The role of iron oxide nanoparticles in the diagnosis of vascular diseases: a systematic review

Background: Vascular diseases remain a cause of high patient mortality globally. Current diagnoses are often through contrast-enhanced computed-tomography or magnetic-resonance-imaging (MRI) with approximately 80% sensitivity. Iron oxide nanoparticles are increasingly used in enhancing vascular disease diagnosis due to their ability to selectively deliver imaging agents to specific locations. This article describes studies investigating the use of iron oxide nanoparticles in the diagnosis of vascular diseases in humans. Method: A literature search was conducted to identify studies assessing the role of nanoparticles in the management of vascular diseases using PubMed from Jan 2011 to June 2016. The following search terms were applied "vascular diseases" AND "nanoparticles". Human studies investigating the role of nanoparticles in vascular diseases were included. Studies excluded were ex vivo and in vitro human association studies, and non-English studies. Results: Nine out of 179 studies met the inclusion criteria. Sample size ranged from 1 to 23 median 14, inter-quartile range (IQR, 5.5 - 20.0). Five studies reported that ultra-small super paramagnetic iron oxide (USPIO) enhanced MRI assessment of vascularity, and macrophage content in atherosclerotic carotid plaques. Three studies demonstrated that ultra-small super paramagnetic iron oxide improved MRI diagnosis of myocardial infarction and allows the detection of the peri-infarct zone. One study did not support the latter findings. Conclusions: Iron oxide nanoparticles are effective at improving detection and diagnosis of vascular diseases, although the long term effects of these agents are not yet known

The role of iron oxide nanoparticles in the diagnosis of vascular diseases: a systematic review

Background: Vascular diseases remain a cause of high patient mortality globally. Current diagnoses are often through contrast-enhanced computed-tomography or magnetic-resonance-imaging (MRI) with approximately 80% sensitivity. Iron oxide nanoparticles are increasingly used in enhancing vascular disease diagnosis due to their ability to selectively deliver imaging agents to specific locations. This article describes studies investigating the use of iron oxide nanoparticles in the diagnosis of vascular diseases in humans. Method: A literature search was conducted to identify studies assessing the role of nanoparticles in the management of vascular diseases using PubMed from Jan 2011 to June 2016. The following search terms were applied "vascular diseases" AND "nanoparticles". Human studies investigating the role of nanoparticles in vascular diseases were included. Studies excluded were ex vivo and in vitro human association studies, and non-English studies. Results: Nine out of 179 studies met the inclusion criteria. Sample size ranged from 1 to 23 median 14, inter-quartile range (IQR, 5.5 - 20.0). Five studies reported that ultra-small super paramagnetic iron oxide (USPIO) enhanced MRI assessment of vascularity, and macrophage content in atherosclerotic carotid plaques. Three studies demonstrated that ultra-small super paramagnetic iron oxide improved MRI diagnosis of myocardial infarction and allows the detection of the peri-infarct zone. One study did not support the latter findings. Conclusions: Iron oxide nanoparticles are effective at improving detection and diagnosis of vascular diseases, although the long term effects of these agents are not yet known

Prognostic Accuracy of Antenatal Doppler Ultrasound Measures in Predicting Adverse Perinatal Outcomes for Pregnancies Complicated by Diabetes: A Systematic Review

