people with myotonia when mexiletine awareness/access is limited.

Clinical implications of Type 2 diabetes on outcomes after cardiac transplantation.

T2D is an increasingly common disease that is associated with worse outcomes in patients with heart failure. Despite this, no contemporary study has assessed its impact on heart transplantation outcomes. This paper examines the demographics and outcomes of patients with type 2 diabetes (T2D) undergoing heart transplantation. Using the United Network for Organ Sharing (UNOS) database, patients listed for transplant were separated into cohorts based on history of T2D. Demographics and comorbidities were compared, and cox regressions were used to examine outcomes. Between January 1st, 2011 and June 12th, 2020, we identified 9,086 patients with T2D and 23,676 without T2D listed for transplant. The proportion of patients with T2D increased from 25.2% to 27.9% between 2011 and 2020. Patients with T2D were older, more likely to be male, less likely to be White, and more likely to pay with public insurance (p<0.001, all). After adjustment, T2D patients had a lower likelihood of transplantation (Hazard Ratio [HR]: 0.93, CI: 0.90-0.96, p<0.001) and a higher likelihood of post-transplant mortality (HR: 1.30, CI: 1.20-1.40, p<0.001). Patients with T2D were more likely to be transplanted in the new allocation system compared to the old allocation system (all, p<0.001). Over the last ten years, the proportion of heart transplant recipients with T2D has increased. These patients are more likely to be from traditionally underserved populations. Patients with T2D have a lower likelihood of transplantation and a higher likelihood of post-transplant mortality. After the allocation system change, likelihood of transplantation has improved for patients with T2D.

Infectious Agents of Reptiles and Amphibians: Peer-reviewed publications, January–June 2022

Infectious Agents of Reptiles and Amphibians: Peer-reviewed publications, January–June 2022

COVID-19 AND MIGRANT WORKER: A CASE STUDY OF THE EDUCATION AND HEALTH OF CHILDREN OF MIGRANT WORKERS IN EAST LOMBOK DURING THE COVID-19 PANDEMIC

The phenomenon of migrant workers from Indonesia leads to numerous internal issues in the family. Parents who play a significant role in the family are unable to perform their duties to their full potential, particularly when it comes to supporting the growth of children in their health and education. Children who have their migrant worker parents abandon them frequently face a variety of disadvantages, such as poor health and educational opportunities. Children's education will undoubtedly be impacted, particularly in light of the Covid-19 epidemic, which has an effect on educational institutions. Their health is also in danger. Due to this circumstance, this article focuses on the education and health of migrant worker children as well as how they develop academically. This study was carried out over the course of six months (January–June 2022) In Suralaga, East Lombok utilizing qualitative techniques and a phenomenological perspective. Ways for gathering data by observations-participation, in-depth interviews, and documentation. The study included a sample of 30 respondents, including migrant workers, those who looked after their children, teachers, healthcare professionals, and local government. According to the findings of this study, migrant workers' children in Suralaga District generally lead happy lives. Children of migrant workers have good physical and educational outcomes, but they struggle with mental health issues. Therefore, especially during the Covid-19 pandemic, parents' attendance is crucial for their children's education and health.