Level Of Protection Research Articles

Global drivers of mangrove loss in protected areas.

Despite increasing efforts and investment in mangrove conservation, mangrove cover continues to decline globally. The extent to which protected area (PA) management effectively prevents mangrove loss globally across differing management objectives and governance types is not well understood. We combined remote sensing data with PA information to identify the extent and the drivers of mangrove loss across PAs with distinct governance types and protection levels based on categories developed by the International Union for Conservation of Nature (IUCN). Mangrove loss due to storms and erosion was prevalent across all governance types and most IUCN categories. However, the extent of human-driven loss differed across governance types and IUCN categories. Loss was highest in national government PAs. Private, local, shared arrangement, and subnational government agencies had low human-driven mangrove loss. Human-driven loss was highest in PAs with the highest level of restrictions on human activities (IUCN category I) due to mangrove conversion to areas for commodity production (e.g., aquaculture), whereas PAs that allowed sustainable resource use (e.g., category VI) experienced low levels of human-driven mangrove loss. Because category I PAs with high human-driven loss were primarily governed by national government agencies, conservation outcomes in highly PAs might depend not only on the level of restrictions, but also on the governance type. Mangrove loss across different governance types and IUCN categories varied regionally. Specific governance types and IUCN categories thus seemed more effective in preventing mangrove loss in certain regions. Overall, we found that natural drivers contributed to global mangrove loss across all PAs, whereas human-driven mangrove loss was lowest in PAs with subnational- to local-level governance and PAs with few restrictions on human activities.

Evaluating Competitiveness of Container Shipping Operators in the Sustainability and Digitalization Era

This study aims to comprehensively analyze the operational status and international competitiveness of global container shipping enterprises in the era of sustainability and digitalization within the field of international container transportation. Utilizing the entropy method, this study quantitatively evaluates the direct operational strength of 14 leading container shipping enterprises while considering multiple factors including environmental protection, service quality, company scale, customer satisfaction, research and development level, and brand influence. The contributions of this study to the existing knowledge are primarily manifested in several aspects: firstly, by constructing a comprehensive evaluation framework, it offers a new perspective for assessing the international competitiveness of container shipping enterprises, facilitating a more comprehensive understanding of their strengths and weaknesses. Secondly, this study emphasizes the crucial roles of environmental protection and customer service in the competitiveness of shipping enterprises, providing new strategic directions for the industry’s sustainable development and digital transformation. Lastly, through detailed analysis of the operational performance of different companies, this study provides specific improvement suggestions for shipping enterprises, aiding them in achieving more precise management and more efficient development. The research findings demonstrate that companies exhibit varied performance in different aspects, showcasing their respective strengths and challenges. Particularly, this study identifies leading enterprises that have made significant progress in environmental technology innovation and customer service, while also highlighting deficiencies in some companies regarding scale expansion and brand building. These findings not only offer valuable insights for the development of the shipping industry but also serve as a window for policymakers, investors, and consumers to gain a deeper understanding of the shipping market. Through the thorough analysis conducted in this study, we aim to contribute to the sustainable development and digital transformation of the global container shipping industry.

Antibody persistence to diphtheria toxoid, tetanus toxoid, Bordetella pertussis antigens, and Haemophilus influenzae type b following primary and first booster with pentavalent versus hexavalent vaccines

ABSTRACT Thailand has incorporated the whole-cell (wP) pertussis vaccine into the expanded program on immunization since 1977 and has offered the acellular pertussis (aP) vaccine as an optional vaccine for infants since 2001. We followed healthy children from a clinical trial (ClinicalTrials.gov NCT02408926) in which children were randomly assigned to receive either pentavalent (DTwP-HB-Hib) or hexavalent (DTaP-IPV-HB-Hib) vaccines for their primary series (administered at 2, 4, and 6 months) and first booster vaccination (18 months). Both groups received Tdap-IPV as a second booster at the age of 4 y. Blood samples were collected for evaluation of antibody persistence to diphtheria toxoid (DT), tetanus toxoid (TT), and Bordetella pertussis (B. pertussis) between 2 and 6 y of age annually, and for the immunogenicity study of Tdap-IPV at 1 month after the second booster. Antibody persistence to Haemophilus influenzae type b (Hib) was followed until 3 y of age. A total of 105 hexavalent-vaccinated children and 91 pentavalent-vaccinated children completed this study. Both pentavalent and hexavalent groups demonstrated increased antibody levels against DT, TT, and B. pertussis antigens following the second booster with Tdap-IPV. All children achieved a seroprotective concentration for anti-DT and anti-TT IgG at 1 month post booster. The hexavalent group possessed significantly higher anti-pertactin IgG (adjusted p = .023), whereas the pentavalent group possessed significantly higher anti-pertussis toxin IgG (adjusted p < .001) after the second booster. Despite declining levels post-second booster, a greater number of children sustained protective levels of anti-DT and anti-TT IgG compared to those after the first booster.

