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

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

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

Effectiveness of the BNT162b2 (Pfizer-BioNTech) Vaccine in Children and Adolescents: A Systematic Review and Meta-Analysis

Efforts to control the COVID-19 pandemic have expanded to the vaccination of children and adolescents. This systematic review assesses the utility of the BNT162b2 (Pfizer-BioNTech) vaccine in children and adolescents aged 5–18 years, considering its effectiveness against COVID infection, hospital and intensive care admission and duration of effectiveness after vaccination. Six databases were searched following the PRISMA guidelines. Pooled estimates and 95% confidence intervals (CIs) were calculated using meta-analysis. Fifteen studies were included in the systematic review, while 12 studies were included in the meta-analysis. Evidence suggests that the two-dose vaccination regime provided high effectiveness of 92% (95% CI, 86–96) against COVID infection. Vaccination also conferred high protection against hospitalisation (91%) and intensive care admission (85%). The vaccine was highly protective against the Delta variant of the virus, but showed a lower protection against the Omicron variant. Most adverse effects were transient and mild, commonly including pain at the injection site, fatigue and headache. Current findings are suggestive of waning immunity over time; however, further research is needed to investigate the relevance of booster doses in this age group. In summary, the Pfizer-BioNTech BNT162b2 vaccine demonstrated high levels of protection against COVID-19 infection and its complications while maintaining an adequate safety profile in children and adolescents

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

Editorial: Environmental stressors, multi-hazards and their impact on health

[Extract] nvironmental stressors, such as air pollution, noise pollution, and chemical exposure, can adversely affect human health by increasing the risk of chronic diseases and mortality. The sixth assessment report of the United Nations’ Intergovernmental Panel on Climate Change reported that the global temperature is projected to reach or exceed 1.5◦C of warming over the next 20 years, exacerbating exposure to environmental stressors. Air pollution alone is estimated to cause 4.2 million deaths annually, and most of the world’s population (99%) is exposed to air quality levels that exceed the WHO Air Quality Guidelines

Individual anthropometric, aerobic capacity and demographic characteristics as predictors of heat intolerance in military populations

Background and objectives: The Australian Defence Force (ADF) engages in combat-related activities in hot climatic conditions, which exposes ADF members to the threat of exertional heat illness (EHI). After an episode of EHI, the heat tolerance test (HTT) is conducted to determine heat tolerance. Heat intolerance is the inability to maintain thermal balance while exercising in a hot environment. This study investigated the predictive roles of individual characteristics (age, gender, aerobic capacity (VO2max) and body composition) on physiological responses to the HTT in a group comprising ADF personnel and civilian volunteers. Materials and Methods: A quasi-experimental design was used and 52 (38 males and 14 females) participants were recruited from the ADF and the general population for the HTT. Heat intolerance was defined following the standard criteria for the HTT (temperature and heart rate). Data were analysed using inferential statistics. Results: The mean age of the participants was 31.1 ± 11.6 years, and 44% (23 people: 19 males and 4 females) of the participants were heat intolerant. Independent samples T-test showed that body mass index (p = 0.011) and body fat% (p = 0.034) of heat-intolerant participants were significantly higher than their heat-tolerant counterparts. Body surface area to mass ratio (p = 0.005) and aerobic capacity (p = 0.001) were significantly lower in heat-intolerant participants. Regression analyses showed that age, gender, aerobic capacity and body fat% were significant (p < 0.001) predictors of heat tolerance outcomes, with R2 values ranging from 0.505 to 0.636. Conclusion: This study showed that aerobic capacity, body fat%, age and gender are predictors of heat intolerance among military and non-military populations. However, there may be a need for future studies to consider identifying other indicators such as clinical biomarkers of heat intolerance, which could be used to develop a more reliable HTT protocol

Next Generation Sequencing of Genotype Variants and Genetic Association between Heat Shock Proteins HSPA1B Single Nucleotide Polymorphism at the g.31829044 Locus and Heat Tolerance: A Pilot Quasi-Experimental Study

Heat tolerance and exertional heat stroke (EHS) are rare health conditions that have been described and characterised but have never been genetically solved. Knowledge of the role of single nucleotide polymorphisms (SNPs) in heat shock proteins (HSPs) genes and their associations with heat tolerance and EHS is limited. This pilot study aimed to identify SNP in HSPA1B, HSP90AA2 and DNAJA1 genes and their associations with heat tolerance and EHS history in a quasi-experimental design. Participants comprised Australian Defence Force members (ADF) who had a history of EHS and the general population. Genomic DNA samples were extracted from the venous blood samples of 48 participants, sequenced and analysed for SNP. Forty-four per cent (44%) of the participants were heat intolerant, and 29% had a history of EHS. Among participants with a history of EHS, there was an association between heat tolerance and HSPA1B SNP at the g.31829044 locus. However, there were no associations between HSPA1B and HSP90AA2 SNP and heat tolerance. All participants had the same distribution for the DNAJA1 SNP. In conclusion, the findings indicate an association between the HSPA1B genetic variant at the g.31829044 locus and heat tolerance among ADF participants with a history of EHS. Further research with a larger number of military participants will shed more light on the associations between HSP genes and heat tolerance