OBJECTIVE: This study aimed to assess the prognostic accuracies of Doppler ultrasound measures in predicting adverse perinatal outcomes for pregnancies complicated with preexisting or gestational diabetes mellitus. DATA SOURCES: An online database search of MEDLINE, Cochrane, Embase, CINAHL, Scopus, and Emcare from inception to April 2022 was conducted. STUDY ELIGIBILITY CRITERIA: Studies reporting singleton, nonanomalous fetuses of women with either preexisting (type 1 or 2 diabetes mellitus) or gestational diabetes mellitus during pregnancy were included. In addition, the included studies assessed cerebroplacental ratio and middle cerebral artery and/or umbilical artery pulsatility index in the prediction of either: preterm birth, cesarean delivery for fetal distress, APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score 24 hours), acute respiratory distress syndrome, jaundice, hypoglycemia, hypocalcemia, or neonatal death. METHODS: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed and 610 articles were identified, of which 15 were included. Two authors independently extracted prognostic data from each article and assessed the study applicability and risk of bias using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) scoring criteria. RESULTS: A total of 15 studies were included in the review and comprised prospective (n=10; 66%) and retrospective (n=5; 33%) cohorts. Sensitivity and positive predictive values varied widely across each Doppler measurement. Umbilical artery sensitivities were higher than those of cerebroplacental ratio and middle cerebral artery for hypoglycemia, jaundice, neonatal intensive care unit admission, respiratory distress, and preterm birth. Cerebroplacental ratio was the most reported index test; however, prognostic accuracy was worse than that of umbilical artery and middle cerebral artery Doppler across all adverse perinatal outcomes. Significant risk of bias was present in 14 (94%) studies, with substantial heterogeneity observed across studies in terms of study design and outcomes assessed. CONCLUSION: Abnormal umbilical artery pulsatility index may be of more clinical value in predicting adverse perinatal outcomes compared with cerebroplacental ratio and middle cerebral artery pulsatility index in diabetic pregnancies. Further evaluation of umbilical artery Doppler measurements in diabetic pregnancies using standardized variables across studies is required for broader clinical application. The significant association between abnormal Doppler measurement and hypoglycemia may warrant further investigation

Evaluation of the effect of border closure on COVID-19 incidence rates across nine African countries: an interrupted time series study

Background: Border closure is one of the policy changes implemented to mitigate against coronavirus disease 2019 (COVID-19). We evaluated the effect of border closure on the incidence rate of COVID-19 across nine African countries. Methods: An interrupted time series analysis was used to assess COVID-19 incidence rates in Egypt, Tunisia, Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Ghana, Nigeria, Senegal and South Africa (SA). Data were collected between 14 February and 19 July 2020 from online data repositories. The linear trend and magnitude of change were evaluated using the itsa function with ordinary least-squares regression in Stata with a 7-d deferred interruption point, which allows a period of diffusion post-border closure. Results: Overall, the countries recorded an increase in the incidence rate of COVID-19 after border closure. However, when compared with matched control groups, SA, Nigeria, Ghana, Egypt and Kenya showed a higher incidence rate trend. In contrast, Ethiopia, DRC and Tunisia showed a lower trend compared with their controls. Conclusions: The implementation of border closures within African countries had minimal effect on the incidence of COVID-19. The inclusion of other control measures such as enhanced testing capacity and improved surveillance activities will reveal the effectiveness of border closure measures

A systematic review of the gender differences in the epidemiology and risk factors of exertional heat illness and heat tolerance in the Armed Forces

Objectives: This review aimed to describe the epidemiology of all heat related illnesses in women compared to men in the armed forces and to identify gender-specific risk factors and differences in heat tolerance. Design: A systematic review of multiple databases (MEDLINE, Emcare, CINAHL, PsycINFO, Informit, and Scopus) was conducted from the inception of the databases to 1 April 2019 using the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. Eligibility criteria: All relevant studies investigating and comparing heat illness and heat tolerance in women and men in the armed forces were included in the review. Results: Twenty-four (24) studies were included in the systematic review. The incidence of heat stroke in women ranged from 0.10 to 0.26 per 1000 person-years, while the incidence of heat stroke ranged from 0.22 to 0.48 per 1000 person-years in men. The incidence of other heat illnesses in women compared to men ranged from 1.30 to 2.89 per 1000 person-years vs 0.98 to 1.98 per 1000 person-years. The limited evidence suggests that women had a greater risk of exertional heat illness compared to men. Other gender-specific risk factors were slower run times and body mass index. Although there was a higher proportion of women who were heat intolerant compared to men; this finding needs to be interpreted with caution due to the limited evidence. Conclusion: The findings of this review suggest that men experienced a slightly higher incidence of heat stroke than women in the armed forces. In addition, the limited available evidence suggests that a higher proportion of women were heat intolerant and being a female was associated with a greater risk of exertional heat illnesses. Given the limited evidence available, further research is required to investigate the influence of gender differences on heat intolerance and heat illness