HEPATITIS B VACCINATION STATUS AMONG A TARGET GROUP BORN IN 1992-2000: A STUDY FROM BULGARIA

The purpose of this study is to determine the prevalence of stress among students of various health Hepatitis B virus (HBV) infection is a significant cause of morbidity and mortality and a leading cause of chronic liver disease. Vaccination has a key role in hepatitis B prevention. Compulsory immunization for all healthy newborns was introduced in Bulgaria in 1992 as part of the WHO global strategy. Purpose: The aim of this study was to determine the extent of post-vaccination seroprotection among persons born in 1992 – 2000 who received recombinant hepatitis B vaccine. Material/methods: A total of 923 serum samples of a target group of vaccinated individuals (412 males and 511 females) at a mean age of 23.0±2.7 years were tested over a two-year period (2018-2019). The quantitative analysis of hepatitis B surface antibodies (anti-HBs) levels was performed by CLIA using a LIAISON® anti-HBs II quantitative diagnostic kit (Dia Sorin, Italy). Results: All 923 individuals included in the study were hepatitis B surface antigen (HBsAg) negative. Protective anti-HBs titers ranging from 11 to &gt;1000 mIU/mL were found in 45.3% of them. The sex distribution of the tested subjects varied significantly between years (p=0.023). The difference in protective anti-HBs levels between the two sexes was non-significant (p&gt;0.05). There was a weak negative correlation between year of birth and anti-HBs titer (Pearson's r=0.351, p&lt;0.001). Conclusions: The results of this large study conducted among subjects immunized against hepatitis B in childhood showed varying levels of post-vaccination seroprotection. On average, 23 years after universal immunization, 54.7% of the study cohort had no protective levels of anti-HBs (negative or equivocal result).

Maternal immunization and vitamin A sufficiency impact sow primary adaptive immunity and passive protection to nursing piglets against porcine epidemic diarrhea virus infection

Porcine epidemic diarrhea virus (PEDV) causes a highly contagious enteric disease with major economic losses to swine production worldwide. Due to the immaturity of the neonatal piglet immune system and given the high virulence of PEDV, improving passive lactogenic immunity is the best approach to protect suckling piglets against the lethal infection. We tested whether oral vitamin A (VA) supplementation and PEDV exposure of gestating and lactating VA-deficient (VAD) sows would enhance their primary immune responses and boost passive lactogenic protection against the PEDV challenge of their piglets. We demonstrated that PEDV inoculation of pregnant VAD sows in the third trimester provided higher levels of lactogenic protection of piglets as demonstrated by &amp;gt;87% survival rates of their litters compared with &amp;lt;10% in mock litters and that VA supplementation to VAD sows further improved the piglets’ survival rates to &amp;gt;98%. We observed significantly elevated PEDV IgA and IgG antibody (Ab) titers and Ab-secreting cells (ASCs) in VA-sufficient (VAS)+PEDV and VAD+VA+PEDV sows, with the latter maintaining higher Ab titers in blood prior to parturition and in blood and milk throughout lactation. The litters of VAD+VA+PEDV sows also had the highest serum PEDV-neutralizing Ab titers at piglet post-challenge days (PCD) 0 and 7, coinciding with higher PEDV IgA ASCs and Ab titers in the blood and milk of their sows, suggesting an immunomodulatory role of VA in sows. Thus, sows that delivered sufficient lactogenic immunity to their piglets provided the highest passive protection against the PEDV challenge. Maternal immunization during pregnancy (± VA) and VA sufficiency enhanced the sow primary immune responses, expression of gut–mammary gland trafficking molecules, and passive protection of their offspring. Our findings are relevant to understanding the role of VA in the Ab responses to oral attenuated vaccines that are critical for successful maternal vaccination programs against enteric infections in infants and young animals.

Can EU Law Be Used to Challenge Better Regulation Practices That Do Not Lead to Better Health?

Legislation produced under the EU Commission's Better Regulation Agenda sometimes fails to achieve the Treaty obligation to ensure a high level of health protection in all EU policies and activities. Public health advocates have raised the question of whether EU law can be employed to challenge this apparent breach of Treaty obligations at the proposal preparation stage, compelling the Commission to amend prospective EU legislation so that it better protects health. This article will demonstrate that unfortunately this is not possible due to the justiciability of both Article 168 TFEU and the Better Regulation Agenda. However, this awareness can help public health advocates to re-focus their efforts on strategies that will likely have a greater impact in swaying the direction of EU health policy.

Privacy‐preserving data aggregation achieving completeness of data queries in smart grid

AbstractIn smart grid systems, the control center formulates strategies and provides services by analyzing electricity consumption data. However, ensuring the privacy and security of user data is a critical concern. While traditional data aggregation schemes can provide a certain level of privacy protection for users, they also impose limitations on the control center's access to fine‐grained data. To address these challenges, we propose a privacy‐preserving data aggregation scheme supporting data query (PAQ). We designed a multi‐level data aggregation mechanism based on Paillier semi‐homomorphic encryption to achieve efficient aggregation of user data in the control center. Additionally, a data query mechanism based on electricity consumption intervals is introduced, allowing the control center to query aggregated ciphertexts for different user categories from outsourced data on the cloud server. Security analysis demonstrates that PAQ design effectively solves security issues in data aggregation and query processes. Performance analysis indicates that the proposed scheme outperforms existing solutions in terms of efficiency.

Baseline characteristics of SARS-CoV-2 vaccine non-responders in a large population-based sample.

Studies indicate that individuals with chronic conditions and specific baseline characteristics may not mount a robust humoral antibody response to SARS-CoV-2 vaccines. In this paper, we used data from the Texas Coronavirus Antibody REsponse Survey (Texas CARES), a longitudinal state-wide seroprevalence program that has enrolled more than 90,000 participants, to evaluate the role of chronic diseases as the potential risk factors of non-response to SARS-CoV-2 vaccines in a large epidemiologic cohort. A participant needed to complete an online survey and a blood draw to test for SARS-CoV-2 circulating plasma antibodies at four-time points spaced at least three months apart. Chronic disease predictors of vaccine non-response are evaluated using logistic regression with non-response as the outcome and each chronic disease + age as the predictors. As of April 24, 2023, 18,240 participants met the inclusion criteria; 0.58% (N = 105) of these are non-responders. Adjusting for age, our results show that participants with self-reported immunocompromised status, kidney disease, cancer, and "other" non-specified comorbidity were 15.43, 5.11, 2.59, and 3.13 times more likely to fail to mount a complete response to a vaccine, respectively. Furthermore, having two or more chronic diseases doubled the prevalence of non-response. Consistent with smaller targeted studies, a large epidemiologic cohort bears the same conclusion and demonstrates immunocompromised, cancer, kidney disease, and the number of diseases are associated with vaccine non-response. This study suggests that those individuals, with chronic diseases with the potential to affect their immune system response, may need increased doses or repeated doses of COVID-19 vaccines to develop a protective antibody level.

Implications of Microplastic Pollution for the Conservation of Marine Protected Areas Authors