Epidemiology, risk factors and measures for preventing drowning in Africa: a systematic review

Background: Drowning is a leading cause of unintentional injury related mortality worldwide, and accounts for roughly 320,000 deaths yearly. Over 90% of these deaths occur in low- and middle-income countries with inadequate prevention measures. The highest rates of drowning are observed in Africa. The aim of this review is to describe the epidemiology of drowning and identify the risk factors and strategies for prevention of drowning in Africa. Methods: A review of multiple databases (MEDLINE, CINAHL, PsycINFO, Scopus and Emcare) was conducted from inception of the databases to the 1st of April 2019 to identify studies investigating drowning in Africa. The preferred reporting items for systematic review and meta-analysis (PRISMA) was utilised. Results: Forty-two articles from 15 countries were included. Twelve articles explored drowning, while in 30 articles, drowning was reported as part of a wider study. The data sources were coronial, central registry, hospital record, sea rescue and self-generated data. Measures used to describe drowning were proportions and rates. There was a huge variation in the proportion and incidence rate of drowning reported by the studies included in the review. The potential risk factors for drowning included young age, male gender, ethnicity, alcohol, access to bodies of water, age and carrying capacity of the boat, weather and summer season. No study evaluated prevention strategies, however, strategies proposed were education, increased supervision and community awareness. Conclusions: There is a need to address the high rate of drowning in Africa. Good epidemiological studies across all African countries are needed to describe the patterns of drowning and understand risk factors. Further research is needed to investigate the risk factors and to evaluate prevention strategies

Occupational tuberculosis in health care workers in sub-Saharan Africa: a systematic review

Background: Tuberculosis (TB) is a leading cause of death globally. Sub-Saharan Africa (SSA) in particular has a high burden of TB, which places health care workers (HCWs) at increased risk of occupational exposure to TB. Aim: To describe the incidence, and prevalence of latent TB infection/disease in HCWs, and explore the effectiveness of infection control measures to protect HCWs in SSA. Method: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted using the databases: PubMed, Web of Science, Scopus, and Medline, up to March 2016. Thirteen studies were found reporting the prevalence, incidence of latent TB infection/TB disease among HCWs, and the effectiveness of infection control strategies in SSA. Results: The median prevalence of latent TB infection (using a positive tuberculin skin test) in HCWS was 61% (range 45% to 84%). Markers of occupational exposure associated with latent TB infection among HCWS were longer duration of work, and exposure to TB patients. The median annual incidence of TB infection attributable to occupational exposure was 29% (range 19.3% to 38%) after accounting for the infection in the general population. The rate of active TB in HCWS was higher than in the general population. Administrative, personal and engineering control measures had no impact on the development of TB disease. Conclusions: The risk of acquiring TB disease among HCWs in SSA was high and was associated with poor infection control measures. This may impact on the recruitment, longevity and retention of HCWs

Role of formative assessment in predicting academic success among GP registrars: a retrospective longitudinal study

Objectives The James Cook University General Practice Training (JCU GPT) programme’s internal formative exams were compared with the Royal Australian College of General Practitioners (RACGP) pre-entry exams to determine ability to predict final performance in the RACGP fellowship exams. Design A retrospective longitudinal study. Setting General Practice (GP) trainees enrolled between 2016 and 2019 at a Registered Training Organisation in regional Queensland, Australia. Participants 376 GP trainees enrolled in the training programme. Exposure measures The pre-entry exams were Multiple-Mini Interviews (MMI), Situational Judgement Test (SJT) and Candidate Assessment and Applied Knowledge Test. The internal formative exams comprised multiple choice questions (MCQ1 and MCQ2), short answer questions, clinical skills and clinical reasoning. Primary outcome measure The college exams were Applied Knowledge Test (AKT), Key Feature Problems (KFP) and Objective Structured Clinical Examination (OSCE). Results Correlations (r), coefficients of determination (R2) and OR were used as parameters for estimating strength of relationship and precision of predictive accuracy. SJT and MMI were moderately (r=0.13 to 0.31) and MCQ1 and MCQ2 highly (r=0.37 to 0.53) correlated with all college exams (p<0.05 to p<0.01), with R2 ranging from 0.070 to 0.376. MCQ1 was predictive of failure in all college exams (AKT: OR=2.32, KFP: OR=3.99; OSCE: OR=3.46); while MCQ2 predicted failure in AKT (OR=2.83) and KFP (OR=3.15). Conclusion We conclude that the internal MCQ formative exams predict performance in the RACGP fellowship exams. We propose that our formative assessment tools could be used as academic markers for early identification of potentially struggling trainees