Marine Protected Areas (MPAs) function as a tool for the protection and conservation of marine ecosystems. These designated areas should be free of any environmentally harmful pollutants. Microplastics (MPs) are plastic fragments measuring less than 5 mm (about 0.2 in). These fragments are an emerging threat to our oceans, and we are investigating the effectiveness of MPAs against these pollutants. We analyzed data gathered from research conducted on microplastic concentrations in MPAs and non-MPAs around the world. 53 MPAs and 53 non-MPAs around the world were used and the microplastic concentrations were deemed low, medium, or high by using the classifications established by the researchers. The Marine Protection Atlas (MPATLAS), created by the Marine Conservation Institute, was used to identify the levels of protection of each MPA and confirm the size of the protected area. The population density of cities nearest to an MPA or non-MPA was obtained by dividing the city’s population by the total area. Microplastics were found in all 106 sites researched, including waters near Antarctica and the northern waters of Greenland. When compared to non-MPAs, MPAs showed a higher number of areas with a “high” or “medium” concentration of microplastics. This indicates that Marine Protected Areas are an inefficient conservation tool against microplastic pollution. Population density did not appear to have a relationship with microplastic concentrations in MPAs and non-MPAs. The prominence of microplastics in protected marine ecosystems highlights the urgency to uncover their effects and a way to combat these anthropogenic pollutants.

A study of the effect of organic acids (gallic acid and ascorbic acid) on the coloration and functionalization of wool yarns with Millettia laurentii sawdust natural dye

Wastewater from the textile industry, especially the dyeing sector, is a major contaminant for aquatic ecosystems. Synthetic dye compounds and metal salts from leftover mordant and dyeing baths are washed into rivers, endangering aquatic life and the environment. In regards to the current study’s examination of Millettia laurentii sawdust’s potential as a natural color source, eco-friendly organic acids (gallic acid and ascorbic acid) were studied in conjunction with small amounts of metal salts (aluminum sulfate, stannous chloride, copper sulfate, and ferrous sulfate) for enhancing the color shade palette with simultaneous functionalization (antimicrobial and UV-protection) of wool yarns. The effects of metal salts up to ecologically permissible concentration limits on the dyeing and functional properties were assessed in combination with organic acids. The study focused on optimizing dyeing variables including pH (2–8), temperature (65–95 °C), dye concentration (25–125% o.w.f.), and dyeing time (15–90 min) using a one-factor-at-a-time (OFT) optimization by determining the color depth (K/S) values on the wool yarns. The optimized dyeing conditions were pH of 4, temperature of 95 °C, dye concentration of 75.0% (o.w.f.), and dyeing time of 60 min. The color characteristics (CIEL*a*b*c*ho) and fastness (Wash, rub, and light) properties are evaluated comparatively against control dyed wool yarns using standard methods. The antimicrobial activity of control dyed and mordanted dyed wool yarns was evaluated in terms of the percentage microbial reduction of bacterial colonies. Metal salts especially ferrous sulfate in conjunction with gallic acid (Fe/GA) provided the highest average color strength (13.50) with a maximum percentage microbial reduction of 96.67%. UV protection ability was assessed by an Australian and New Zealand standards (AS/NZS 4399: 1996) method in terms of UPF values. UV protection levels were significantly improved by using binary combinations of organic acids and metal salts with the maximum protection offered by Fe/GA (97.66) and Sn/GA (97.90). Dyeing outcomes were significantly impacted by the chemical structure of organic acids (gallic acid and ascorbic acid) and the type of metal salts; the research proposes a more environmentally friendly natural dyeing process for the textile industry.

ESG Performance and Corporate Default Risk: Do Countries’ Shareholder Protection Levels Affect This Relationship?

This paper explores the nexus between environmental, social, and governance (ESG) performance and corporate default risk. Employing a panel dataset from 1,094 non-financial companies in 21 nations in Europe, corresponding to 9,522 firm-year observations, and using fixed effects estimations, we empirically demonstrate that corporations with higher ESG scores tend to have lower firm default risk. Among the three categories of the ESG score, both the social and the environmental categories participate in this significant association. Moreover, our study presents novel evidence that within ESGs’ ten subcategories, resource use, product responsibility, emissions, human rights, workforce, and CSR strategy significantly reduce firm default risk. Furthermore, country-level shareholder protection moderates the linkage between default risk and ESG performance, such that the negative impact of ESG on default risk is lower for corporations located in nations with higher shareholder protection. Hence, if the countries’ shareholder protection levels are high, stronger ESG would decrease firm default risk by a lesser amount than countries with lower shareholder protection levels. Our findings are robust to alternate variable measurements and alternate methodologies, capturing endogeneity issues.

Conservation units alone are insufficient to protect Brazilian Amazonian chelonians

The creation of protected areas (PAs) is not always based on science; consequently, some aquatic species may not receive the same level of protection as terrestrial ones. The objective of this study was to identify priority areas for the conservation of chelonians in the Brazilian Amazon basin and assess the contribution of PAs, distinguishing between Full Protection Areas, Sustainable Use Areas, and Indigenous Lands for group protection. The entire species modeling procedure was carried out using Species Distribution Models. Location records were obtained from platforms such as SpeciesLink, GBIF, the Hydroatlas database, and WorldClim for bioclimatic variables adjusted with algorithms like Maximum Entropy, Random Forest, Support Vector Machine, and Gaussian-Bayesian. Indigenous lands cover more than 50% of the distribution areas of chelonian species in the Brazilian Amazon. Protected areas with higher conservation importance (Full Protection Areas and Sustainable Use Areas) hold less than 15% of the combined species distribution. Researchers face significant challenges when making decisions with models, especially in conservation efforts involving diverse taxa that differ significantly from one another within a group of individuals.

PAG Masked Protective Physical Exercise-Induced High H2S Levels in 5/6 Nephrectomized Rats

Background: To investigate the mechanisms of exercise therapeutics in preclinical animal models of chronic kidney disease (CKD), PAG (D, L-propargylglycine), an inhibitor of hydrogen sulfide production, was used to examine the protective effects of physical activity on oxidative stress and inflammation levels during CKD. Methods: Male Wistar rats with CKD, induced by the 5/6 nephrectomy procedure and subjected to 8 weeks of exercise training, received injections of PAG, a cystathionine γ-lyase (CSE) inhibitor, at a dose of 19 mg/kg, i.p., twice a week during those 8 weeks. The systolic blood pressure (BP) and renal sympathetic nerve activity (RSNA) were assessed. Additionally, plasma creatinine, BUN, renal hydrogen sulfide (H2S) levels, oxidative stress, and inflammatory markers were evaluated. Results: In the PAG group, inhibition of H2S production significantly reversed the improvements in plasma creatinine, BUN, renal malondialdehyde (MDA) level, superoxide dismutase (SOD) activity, TNF-α, and IL-6 that were achieved by exercise. Additionally, high RSNA and high BP, which were also reversed in the PAG group, compared to the CKD group subjected to exercise training. Conclusions: The results suggest that the improvement in BP, oxidative stress, and inflammation status by exercise in CKD may be at least partially due to CSE/H2S signaling.

Legal amendments on the reorganization of business entities

Legal amendments on the reorganization of business entities

CONSUMER PROTECTION AND PUBLIC HEALTH

One of the objectives of the European Union is to ensure a high level of protection for its citizens, an objective that cannot be achieved without guaranteeing the protection of the health, safety and economic interests of consumers. In the context of these concerns, the European legislator has integrated consumer protection into all relevant policy areas of European Union legislation. The central aim of this policy is the protection of citizens' health, although the main responsibility in this direction rests with the Member States. Looking beyond the borders of the member states and even of the European Union, the Covid-19 pandemic has proven that health is a priority and goes beyond the area of interest, which is limited to the borders of a state or a union of states, but has gained global relevance.

Evaluation of Gastroprotective Activity of the Methanolic Extract of Justicia pectoralis Jacq. (Acanthaceae)

Introduction: Justicia pectoralis Jacq. is traditionally applied in folk medicine in Brazil and in several Latin American countries. The leaves are used in tea form, especially in the treatment of respiratory disorders, acting as an expectorant. It also has activity in gastrointestinal disorders, and it is anti-inflammatory, antioxidant, sedative, and estrogenic, among others. Aims: To investigate the gastroprotective activity of the methanol extract of the leaves of Justicia pectoralis Jacq. (MEJP) in different experimental models of gastric ulcers. Materials and methods: The adult leaves of Justicia pectoralis Jacq. were collected and cultivated in beds, with an approximate spacing of 40 × 40 cm, organic fertilization, irrigation with potable water and without shelter from light. The MEJP was prepared from the dried and pulverized leaves and concentrated under reduced pressure in a rotary evaporator. For the experimental model of gastric ulcer, Swiss male albino mice were used. The inputs used in the experiment were MEJP at three different concentrations (250, 500 and 1000 mg/kg p.o.), cimetidine (50 mg/kg p.o.), indomethacin (50 mg/kg s.c.) and vehicle (10 mL/kg p.o.). Results: MEJP (250, 500 and 1000 mg/kg p.o.) demonstrated gastroprotective activity, with levels of protection of 45.65%, 44.80% and 40.22%, respectively, compared to the control (vehicle). Compared with cimetidine (48.29%), MEJP showed similar gastroprotective activity. Conclusions: This study demonstrated the gastroprotective activity of MEJP and contributes to validate the traditional use the species for gastric disorders and provides a pharmacological basis for its clinical potential.