The epidemiological trend of monkeypox and monkeypox-varicella zoster viruses co-infection in North-Eastern Nigeria

Background: Monkeypox (MPX) is endemic in Nigeria, but it was first reported in Adamawa state, North-Eastern Nigeria, in January 2022. There are currently 172 cases of MPX in Nigeria, with four reported deaths, and Adamawa has the second-highest case count. Therefore, this study was undertaken to evaluate the epidemiological profile of this viral disease. Methods: This is a cross-sectional study. The skin and blood samples were screened for the presence for Monkeypox virus (MPXV) and Varicella Zoster virus (VZV) DNA by real-time PCR; the clinical diagnosis was based on symptoms of visual signs of skin lesions and other clinical symptoms from January to July 2022. Results: A total of 33 suspected cases aged 1–57 years [26 (79%) males vs. 7 (21%) females] were screened for MPX and VZV. Twenty-four (72.7%) were positive (6.1% were MPX only, 39% were VZV only, and 27% were both MPX and VZV). Most cases of MPX (82%), VZV (69%) and MPX-VZV co-infection (78%) occurred in males. More than half (54%) of those infected were children and adolescents between 0 and 19 years. All patients experienced body rashes and itching, and other clinical symptoms included fever, headache, mouth sores, muscle aches and lymphadenopathy. Over 64 and 86% of patients had contact with livestock and rodents, respectively. Conclusion: MPXV, VZV and MPXV-VZV co-infections occurred predominantly among males and children in Adamawa state, Nigeria. Given the patient contact with rodents and livestock, further research on the animal reservoir is needed to highlight the transmission of MPXV in Adamawa

Key elements of effective postgraduate GP educational environments: a mixed methods study

Objectives Evidence in the literature suggests that satisfaction with postgraduate general practice (GP) training is associated with the quality of the educational environment. This study aimed to examine GP registrars’ level of satisfaction with a distributed model of training in a regional educational environment and investigate the relationship between satisfaction and academic performance. Study design A longitudinal 3-year study was conducted among GP registrars at James Cook University using a sequential explanatory mixed methods research design. GP registrars’ satisfaction was obtained using the scan of postgraduate educational environment domains tool. A focus group discussion was conducted to explore GP registrars’ perceptions of satisfaction with the educational environment. Setting James Cook University General Practice Training (JCU GPT) programme. Participants Six hundred and fifty one (651) GP registrars enrolled between 2016 and 2018 at JCU GPT programme. Results 651 registrars completed the satisfaction survey between 2016 and 2018. Overall, 92% of the registrars were satisfied with the educational training environment. Registrars who had become fellows reported higher satisfaction levels compared with those who were still in training (mean=4.39 vs 4.20, p=0.001). However, academic performance had no impact on level of satisfaction with the educational environment. Similarly, practice location did not influence registrars’ satisfaction rates. Four themes (rich rural/remote educational environment, supportive learning environment, readiness to continue with rural practice and practice culture) emerged from the thematic data analysis. Conclusion A clinical learning environment that focuses on and supports individual learning needs is vital for effective postgraduate medical training. This study suggests that JCU GPT programme’s distributed model fostered a satisfying and supportive training environment with rich educational experiences that enhance retention of GP registrars in rural/remote North Queensland, Australia. The findings of this study may be applicable to other settings with similar training models