In-depth exploration of the radiation exposure to staff performing endoscopic retrograde cholangiopancreatography procedures (ERCP) through RANDO phantom and TLDs.

This study provides a comprehensive evaluation of the occupational radiation exposure faced by healthcare professionals during Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. Utilizing an anthropomorphic RANDO phantom equipped with Thermoluminescent Dosimeters (TLDs), we replicated ERCP scenarios to measure radiation doses received by medical staff. The study meticulously assessed radiation exposure in various corresponding body regions typically occupied by medical staff during ERCP, with a focus on eyes, thyroid, hands, and reproductive corresponding organ regions. The findings revealed significant variations in radiation doses across different body parts, highlighting areas of higher exposure and underscoring the need for improved protective measures and procedural adjustments. The effective radiation doses were calculated using standard protocols, considering the varying levels of protection offered by lead aprons and thyroid shields. The results demonstrate the substantial radiation exposure experienced by healthcare staff, particularly in regions not adequately shielded. This study emphasizes the necessity for enhanced radiation safety protocols in clinical settings, advocating for advanced protective equipment, training in radiation safety, and the exploration of alternative imaging modalities. The findings have crucial implications for both patient and staff safety, ensuring the continued efficacy and safety of ERCP and similar interventional procedures. This research contributes significantly to the field of occupational health and safety in interventional radiology, providing vital data for the development of safer medical practices.

Chlorella vulgaris algae ameliorates chlorpyrifos toxicity in Nile tilapia with special reference to antioxidant enzymes and Streptococcus agalactiae infection

BackgroundChlorpyrifos (CPF) is a widely used pesticide in the production of plant crops. Despite rapid CPF biodegradation, fish were exposed to wastewater containing detectable residues. Recently, medicinal plants and algae were intensively used in aquaculture to replace antibiotics and ameliorate stress impacts.Methods and resultsAn indoor experiment was conducted to evaluate the deleterious impacts of CPF pollution on Nile tilapia health and the potential mitigation role of Chlorella vulgaris algae. Firstly, the median lethal concentration LC50 − 72 h of CPF was determined to be 85.8 µg /L in Nile tilapia (35.6 ± 0.5 g body weight) at a water temperature of 27.5 °C. Secondly, fish were exposed to 10% of LC50 − 72 h for six weeks, and tissue samples were collected and examined every two weeks. Also, Nile tilapia were experimentally infected with Streptococcus agalactiae. Exposed fish were immunosuppressed expressed with a decrease in gene expressions of interleukin (IL) 1β, IL-10, and tumor necrosis factor (TNF)-α. Also, a decline was recorded in glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) gene expression in the head kidney tissue. A high mortality rate (MR) of 100% was recorded in fish exposed to CPF for six weeks and challenged with S. agalactiae. Fish that received dietary C. vulgaris could restore gene expression cytokines and antioxidants compared to the control. After six weeks of CPF exposure, fish suffered from anemia as red blood cell count (RBCs), hemoglobin (Hb), and packed cell volume (PCV) significantly declined along with downregulation of serum total protein (TP), globulin (GLO), and albumin (ALB). Liver enzymes were significantly upregulated in fish exposed to CPF pollution, alanine aminotransferase (ALT) (42.5, 53.3, and 61.7 IU/L) and aspartate aminotransferase (AST) (30.1, 31.2, and 22.8) after 2, 4, and 6 weeks, respectively. On S. agalactiae challenge, high MR was recorded in Nile tilapia exposed to CPF (G3) 60%, 60%, and 100% in week 2, week 4, and week 6, and C. vulgaris provided a relative protection level (RPL) of 0, 14.29, and 20%, respectively.ConclusionsIt was concluded that CPF pollution induces immunosuppressed status, oxidative stress, and anemic signs in Nile tilapia. In contrast, C. vulgaris at a 50 g/kg fish feed dose could partially ameliorate such withdrawals, restoring normal physiological parameters.

Socioeconomic status and health disparities drive differences in accelerometer-derived physical activity in fatty liver disease and significant fibrosis

Background and aims The cornerstone of clinical management of patients with nonalcoholic fatty liver disease (NAFLD) are lifestyle changes such as increasing physical activity (PA) aimed at improving cardiometabolic risk. To inform NAFLD prevention and treatment guidelines we aimed to: (i) quantify the role of PA on lowering the risk for NAFLD and fibrosis; (ii) characterize NAFLD and fibrosis association with PA in the context of socioeconomic environment. Methods A sample of 2648 participants from the NHANES 2003–2006 was selected to develop survey weighted multivariable logistic regression models for predicting NAFLD and significant fibrosis, diagnosed non-invasively via fatty liver index (FLI) and fibrosis-4 (FIB-4) index. The PA measures were obtained from a hip-worn accelerometer. Results The predictive model for NAFLD showed AUC of 0.687 and a decrease of 43% in NAFLD risk with moderate vigorous PA (MVPA) (OR = 0.569, p &lt; 0.001). The predictive model for fibrosis had AUC of 0.755 and there was a 48% and a 70% decrease in significant fibrosis risk with MVPA (OR = 0.518, p = 0.022) and total log activity count (TLAC) (OR = 0.296, p = 0.017), respectively. Participants with NAFLD and NAFLD with fibrosis engage in declining PA. Despite having jobs with higher level of PA and participating in more moderate-to-vigorous PA, a larger proportion of Hispanics participants had NAFLD and significant fibrosis. Conclusions These findings demonstrate the role of PA as a protective factor against the presence of NAFLD and significant fibrosis. Protective levels of PA in NAFLD differ by races.

Association between Usage of Prophylactic AYUSH Medicines and Disease Severity in COVID-19 Patients: A Retrospective Cohort Study.

Prior vaccination is often studied for its impact on individuals' post-infection prognosis. Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) medicines, advised by the Government of India as prophylaxis during the first wave of the coronavirus disease 2019 (COVID-19) pandemic, were consumed by the masses in 2020. A study was therefore undertaken to observe any association between the prior usage of AYUSH prophylactic medicines and post-infection severity as reported by recovered COVID-19 individuals. This was a retrospective, multi-centre, cohort study conducted in 21 cities of India from 5th August to 30th November 2020. Data from recovered COVID-19 patients, of either sex or any age, captured information about AYUSH prophylactic medicines intake prior to infection, disease severity, symptomatology, duration of complaints, etc. The study participants were grouped into AYUSH intake and non-intake. Primary composite outcome was the disease clinical course. Secondary clinical outcomes were the rate of and time to clinical recovery. Data of 5,023 persons were analysed. Ayurveda or homeopathic prophylactic medicines were consumed by more than half of the study participants: that is, 56.85% (n = 1,556) and 56.81% (n = 1,555) respectively. The overall adjusted protective effect (PE) of AYUSH prophylactic intake against moderate/severe forms of COVID-19 disease was 56.7% (95% confidence interval [CI], 48.7 to 63.50; p < 0.001). Adjusted PE for homeopathy and Siddha was 52.9% (95% CI, 42.30 to 61.50; p < 0.001) and 59.8% (95% CI, 37.80 to 74.10; p < 0.001), respectively. A statistically significant association was found between AYUSH prophylactic medicine intake and clinical recovery more frequently by the 3rd day of illness (χ2 = 9.01; p = 0.002). Time to resolution of symptoms in the AYUSH intake group was on average 0.3 days earlier than in the non-intake group (p = 0.002). AYUSH prophylactics were associated with statistically significant levels of protection against COVID-19 disease severity. Amongst these, previous intake of homeopathy or Siddha medicines was associated with some protection against moderate/severe illness and with a somewhat quicker clinical recovery. Prospective studies with experimental research design are needed to validate the findings of this study. Clinical Trials Registry-India (CTRI/2020/08/027000).